Spinal Cord Injury

Question 1

Spinal Cord Injury

Answer 1

Injury to the spinal cord resulting in a change, either temporary or permanent, in its normal sensory, motor or autonomic function

Question 2

SCI Causes

Answer 2

Hyperflexion/extension
Axial loading
Bruising
Severing
With or without spinal fracture or dislocation

Question 3

SCI Causes - Atraumatic

Answer 3

Vascular
Neoplastic
Degenerative

Question 4

Traumatic SCI %

Answer 4

MVC - 39%
Falls - 28%
Gun-related - 15%
Sports - 8%
Other trauma - 10%

Question 5

Common SCI Co-morbidities

Answer 5

Brain injury
Fractures
Pneumothorax
Peripheral nerve injury

Question 6

Who’s more likely to get SCI?

Answer 6

Males

Question 7

Tetraplegia

Answer 7

Between C2 and T1

Question 8

Paraplegia

Answer 8

T1 down

Question 9

Spinal Cord Injury Manifestation

Answer 9

Traumatic blow to spine
Changes in blood flow cause damage
Excessive release of neurotransmitters kills nerve cells
Immune system cells create inflammation
Free radicals attack nerve cells
Nerve cells self-destruct

Question 10

Aspen Collar

Answer 10

Most common cervical

Question 11

Miami J Collar

Answer 11

Prevents head from developing wound

Question 12

Philadelphia Collar

Answer 12

Preventative if not sure about injury

Can be intubated

Question 13

SCI Evaluation

Answer 13

MOI
Co-morbidities
Past history
Precautions
ASIA level
Level of injury

Question 14

Cervical Precautions

Answer 14

Unstable, on bed rest
Pending clearance, and no fracture/dislocation identified, may use a collar
Post fixation, to be up, will use a collar

Question 15

Thoracic and Lumbar Precautions

Answer 15

Bedrest
Limit extremity movement
Don't elevate HOB
Place in reverse trendelenburg (30 deg) to prevent aspiration
Log roll x 2 assist

Question 16

Level of Injury

Answer 16

Determined by last intact muscle group and dermatome, not by fracture

Question 17

ASIA Sensory Grading

Answer 17

0 - absent
1 - altered
2 - normal

Question 18

ASIA Motor Grading

Answer 18

Same as MMT

Question 19

“Completeness” of Injury

Answer 19

Relates to presence or absence of rectal tone or sensation

Takes into consideration if any sensation or motor function is present below level of injury

Question 20

ASIA “A” Classification

Answer 20

Complete - no motor or sensory function is preserved

Question 21

ASIA “B” Classification

Answer 21

Sensory Incomplete - sensory, but not motor function is preserved below neurological level

Question 22

ASIA “C” Classification

Answer 22

Motor Incomplete - motor function preserved below neurological level and more than half of key muscle functions below NLI have grade less than 3

Question 23

ASIA “D” Classification

Answer 23

Motor Incomplete - motor function preserved belos neurological level and at least half of key muscle functions below NLI have grade more than 3

Question 24

ASIA “E” Classification

Answer 24

Normal - follow up of patients who initially had deficits

Question 25

Incomplete Lesions

Answer 25

Pattern of clinical presentations directly related to cross-sectional anatomy of spinal cord

Question 26

Anterior Cord Syndrome

Answer 26

Loss of function of the ventral pathway and the conservation of the dorsal column Not good prognosis

Question 27

Anterior Cord Syndrome Result

Answer 27

Preservation of light touch, proprioception and deep pressure with absences of pain and motor function

Question 28

Anterior Cord Syndrome Causes

Answer 28

Anterior spinal artery infarction Disc herniation Radiation myelopathy

Question 29

Central Cord Syndrome

Answer 29

Central area of injury which affects the medially located motor fibers that control distal upper extremity function Favorable functional recovery

Question 30

Central Cord Syndrome Result

Answer 30

UE weakness greater than LE weakness | Sacral sensory spared

Question 31

Central Cord Syndrome Causes

Answer 31

Syringomyelia Tumor Spondylotic myelopathy

Question 32

Brown-Sequard Syndrome

Answer 32

Damage that affects one-half of the spinal cord significantly greater than the other half

Question 33

Brown-Sequard Syndrome Result

Answer 33

Spastic paresis Loss of light touch and vibration Sensation on the damaged side Loss of pain and temperature on the contralateral side

Question 34

Cauda Equina Results

Answer 34

``` Low back pain Radicular pain Lower extremity paresis or paralysis Sensory deficit in the perineal area Bowel or bladder dysfunction Diminished or absent patellar and Achilles reflexes ```

Question 35

Factors with Improved Outcomes

Answer 35

*Completeness of injury* Age So-so early surgical intervention Zones of partial preservation

Question 36

Secondary Conditions from SCI

Answer 36

``` Autonomic dysreflexia DVT Pressure ulcers UTI/Renal problems Fractures Pain Spasticity ```

Question 37

Autonomic Dysreflexia

Answer 37

Risk at T6 and higher | Inc blood pressure which increases risk for cerebral hemorrhage or heart failure

Question 38

AD Symptoms

Answer 38

``` Headache Sweating Nasal congestion Hyperhidrosis Paresthesias ```

Question 39

AD Causes

Answer 39

``` Bowel/bladder distension Rectal stimulation Cutaneous lesions Fractures Body-positioning *BLOCKED URINARY CATHETER* ```

Question 40

DVT

Answer 40

Result of coagulation of blood | Highest incidence in first 2 weeks

Question 41

DVT signs

Answer 41

Rapid onset of swelling | Increased temperature in limb

Question 42

Pressure Ulcers

Answer 42

Due to immobilization or poor handling Prolonged compression between bony prominence against support surface Decrease tissue perfusion

Question 43

Heterotrophic Ossification

Answer 43

Ectopic bone formation in soft tissue surround joint Usually caudal to injury Sudden limitation of ROM

Question 44

Bone Fracture

Answer 44

SCI patients see bone demineralization

Question 45

Syringomyelia

Answer 45

Fluid filled cavity within spinal cord extending multiple levels Decrease in motor function is sign of new pathology

Question 46

Spasticity

Answer 46

Hypertonicity of muscle below lesion

Question 47

Nociceptive Pain

Answer 47

People with spastic paresis or paralysis, reflex is exaggerated

Question 48

Neuropathy Pain

Answer 48

Pain or sensory disturbance due to abnormal processing of afferent input