Spinal Cord Injury (SCI)

Question 1

Types of SCI

Answer 1

Complete: lesion to Spinal Cord where there is no preserved motor/sensory function below lesion

Incomplete: lesion w/ incomplete damage to Spinal Cord = scattered motor/sensory function below level of lesion

Question 2

Anterior Cord Syndrome

Answer 2

Type: Incomplete
Etiology: results from compression/damage to anterior SC/spinal artery, usually via cervical flex
Presentation: loss of motor function, pain, temperature below level of lesion due to damage of corticospinal and spinothalamic tracts

Question 3

Brown-Sequard’s Syndrome

Answer 3

Type: Incomplete
Etiology: stab wound = hemisection of SC
Presentation: paralysis/ loss of vibration sense on same side as lesion due to damage of corticospinal & dorsal columns. Loss of pain/temp on opposite side from damage to lateral spinothalamic tract
**Pure Brown-Squard’s is rare- most SCI lesions are atypical

Question 4

Cauda Equina Injuries

Answer 4

Type: can be complete, mostly incomplete due to # of nerves
Etiology: peripheral nerve injury below L1
Presentation: flaccidity, areflexia, impairment of bowel/bladder function
**Full recovery not typical due to distance needed for axonal regeneration

Question 5

Central Cord Syndrome

Answer 5

Type: Incomplete
Etiology: compression/damage to central SC, usually via cervical hyperextension = damage to spinothalamic, corticospinal and dorsal columns
Presentation: UE = greater involvement than LE, greater motor deficits than sensory

Question 6

Posterior Cord Syndrome

Answer 6

Relatively Rare
Etiology: compression of posterior spinal artery
Presentation: loss of proprioception, two-point discrimination, stereognosis. motor function preserved

Question 7

Complications of SCI: Deep Vein Thrombosis

Answer 7

E: dislodged blood clot (embolus) due to decrease/absence of normal pumping action created by active muscle contraction in LE = SERIOUS medical condition since embolus may obstruct an artery
Prevention: prophylactic anticoagulants, positioning schedule, ROM, positiong to avoid excess venous stasis, elastic (compression) stockings
S/S: swelling of LE, pain, sensitivity over area of clot, warmth in area
Tx: NO active/passive movement in LE, bedrest + anticoagulants, surgery if necessary

Question 8

Complications of SCI: Ectopic Bone (heterotropic ossification)

Answer 8

E: spontaneous formation of bone in soft tissue, usually around large joints (hip/knees), possibly from tissue hypoxia/ abnormal calcium metabolism
S/S: edema, decreased ROM, increased temp of involved joint
Tx: diphosphates to inhibit ectopic bone formation, surgery, PT to maintain functional ROM, allow pt most independent functional outcome possible

Question 9

Complications of SCI: Orthostatic Hypotension

Answer 9

E: loss of sympathetic control of vasoconstriction in combo w/ absent/severely reduced muscle tone- indicated by drop of systolic BP by 20 mmHg or more
S/S: dizziness, lightheadedness, nausea, “blacking out” when transferring from horizontal to vertical position
Tx: monitor vitals, compression stocking/ace wraps to LE, abdominal binders, gradual progression to vertical position, meds to increase BP

Question 10

Complications of SCI: Pressure Ulcers

Answer 10

E: sustained pressure, friction and/or shearing force to skin- most common areas = coccyx, sacrum, ischium, trochanters, elbows, buttocks, malleoli, scapulae, prominent vertebrae
S/S: reddened area that persists/ open area of skin
Tx: PREVENTION FIRST! immediate medical intervention, change position frequently, proper skin care, sit on appropriate cushion, consistently weight shift, proper nutrition/hydration, surgery often necessary w/ advanced cases

Question 11

Complications of SCI: Spasticity

Answer 11

E: SCI- can occasionally be useful, more often interferes w/ functional activity. Enhanced by internal/external sources (stress, decubiti, UTI, bladder obstruction, temp changes, touch)
S/S: increased involuntary contraction of muscle groups, increased tonic stretch reflexes, exaggerated DTRs
Tx: Meds (dantrium, baclofen, lioresal)- aggresive tx = phenol blocks/ rhizotomies/ myelotomies/ other surgeries. PT = positioning, aquatic ther-ex, WB activity, functional e-stim, ROM, resting splints, inhibitive casting

Question 12

Cauda Equina Injury

Answer 12

injury below L1- considered lower motor neuron lesion

Question 13

Dermatome

Answer 13

designated sensory area based on spinal segment innervation

Question 14

Myelotomy

Answer 14

surgical procedure that severs certain tracts w/in spinal cord to decrease spasticity/ improve function

Question 15

Myotome

Answer 15

designated motor areas based on spinal segment innervation

Question 16

Neurectomy

Answer 16

surgical removal of segment of nerve to decrease spasticity/ improve function

Question 17

Neurogenic bladder

Answer 17

bladder empties reflexively for pt w/ SCI above S2- sacral arc reflex remain intact

Question 18

Neurologic Level

Answer 18

lowest segment of SC w/ intact strength/sensation- muscle groups @ level must receive MMT of “fair”

Question 19

Nonreflexive bladder

Answer 19

bladder is flaccid due to cauda equina/ conus medullaris lesion- sacral reflex arc is damaged

Question 20

Paraplegia

Answer 20

injuries @ thoracic/ lumbar/ sacral level

Question 21

Rhizotomy

Answer 21

surgical resection of sensory component of spinal nerve to decrease spasticity/ improve function

Question 22

Sacral Sparing

Answer 22

incomplete lesion where some of innermost tracts remain innervated.
S/S: sensation in saddle area, movement of toe flexors, rectal sphincter contraction

Question 23

Spinal Shock

Answer 23

physiologic response occurring 30-60 min post SC trauma, can last up to several weeks
S/S: total flaccid paralysis/ loss of all reflexes below level of injury

Question 24

Tenodesis

Answer 24

pt’s w/ tetraplegia that DO NOT process motor control for grasp can use tight finger flexors in combo w/wrist ext to produce form of grasp

Question 25

Tetraplegia (quadriplegia)

Answer 25

term adopted by American Spinal Cord Injury Associate to describe injuries @ cervical level