What level of respiratory function does a C1-C2 patient have?
paralysis of diaphragm
ventilator dependent
What level of respiratory function does a C3-C5 patient have?
various degrees of diaphragm paralysis.
Some diaphragm control may need vent support weaning depends on preinjury pulmonary status.
What level of respiratory function does a C6-T11 patient have?
various degrees of impaired intercostal muscles and abdominal muscles.
Compromised resp function reduced inspiratory ability paradoxical breathing patterns ineffective cough and sneeze
C1-C4 functional ability
requires electric wheelchair with breath head or shoulder controls
C5 functional ability
needs electric wheelchair with hand control and/or manual wheelchair with trim projections may require adaptive devices to assist with ADLs.
C6 functional ability
independent in manual wheelchair on level surface may need hand controls adaptive devices may be needed for ADLs.
C7 functional ability
requires manual wheelchair on most surfaces.
C8-T1 functional ability
may need adaptive devices
C8-T1 functional ability
may need adaptive devices
ASIA A
A = Complete : No motor or sensory function is preserved in the sacral segments S4-5. (sensation or motor function at anal opening)
ASIA B
B = Incomplete: Sensory but no motor function is preserved below the neurological level and extends through the sacral segments S4-5. (anterior cord pts)
ASIA C
C = Incomplete: Motor function is preserved below the neurological level and the majority of key muscles below the neurological level have a muscle grade less than 3. 3- can bring it against gravity, not walking
ASIA D
D = Incomplete: Motor function is preserved below the neurological level, and the majority of key muscles below this level have a muscle grade greater than or equal to 3. Part time walkers
ASIA E
E = Normal: Motor and sensory function is normal. Might be on bowel and bladder program
What is the significance of the phrenic nerve?
The phrenic nerve is important due to the fact that it sends signals to initiate breathing in the diaphragm and there is a R&L nerve
Pair of nerves that arise from the cervical spinal roots (C3) & passes down the thorax to innervate the diaphragm & help control breathing.
C3 fracture of injury can’t be phrenic nerve paced
What is meant by a complete injury?
It results in the total loss of sensory and motor functions below the level of injury.
Which results in complete dissection of the spinal cord.
Tetraplegia- injury that happens C1-T1.
Parapalegia involves T2-L1 and these patients may just need a wheelchair since they might have full use of their arms.
Motor & Sensory neural pathways completely transected and total loss of sensory & motor function below the level of injury through the S4-S5. No movement or feeling below the zone of injury. (Ex: tetraplegia or paraplegia)
An incomplete injury?
mixed loss of voluntary motor activity and sensation below the level of the lesion.
This injury exists if any function remains below the level of injury.
Partial preservation of sensory and/or motor function below neurological level of injury including S4-S5. Has movement and / or feeling below the site of injury, some level of movement and sensation below the level of injury. (Ex: Brown-Sequard, Central, Anterior, and Posterior Cord Syndrome)
If a patient loses “Vasomotor” tone due to a spinal cord injury, what effect will that have on blood vessels? Will they constrict more or vasodilate more?
the vessels would vasodilate which would result in orthostatic hypotension.
Vasomotor is a sympathetic nervous system response providing a degree of tension to the smooth muscle within the walls of blood vessels (giving a constant nervous stimulation to maintain a resting level of contraction). It will maintain the diameter of the blood vessels & will maintain BP. A loss would cause a massive vasodilation which will lead to a neurogenic shock (hypotension, bradycardia, and hypothermia)
Anterior Cord Syndrome Clinical Application
- Loss of movement and pain sensation.
- Preserved touch and proprioception.
- Presents with paralysis and loss of pain sensation but has spared touch and proprioception .
- Most common
- Will have to be the eyes of the pt, because can’t feel if they are sitting on something or if developing skin injuries/pressure ulcers – DON’T FEEL PAIN AND TEMP
Brown Sequard Syndrome Clinical Application
- Loss of movement and touch / proprioception sensation ipsilateral side.
- Loss of pain sensation contralateral side.
- Presents like hemiplegia and loss of pain sensation on good side.
- 2nd most common
- – lost touch and perp on L, movement of L, and pain and temp of R
- Weak side is the side that feels pain and temp the best so needs to test hot water with weak side
Central Cord Syndrome
- Greater loss of movement / sensation to the upper extremities vs. lower extremities.
- Pressure around whole spinal cord
- Loss of arm function greater than loss of leg function
- Diving injury
- Pt walk into clinic with arms paralyzed
Posterior Cord Syndrome
- Loss of proprioception.
- Generally spared movement and sensation to pain.
- Pt presents with poorly coordinated movements.
- Can’t feel touch
- Can move with pain and temp attatched
- Least common – tumor pts
Why is dexamethasone (Decadron) given to a SCI patient?
It is given because it can help improve the patient’s neurological outcome
Improves the neurological outcome and prevents post-traumatic spinal cord ischemia, improves energy metabolism, restores extracellular Ca+, and improves nerve impulse conduction.
What is the purpose of a Halo vest?
The halo vest is a metal ring that is secured to the skull with two occipital and two temporal screws. The brace immobilizes the spine which allows the patient to ambulate and participate in self-care.
