Spinal Cord Injury Flashcards
(95 cards)
1
Q
Whats the leading cause of SCI in people under 65?
A
MVA (overall this is probably most people, 50%)
2
Q
Whats the leading cause of SCI in people over 65?
A
Falls (20%)
3
Q
What caused about 18% of SCI cases?
A
Sports and recreation
4
Q
Non-Traumatic Stroke
A
Spinal stroke, blood flow to spine gets blocked = tissue damage, tumor
5
Q
Spinal Concussion
A
Sudden, violent jolt injures the tissues around the cord. Usually temporary and goes away in a few hours.
6
Q
Spinal Contusion
A
Causes bleeding to occur in the spinal column. The pressure from the bleeding can kill neurons. (injury of SC is secondary to bleeding)
7
Q
Spinal Compression
A
Object (i.e. tumor) puts pressure on the spinal cord.
8
Q
Shearing/Tearing of SC
A
Torn by some type of injury, neurons are also damaged.
9
Q
Completely Cut SC
A
Spinal cord is dissected
10
Q
Other causes of SCI
A
Infection, Vascular malformations, vertebral subluxations, cysts on SC, MS/ALS, disc/vertebral degeneration in neck
11
Q
Ratio of those at risk
A
Males more likely than females 4:1
12
Q
What percentage of SCI occurs from 16-30 y.o.?
A
51.6%
13
Q
Mean Age for traumatic SCI
A
39 y.o.
14
Q
Mean Age for non-traumatic SCI
A
55 y.o.
15
Q
Distribution of SCI
A
Cervical 51%
Throacic 35%
Lumbosacral 10%
16
Q
Types of injury
A
Compression Fx, Burst Fx, Subluxation, Dislocation, Fracture Dislocation
17
Q
Tetraplegia
A
i.e. Quadriplegia
Paralysis of all four extremities and trunk
18
Q
Paraplegia
A
Paralysis of all or part of the trunk and both LE
19
Q
Incomplete Spinal Cord Injury
A
Preserved anal sensation in S4-5 dermatome (light touch/sharp dull)
20
Q
Motor Incomplete injury
A
Preserved voluntary anal sphincter contraction
21
Q
MOST to LEAST frequent Incomplete Injuries
A
Incomplete tetra
Complete para
Complete tetra
Incomplete para
22
Q
Vertebral lesion level
A
Anatomical injury at the vertebrae –> not referring to that nerve root necessarily. (T5 vertebral burst Fx)
23
Q
Neurological Lesion Level
A
Most caudal level of the SC with NORMAL motor AND sensory function on BOTH the R&L sides of the body
24
Q
Motor Lesion Level
A
Most caudal level of the SC with NORMAL motor function (can be rated separately from sensory)
25
Sensory Lesion Level
Most caudal level of the SC with NORMAL sensory function (can be rated separately from motor)
26
Sensory Test Grades
```
0 = Absent
1 = Altered
2 = Intact
```
27
How many sensory points on ASIA?
28, LT & PP at each point
28
How many key motor?
10
29
ASIA Motor Muscle Grading 0
Total Paralysis
30
ASIA Motor Muscle Grading 1
Palpable/Visible contraction
31
ASIA Motor Muscle Grading 2
Active movement, full range gravity elim
32
ASIA Motor Muscle Grading 3
Active movement, full range against gravity
33
ASIA Motor Muscle Grading 4
Active movement, full range against gravity and mod resistance in muscle specific position
34
ASIA Motor Muscle Grading 5
Active movement, full range against gravity and full resistance in muscle specific position. Expected from otherwise unimpaired person
35
ASIA Motor Muscle Grading 5*
active movement, full ROM against gravity and sufficient resistance to be considered normal if identifiable inhibiting factors (i.e. pain, disuse) were not present
36
NT
Not Testable (immobilization , severe pain, amputation, contracture >50% normal ROM)
37
ASIA: Intact Innervation of Key Muscles
grade 3/5 or 4/5 AND most rostral key muscle 5/5
| If myotome not clinically testable, sensory level serves as motor level also. (so 5-5-5-5-3 = last normal level)
38
ASIA impairment scale
```
A = Complete
B = Sensory Incomplete
C =Motor Incomplete
D = Motor Incomplete
E = Normal
```
39
ASIA B
S4-5 sensory but not motor
40
ASIA C
motor S4-5, more than ½ key mm below neurological level
41
ASIA D
1/2 or more key muscles >/= 3 MMT
42
FIM (functional independence measure)
7 point scale. 6-7 don't need helper, 6 additional time or AD
43
Vascular Supply of the Spinal Cord
Anterior Spinal Artery (2/3)
| Posterior Spinal Artery (1/3)
44
What is Brown-Sequard Syndrome?
Hemisection of the Spinal Cord; asymmetrical sequelae
45
What does Brown-Sequard Syndrome damage?
Corticospinal tract: Spastic paralysis
Fasciculus gracilis/cuneatus: loss of vibration/proprio
Spinothalamic tract: pain and temp
46
Ipsilateral Sx of Brown-Sequard Syndrome
```
Loss of light touch, deep pressure, proprioceptive sensation
Decreased Reflexes
Lack of Superficial reflexes
Clonus
(+) Babinski Sign
```
47
Contralateral Sx of Brown-Sequard Syndrome
Loss of pain and temp
48
Positive prognostic factor for Brown-Sequard Syndrome
Preservation of motor function in dominant hand
49
What is Anterior Cord Syndrome?
Damage to anterior portion of SC and/or vascular supply to anterior spinal artery. RELATED TO FLEXION INJURIES OF C-SPINE!
50
S/S anterior cord syndrome
Loss of motor function
Loss of pain and temp
Preservation of kinesthesia, vibratory, deep pressure (posterior columns)
Extremely poor prognosis for return of bowel and bladder function, hand function and amb.
51
What is central cord syndrome?
Hyperextension injuries to cervical region or narrowing of spinal canal. Injury causes bleeding into central gray matter. The majority of incomplete lesions result int his.
52
S/S central cord synrome
More involvement of UE than LE, more motor involvement than sensory.
53
Outcomes with central cord syndrome
3/4s ambulatory
1/2 bowel/bladder control
less than 1/2 hand function
54
Positive prognostic factors with Central Cord Syndrome
Higher level of education
Absence of spasticity
Younger age
55
S/S Posterior Cord Syndrome?
Loss of proprioception
Loss of epicritic sensations (graphesthesia, sterognosis, 2 pt discrim)
Altered gait pattern (wide steppage)
56
What is Sacral Sparing?
Most centrally located sacral tracts are spared injury
57
Sacral Sparing: Incomplete Injury
Intact sensation, perianal sensation, external anal sphincter contraction
58
Conus Medullaris Syndrome
Damage to S4-5 Spinal Segment
59
S/S Conus Medullaris Syndrome
```
Interferes with:
Bladder and bowel function
Sexual function
Decreased perianal sensation
Diminished Achilles reflexes
Usually bilateral and symmetric
```
60
What are Cauda Equina injuries?
Technically a peripheral nerve root problem because the SC has terminated.
61
S/S Cauda Equina injuries
Injuries typically partial, LMN injuries, so LMN Sx (flaccid, decreased reflexes)
62
Where in the spine have the highest frequency of injury?
Between C5-7 & T12-L2 (more mobile, less stable)
63
Spinal Shock
Period of areflexia, flaccidity, loss of sensation/motor function below the level of the lesion.
64
Areflexia
Loss of deep tendon reflexes as well as superficial: bulbocavernosus, cremasteric, plantar reflexes
65
What marks the end of spinal shock?
The return of bulbocavernosus reflex
66
Clinical Manifestation of SCI
```
Motor/Sensory Impairment
Autonomic Dysreflexia
Postural Hypotension
Impaired Temp Control
Respiratory Impairment
Spasticity
B/B Dysfucntion
Sexual Dysfunction
```
67
What is autonomic dysreflexia?
An emergency situation. Lesions above T6 (sympathetic splanchnic outflow)
68
Hallmark Symptom of Autonomic Dysreflexia?
Elevated systolic blood pressure (20-40 mmHg above normal)
69
Sx of Autonomic Dysreflexia
```
Inc. systolic BP
Bradycardia
Headache (severe pounding sudden)
Profuse Sweating
Vasodilation/flushing above lesion level
Piloerection (goosebumps)
Blurred Vision
COULD HAVE STROKE
```
70
What should you do if Autonomic Dysreflexia?
Sit pt up to dec BP
Immediate Medical Assistance (strong vasodilators)
Check for causes
71
Some causes of autonomic dysreflexia?
```
Bladder distension (urinary retention)
Rectal distension
Pressure Sores
UTI
Infection
Noxious cutaneous stimuli
```
72
Postural (orthostatic) hypertension
Decreased blood pressure when transitioning to vertical position
Cause: lack of sympathetic vasoconstriction
73
S/S Postural (orthostatic) hypertension
Headache, flushed, dizzy, pale. Vision problems: tunnel vision/blackness
74
Prevention of Postural (orthostatic) hypertension
compression stocking/ace wrap
Abdominal binder
Slow progression to upright
75
What should you do if Orthostatic hypotension?
Lay them down, can put the feet up.
Need to act quickly.
If you're in a wheelchair you tilt the chair back and allow them to rest the head etc. Slowly back to sitting or can get more people/stretcher to transfer in laying position.
Blood pools most in LE & Abdomen.
76
Indirect Impairment/Complication from SCI
```
Respiratory Complications
Pressure Sores [Decubitus ulcers]
DVT
Contractures
Heterotopic (Ectopic) Ossification [H.O.]
Pain
```
77
What is the most common cause of death post SCI?
Pneumonia (reduced ventilation, decreased cough/secretion clearance)
78
Respiratory Complications: C1-C4 Positioning
May have improved respiratory function when reclined 15 deg with head support
79
Glossopharyngeal Breathing
Utilized during emergency situation
80
Paradoxical breathing
People without normal abdominal function. Pouching out in stomach and concavity in chest.
81
What is an effective cough?
one or two large spouts of air coming out in a forceful exhale.
82
Pressure Sore prevention/Tx
Position change every 2 hrs
Skin inspection
Pressure relief equipment
Pressure relief techniques
83
Skin Inspection
Can use mirror, check bony prominences (esp heels, ish tub, poor sensation & WB regions)
84
When do you ned to preserve tenodesis grip?
C6-7 injuries.
85
Heterotopic Ossification
Ectopic bone formation in soft tissues surrounding a joint. Near joint, extra-articular, extra-capsular. Linked with spasticity. Never IN the joint.
86
Where does HO occur primarily?
The hip (also, knee, shoulder, elbow)
87
How common is HO?
1/4 - 1/2 SCI patients will habe it
88
Factors associated with HO
```
Complete injury
Trauma
Severe Spasticity
UTI
Pressure Sores
```
89
Early Sx of HO
Swelling, joint/muscle pain, Decreased ROM, erythema, local warmth near joint (Later Sx = contractures/ankylosis)
90
HO prevention
NSAIDs, Pulsed low-intensity electromagnetic field, Avoid overly aggressive ROM.
91
HO Tx
early ROM exercise, etidronate to prevent calcium deposits, NSAIDs
92
Other secondary conditions
Bone Fx, Syringomyelia (tethered SC), Spasticity, Pain
93
Cervical orthoses
Philadelphia, Aspen, Miami-J, Halo
94
Thoracolumbosacral orthoses (TLSO)
*Jewett brace (hyperextension), Body Cast
95
What is the general concept of orthoses?
3 point stabilization. So TLSO for hyperextension = point on pubic bone, sternum and mid back.
