Spinal Cord Injury

Question 1

Spinal Cord Injury: Etiology

Answer 1

Traumatic:
trauma to spinal cord as a result of compression, shearing force, contusion secondary to MCA, diving accident, penetration wound, sports injury, or fall

Non Traumatic: result from tumors or progressive degenerative diseases

Question 2

Classification of Injury

Answer 2

ASIA impairment scale

Question 3

ASIA Impairment Scale: A

Answer 3

• complete

* no sensory or motor function preserved S4-S5

Question 4

ASIA Impairment Scale: B

Answer 4

• incomplete
• sensory preserved below neurological level
• no motor preserved

Question 5

ASIA Impairment Scale: C

Answer 5

• incomplete
• motor function preserved below neurological level
• majority of muscles below neurological level have muscle grade less than 3

Question 6

ASIA impairment scale: D

Answer 6

• incomplete
• motor function preserved
• majority of muscles below have muscle grade greater than or equal to 3

Question 7

ASIA Impairment Scale: E

Answer 7

• normal

* sensory and motor functions are normal

Question 8

SCI symptoms

Answer 8

• spinal shock (4-8 weeks)
• sensory loss/deficits
• loss of bowel/bladder control
• loss of temperature below lesion
• decreased respiratory function
• sexual dysfunction
• changes in muscle tone (spasticity in UMN and flaccidity below L1)
• loss of motor function

Question 9

Central Cord Syndrome

Answer 9

resulting from hyperextension injuries

•presents as more UE deficits vs LE

Question 10

Brown Sequard Syndrome

Answer 10

hemi-section of cord resulting in:
• ipsilateral spastic paralysis
• ipsilateral loss of position sense
• ipsilateral loss of discriminative touch
• contralateral loss of pain
• contralateral loss of thermal sense

Question 11

Anterior Cord Syndrome

Answer 11

caused by flexion injuries resulting in loss of:
•motor function
•pain
•temperature
below lesion

Question 12

Conus Medullaris

Answer 12

injury of sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and reflexic bowel and bladder

Question 13

Cauda Equina

Answer 13

injury at L1 and below resulting in:
•lower motor neuron lesion
•flaccid paralysis with no spinal reflex activity

Question 14

C1-C3 SCI

Answer 14

paralyzed neck down
require total assistance
o Innervation: cervical paraspinals, sternocleidomastoid, neck accessory muscles,
o Movements: neck flexion, extension, rotation
o Respiratory: vent/wean from vent if able with assistance for secretions
•Require external breathing device (c1-c3)
oSelf Care: dependent for all self care; goals are to be independent in directing self care, family training

oEquipment: 
•	Ventilator
•	Suction equipment
•	Power wheelchair with head/chin/breath control
•	Hoyer lift
•	Reclining or tilt in space padded shower/commode chair
•	ECU, high tech computer access
•	Attendant operated van
oSupervision: 24 hour care at home/SNF
oUpper Extremity:

Goals: control edema, prevent contracture, prevent subluxation
• Use resting hand splints at night, lap tray, supportive arm rests
• Wrist support splints
• E-stim for neurorecovery

oTreatment:
• Low Tech: mouth sticks
• High Tech: wheelchair, computer, voice activated stuff

Question 15

C4 SCI

Answer 15

Deltoids
o Innervation: upper traps, diaphragm, cervical paraspinal muscles
o Movements: neck flexion, extension, rotation, scapular elevation, inspiration
o Assist: total assit in most areas; I in power w/c

Question 16

C5 SCI

Answer 16

biceps, elbow flexors, deltoids

o Innervation: deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus anterior

o Assist: bowel/bladder dependent, total assist in most areas, i= equipment for pressure relief, power w/c, communication, transportation

o Self Care: eating w/ set up equipment; mod assit with dressing

o Mobility: short distances in manual wheelchair

o Supervision: 6hrs homecare/day, personal care 10 hrs/day

o Equipment: power/mechanical lift, slide board, electric bed, padded shower/commode, power w/c and light manual w/c, specialized van, manual cuff

o Treatment:
• Focus on feeding, grooming, UB ADL, table top UE exercise
• Adaptive Equipment
• Assistive Technology: voice activated computer technology, switches
• Strengthening and stretching

o	Upper Extremity:
•	Functional hand splints at night
•	Wrist cock up during day
•	Preserve tenodesis if gain a level
•	Elbow contractures: soft pillow splint, serial casting

Question 17

C6 SCI

Answer 17

wrist extensors = tenodesis grasp

o Innervation: clavicular pectoralis, supinator, extensor carpi radialis longus and brevis, serratus anterior, lattisimus dorsi

o Movements: scapular protraction, horizontal adduction, forearm supination, radial wrist extension

o Self Care: some to total assist; independent feeding, grooming, upper body ADL

o Mobility: independent with manual w/c indoors; independent driving from w/c with adapted van

o	Equipment:
•	Power/mechanical lift
•	Slide board
•	Electric bed/specialty mattress
•	Padded shower commode chair/padded tub slider
•	Power w/c and light weight manual w/c
•	Specialized van
•	Needs similar to C5

o Treatment: focus on minimizing equipment for table top taks and learning to manipulate objects with tenodesis
• Adaptations: cylindrical foam, cathing equipment
• Assistive tech: voice activated computer technology
• Strengthening
o Upper Extremity:
• Tenodesis: lateral pinch preferred
• Splinting: hand splint at night, short opponens during day, dorsal blocking iat night
• Strengthening: prone exercises

Question 18

C7-C8

Answer 18

elbow extensors (C7) - finger flexors (C8)

o Innervation: triceps, finger flexors/extensors, latissimus dorsi, sternal pectoralis, pronator quadratus

o Movement: elbow extension, ulnar/wrist extension, wrist flexion, finger flexion and extension, thumb flexion/extension/abduction

o Assist: can be totally independent/independent to some assist including driving with adapted hand controls

o Equipment:
• Electric bed
• Slideboard
• Lightweight manual w/c and cushion

o Treatment: OT
• Prevent contractures, strength imbalances in hand
• Splinting day/night
• Strengthening: intrinsics and scapula

o C8: can grasp with MP joints in extension and PIP and DIP in flexion (claw hand)

Question 19

T1-T9

Answer 19

small finger abductors

o Innervation: intrinsics of hand/thumb, internal and external intercostals, erector spinae, lunbricals, flexors/extensors/abductor pollicis

o Movement: upper extremities fully intact, limited upper trunk stability

o Function: independent with all ADL and transfers
• Driving with hand controls

o Equipment: padded tub bench and raised toilet seat
• Inspection mirror, long handled items

Question 20

T10-L1

Answer 20

o Innervation: fully intact intercostal, external obliques, rectus abdominis
o Movement Possible: good trunk stability
o Function: household, some assist to independent with bracing
• Usually use manual w/c in community