Spinal cord injury CC4 Flashcards
acute consequences of sci
weakness with a neck injury leads to
quadriparesis/plegia
acute consequences of sci
weakness with a caudal injury leads to
paraparesis/plegia
htn or hypotension in acute phase of sci?
hypotension
urinary ___ in acute phase of sci
retention
Acute consequences of SCI? (5)
quadriparesis/plegia (neck) paraparesis/plegia (caudal)
Sensory loss or abnormalities
Hypotension
Urinary retention
Orthopedic pain
chornic consequencies of sci? (10
- involutnary mvoements
- bladder problems
- decreased bowel motiblity
- sexual dysfunction
- increased risk fo blood clots
- pressure ulcers
- autonomic dysfunction
- metabolic disorders
- musculoskeltal breakdown/fracures
- psych
above T10 injury , bladder problems are
spastic/neurogenic bladder (most common).
Can’t voluntarily relax the external urethral sphincter, so it stays tight as bladder fills.
below T12, bladder sx are
flaccid bladder, can’t contract for emptying
management of flaccid bladder
manage using…intermittent catheterization, condom catheter, indwelling/Foley
catheter, or suprapubic catheter
male sexual dysfunction?
Male, sperm viability is impaired / fertility is impaired.
female sexua problems?
Female, fertility is mostly unaffected but C-section delivery strongly recommended (b/c of autonomic dysreflexia)
Pressure ulcers from __
cutaneous ischemia
Autonomic Dysfunction: sympathetic damage = impaired ___
thermoregulation
* Autonomic Dysreflexia with SCI =
extreme blood pressure swings (240/160) + low heart rate
what causes autonomic dysreflexia?
occurs in response to strong afferent input, ex. pain or overly full bladder
what can happen with repeated occurenced of autonomic dysrefelxia?
chronic hypertension
metabolic disorders with spi are often due to
lifestyle difficuluties
___ sp injuries/year
10,000-12,000
> 50% of injuries are to ___ spine
cervical
> 50% are neurologically “incomplete” - means there is sensation
in S4-S5 region.
“complete” means bilateral injury with total loss of
sensation below injury level
ASIA scale: A is ___ injury
complete/worst injury
ASIA sale B-D is ___
incomplete
ASIA scale e is __
is normal
Three approaches to SCI treatment:
- Neuroprotection of surviving cells/axons from toxic injury environment
- Neurorestoration via replacement cells, neurotrophins, and establishing a growth-
permissive environment - Neurorehabilitation by strengthening existing systems and retraining circuits
methylpredinisolone (steroids) trials results
- found higher mortality in higher tx group
- another found asia scale improvement in pts who were incomplete, 24 hr dosing
- 48 hr dosing beter
parapesis/plegia occurs caudal to __
t1
for___that are crushed by the intial truamtic injury nothing can be done those are gone for food
nerve cell bodies
among pts who started tx ___ of injury the 48 MP group receovered signfiicantly more funciton at 6 weeksn and 6 months than those with 24 MP
3-8
Spontaneous ____ movements seen in patient with C5 incomplete SCI for 17 years
stepping
Spontaneous stepping movements seen in patient with C5 incomplete SCI for 17 years
Caused by arthritic degeneration and subluxation in R. hip —> ___ triggeered CPG
pain upon hip extension
Characteristics of all these walking CPG manifestations:
Always associated with___nput to the spinal cord
pathology / noxious i
Can be “trained” to improve ___ walking in persons with incomplete SCI
voluntary
Studies on Walk-Training with Body-Weight Support
Most subjects show some improvement, but
no greater than seen with physical therapy
Studies on Walk-Training with Body-Weight Support
is wlaking cpg being trained?
no evidence
Studies on Walk-Training with Body-Weight Support
where were impovements seen?
better balance, stronger leg muscles, improved fitness
Autonomic Dysreflexia Typically seen after ___ or ___ SCI
cervical or high-thoracic
Autonomic Dysreflexia is more common after ___ sci
compelte
Potential causes of autonomic dysreflexia? (4)
- loss of brain/brainstem inhibition to symps
- excessive sensory
response to stimuli - excessive sympathetic response to normal sensory input
- excessive vascular response to normal sympathetic activity
in all cases of cpg walking
all were rhythmic but not reciprocal
between agonists and anatogists
electrical stim to ___ can give rise to leg emg comparable to cpg results
lumbar enlargement
what si the cpg in human characterized by?
interlimb reflexes are observed in all persons with
chronic cervical sci
interlimb reflex is more common in
distal upper limb muscles
is interlibm reflex found in able bodied subjects?
no
early interlimb reflexes from
conenctions already established (latents syanspes)
late interlimb reflexes are from ___ connections
novel (regenerative sproutin)
do interlimb reflexes disappear?
no
what happens to interlimb reflexes once they appear
interlimb reflexes are liekly due to new growth within the spinal cord ___
caudal to the lesion
interlimb reflexes are possibly the basis for
autonomic dysreflexia
