SCI

where does spinal cord level end at

L1

Ascending spinal tracts are

Dorsal Column-Medial Lemniscus (DCML) and Anterolateral System (ALS)

Descending spinal tracts are

Corticospinal tracts

DCML functions

Proprioception (jt position), vibration (tuning fork), graphesthesia (to draw), barognosis (pressure how heavy object is), stereognosis (eyes closed, identify object by touch) , 2-pt discrimination, kinesthesia, and fine touch (localized)

Anterior STT function

Crude touch- yes or no, do you feel it

Lateral STT function

Pain and temperature

Corticospinal tract function

Movements

Posterior Cord Syndrome is in what part of what tract?

DCML- so functions will be loss

Proprioception, Vibration, Graphesthesia, Barognosis, Stereognosis, 2 pt discrimination, Kinesthesia, Fine touch

what is the MOI of posterior cord syndrome

iatrogenic. medical error RARE

what is anterior cord syndrome: what tracts are loss? MOI?

bilat corticospinal-motor

bilat STT-pain/temp/crude touch

MOI: hypeflexion injury

Brown Sequard Syndrome ( Hemi-section of spinal cord) symptoms

DCML sensory function loss and motor (CST) function loss below injury level

Brown Sequard Syndrome contralateral symptoms

Loss of pain and temp below and at the level of injury (think BROWN POT)

brown sequard syndrome cause

stab wound or gun shot

what is central cord syndrome

what is mneumonic MUD-E stand for

large lesion: bilat DCML and CST (more UE>LE) and STT

small lesion: both sides of pain and temp are lost

best intervention: walking

MUD-E: motor, UE, distal, Extension

Conus Medullaris location

Bilateral and symmetrical in perineum

Cauda Equina location

Unilateral and asymmetrical in perineum, thighs, leg, back

Conus Medullaris sensory

Saddle distribution, bilateral, symmetric

Cauda Equina sensory

Saddle distribution, unilateral, asymmetric

Conus Medullaris motor

Symmetric

Cauda Equina motor

Asymmetric

Conus Medullaris type

UMN + LMN

Cauda Equina type

LMN

Complete spinal cord injury is

No sensory or motor function in the lowest sacral segments (S4 and S5)

Incomplete spinal cord injury is

Motor and/or sensory function below the neurological level including sensory and/or motor function at S4 and S5

which tracts are incomplete

• Anterior cord syndrome

• Posterior cord syndrome

• Brown Sequard syndrome

• Central cord syndrome

C5 spinal level

Elbow flexors

C6 spinal level

Wrist extensors

C7 spinal level

Elbow extensors

C8 spinal level

Finger flexors

T1 spinal level

Fifth finger abductors

L2 spinal level

Hip flexors

L3 spinal level

Knee extensors

L4 spinal level

Ankle dorsiflexors

L5 spinal level

Long toe extensors

S1 spinal level

Ankle plantarflexors

Sensory Level

Most caudal segment of the spinal cord with normal sensory function on both sides of the body (lowest level where sensation is 2/2).

Motor Level

Most caudal segment of the spinal cord with normal motor function on both sides of the body (lowest key muscle with grade >= 3, provided superior muscles are 5).

Neurological/Functional Level

Most caudal segment of the spinal cord with normal sensory and motor function on both sides of the body.

Motor level determination

1. Lowest level at which strength is at least 3/5. 2. All levels above being 5/5.

Motor level scoring

Scored for each side, overall score is last normal for both.

Sensory level determination

1. Lowest level where you have "2's"

2. All above levels being "2's"

Neurological Level Determination Steps

1. Find Motor and Sensory level

2. Pick the higher one

ASIA A

Complete

No motor or sensory function at S4-S5

ASIA B

Incomplete Sensory but no MOTOR function present below Neurological Level of Injury (NLI) and S4-S5

ASIA C

Incomplete LESS than HALF of key muscle functions below the single NLI have a muscle grade ≥3

ASIA D

Incomplete AT LEAST HALF (half or more) of key muscle functions below the single NLI having a muscle grade ≥3

ASIA E

Normal Motor and sensory function is NORMAL

Cardiac complications of SCI

Orthostatic Hypotension, Autonomic dysreflexia

Pulmonary complications of SCI

Respiratory Dysfunction

GU complications of SCI

Urinary and bowel retention +/- incontinence

Integumentary complications of SCI

Pressure Ulcers

MSK complications of SCI

Contracture, weakness, tone

Autonomic Dysreflexia lesion level

At or above T6

Autonomic Dysreflexia trigger

Noxious stimuli below level of lesion

Autonomic Dysreflexia diagnostic criteria

Rise in systolic blood pressure of 20 to 30 mmHg

Autonomic Dysreflexia timing

More common in chronic stage (3-6 months after injury); can be seen in acute too

Autonomic Dysreflexia and SCI completeness

More common with complete SCI

what are some examples of stimuli for autonomic dysreflexia

bladder, bowel irritation, painful sitmulus BELOW level of lesion, GI irritation, sexual activity, labor, fx below lvl of lesion

s/s of autonomic dysreflexia

inc BP, dec HR, severe headaches, constricted pupil, anxiety, flushing, piloerection above lvl of lesion, dry, pale skin below lesion, inc spasticity

what are the interventions for autonomic dysreflexia

SIT UP and LOWER LEGS

• Remove painful stimuli:

̶Loosen clothing, abdominal binder

̶CHECK BLADDER distension: Unclamp catheter, drain it

• Monitor vitals throughout: If still no change, medical/nursing

assistance > meds to lower BP (Nifedipine, nitrates, and captopril)

which level of independence are these levels:

c4 and below

c5-c6

c7-c8

c4 and below: dependent

c5-6: modified indep

c7-c8 independent

C1-C4 functional level transfers & wheelchair

Mechanical lift; Power wheelchair with head/chin/mouth control

C5 functional level transfers & wheelchair

Dependent sliding board transfer; Manual WC with plastic coated hand rims

C6 functional level transfers & wheelchair

Independent sliding board transfer; Manual WC with plastic coated hand rims

C7/C8 functional level transfers

Even: Independent without sliding board. Uneven: Dependent on sliding board.

C7 functional level wheelchair

Independent on even surfaces; not independent on ramps, curbs

C8 functional level transfers & wheelchair

May be able to do Floor to WC; Manual WC with plastic coated hand rims; Independent on ramps, curbs

T1 functional level

Floor to wheelchair: Independent

T4 functional level

Sitting pivot: Independent

L3 functional level

Standing pivot: Independent