450: Spinal Cord Injuries

Spinal cord injuries concept - complete vs incomplete

Incomplete - innervation below the level of injury is partially spared

Complete - the SC was completely severed, no function is expected below level of injury

Incomplete SCI

wait and see

Complete SCI

asked the most on test because its clearer

Spinal shock syndrome

swelling on the spinal cord

can sometimes present as a higher SCI than it is

How SCI are classified

ASIA scale

incomplete spinal cord syndromes

ASIA scale

American spinal injury association

A - complete, no motor/sensory

B - incomplete, no motor, some sensory

C - incomplete, half or more muscles <3 MMT

D - incomplete, half or more muscles > 3 MMT

E - incomplete, no impairment

AISA scale mnemonic

All gone

Pain in the Butt

Count to 3

Don’t stop

Everything’s OK

Incomplete spinal cord injuries

Central cord syndrome

Cauda Equina syndrome

Brown-sequard syndrome

Anterior spinal cord syndrome

Central cord syndrome

UE affected

Centaurs have arms

Cauda-equina syndrome

LE affected

Horses are all legs

Brown-sequard syndrome

Hemiplegia and contralateral sensory loss

B on one side, S on the other, Body and sensory

Anterior cord syndrome

no motor, sensory spared

ASIA B

Can Feel ants crawling on you, can’t brush them off

SCI concept - where tells us what

Where the spinal cord was injured tells us what deficit to expect

C1-8 - Breathe and basketball

T1-6 - Arms or autonomic dysreflexia

T7-12 - Crunch

L1-5 - Kick

S1-5 - Skip

Where tells us what - cervical C1-4

C1-4: neck control likely needs respirator

“C 3, 4, 5 keep the diaphragm alive”

Power wheelchair with adaptive control unit

sip and puff, chin control, head array, mouth stick (C4)

assisted cough

tilt in space for pressure relief

prevent contractures: anti-deformity, ROM

Where tells us what - cervical C5

C5 - elbow flexion

mobile arm support and universal cuff

can drive power chair

elbow orthotic

Where tells us what - cervical C6

Wrist extension

Tenodesis

short opponent splint

manual or electric wheelchair

still power tilt for pressure relief

likely s/u or some assists with ADLs

Where tells us what - cervical C7

Elbow extension (triceps)

IND transfer/pressure relief (sideboard)

Manual w/c

IND ADLs with AE

Where tells us what - cervical C8

Wrist and finger flexion

close to normal function of hands

Where tells us what - T1

lumbricals (intrinsics)

Full dexterity of hands

Where tells us what - Thoracic

UE have full funtion

T6 - autonomic dysreflexia

T7-12 Core

Autonomic dysreflexia

T6 or above

bodys reaction to something wrong

blood pressure and HR impacted

Sweating anxious

Sit up

“Somethings’s up” remove noxious stimuli

Where tells us what - Lumbar and Sacral

Lumbar - start to get some leg function back

Kick - forward leg movement

Sacral - more leg function

Skip - backward leg movemnt

bladder and bowel control

Transfers for SCI

Look at client facotrs

C6 Slideboard possibly IND or may need assist

C7 - IND level surface slideboard

T2 - IND bed mobility and all transfers without or without equipment

SCI concept - Complications: get moving

Movement addresses or prevents all of the following

Autonomic dysreflexia vs Orthostatic hypotension

Spasticity and contractures

Skin integrity/pressure relief

Heterotopic Ossification

DVT

Orthostatic Hypotension

BP and HR decreases

Dizzy, nausea, LOC

Law down (elevate legs), Binders

Gradually return to upright

Spasticity and Contractures

UMN injuries result in this - limits functional movement

Consistent ROM

stretching

splint or serial casting

Skin integrity/pressure relief

Skin breakdown/pressure sores/ulcers likely due to inability to weight shift, loss of sensation, and incontinence

C6 and above - tilt in space/reclining chair

turning in bed routine

w/c seat cushions

caregiver or self examination routine

frequent repositioning

Heterotopic Ossification

swelling, warmth, decreased ROM (hard end feel)

ROM through available range to maintain

compensate with equipment training

contact physician

DVT

limited movement = increased chance of blood clot

can be fatal

preventable with early, regular mobilization

notify physician

SCI Keyline

Where tells us what

cervical levels

C1-8 - Breathe and basketball

T1-6 - Arms or autonomic dysreflexia

T7-12 - Crunch

L1-5 - Kick

S1-5 - Skip