SCI- chap 20 PART 1

male

Are 80% of the population to get SCI: male or female

16-30

age range for 50% of all SCI

MVC

traumatic SCI leading cause

falls

traumatic SCI 2nd leading cause

nontraumatic SCI

more common than traumatic injuries

nontraumatic SCI

causes: thrombus or embolus, hemorrhage, Spinal stenosis, Neoplasms, Infection, AV malformation

Tetraplegia

caused by Cervical spine injury

Tetraplegia

trunk, repiratory muscles, and all 4 limbs affected

Paraplegia

caused by Thoracic or lumbar spine injury

Paraplegia

caused by Cauda equina injury

Paraplegia

trunk and bilateral LE impacted

above

C1-C7 exit ____ corresponding vertebrar

downward

thoracic nerves exit in a more (downward or horizontal) direction

vertical

thoracic nerves exit in a more (horizontal or vertical ) direction

1

number of coccygeal nerve roots

Neurological Level

refers to most caudal level with normal function on right and left rides

motor level

assessed using MMT

motor level

named for lowest myotome with a 3/5 MMT

Sensory level

Assessed using pinprick & light touch

Sensory level

named for lowest/distal/caudal dermatome with sensation on right and left sides

T

(T/F) right and left sides can have different sensory or motor levels

complete SCI

spinal cord completely transected or cut: rare

complete SCI

No sensory or motor function in lowest sacral segments

complete SCI

No sacral sparing

complete SCI

S4-S5 have no sensory or motor function

S4, S5

allows anal sphincter to contrract

incomplete SCI

Sensory or motor function below neurological level with sensory or motor function at S4 and S5

Zone of partial preservation

areas of intact motor and/or sensory function below neuro level but no sacral sparing

Sacral Sparing

Sacral tracts in cervical area (centrally located) are spared

Sacral Sparing

first signs that cervical lesions are incomplete

Normal function

at least a 3/5 with MMT

C7 complete tetraplegia

Intact C7 nerve root segment with no sensory or motor function below this level

C7 incomplete tetraplegia

Spotty sensation and some motor function (below a 3) below C7

ASIA impairment scale

Distinguishes different types of SCI

A

ASIA: Complete

A

no sensory or motor function is preserved in the sacral segments S4,S5

B

ASIA: sensory incomplete

B

sensory but not motor function is preserved above neurological level and includes sacral segments S4,S5

B

no motor function is preserved more than three levels below the motor level on either side of the body

C

ASIA: motor incomplete

C

motor function is preserved at the most caudal sacral segments for voluntary anal contraction

C

the pt. meets criteria for sensory incomplete status and has some sparing of motor function more then three levels below ipsilateral motor level on either side of the body

D

Motor incomplete with at least half of key muscle function below a single NLI having muscle grade of at least 3/5

E

ASIA: normal

E

pt. had prior deficits and are now graded as normal in all segments

Brown-Sequard Syndrome

Caused by penetrating injury causing hemi section of cord

paralysis and loss of proprioception, Light touch, Vibratory sense

ipsilateral in Brown-Sequard Syndrome

pain, temperature

contralateral in Brown-Sequard Syndrome

Brown-Sequard Syndrome

generally have good prognosis and gain lots of function

Anterior Cord Syndrome

compromise of the anterior spinal artery

Anterior Cord Syndrome

Caused by flexion injury

Anterior Cord Syndrome

bilateral loss of motor function, pain and temperature

Anterior Cord Syndrome

proprioception, light touch and vibration are preserved

Central Cord Syndrome

most common syndrome

Central Cord Syndrome

Caused by hyperextension injuries, congenital or degenerative processes

Central Cord Syndrome

upper extremities are more affected than lower extremities

Central Cord Syndrome

motor deficits are greater than sensory deficits

Cauda Equina Injuries

complete transection is rare because its a bundle

Cauda Equina Injuries

Areflexic bowel and bladder and Saddle anesthesia

Cauda Equina Injuries

is considered a peripheral nerve injury: could regenerate

F

(T/F) full regneration is common in Cauda Equina Injuries

conus medullaris syndrome

very distal portion of spinal cord is damaged

conus medullaris syndrome

mixture of LMN and UMN damage

Spinal shock

Absence of all reflex activity (~24 hours)

Spinal shock

period immediately after spinal cord injury

deep tendon reflexes

biceps, triceps, brachioradialis, patellar, ankle

Bulbocavernosus reflex

squeezing glans penis or touching clitoris and looking for anal sphincter contraction

Cremasteric

males only; stroking inner thigh causes ipsilateral contraction of cremaster muscle which pulls testicle toward inguinal canal

Babinski

stroking lateral sole of foot and across ball of foot causes toes to fan (positive response)

Spinal shock

can last for several weeks with reflexes gradually returning

paralysis

Complete loss of motor function below lesion level

paresis

partial loss of motor function below lesion level

Motor and Sensory Impairments

depends on neurological level, completeness of lesion, and specific features of lesion

Autonomic Dysreflexia

also called Autonomic hyperreflexia

Autonomic Dysreflexia

is a life threatening injury

Autonomic Dysreflexia

mostly seen in complete injuries above T6

Autonomic Dysreflexia

Commonly occurs 3-6 months after SCI

Autonomic Dysreflexia

noxious stimulus below lesion level causes rise in blood pressure

Autonomic Dysreflexia

body cannot autoregulate above T6

Bladder distension

most common cause of Autonomic Dysreflexia; kinked catheter

Decubiti

pressure injuries

Autonomic Dysreflexia

look for kinked catheter or clothes/belt thats too small

Autonomic Dysreflexia

s/s: hypertension, bradycardia, severe headache, Diaphoresis,

lay in supine

DO NOT do this with hypertension

Vasoconstriction

below lesion in Autonomic Dysreflexia

Vasodilation

above lesion in Autonomic Dysreflexia

Piloerection

goosebumps

hypertensive emergency

250-300/200-220 mmHg

1. sit pt. up.

2. check catheter

3. check tight clothes

4. call 911

steps for Autonomic Dysreflexia

red flags, triggers

educate pt.s and caregivers with Autonomic Dysreflexia about these 2 things

Spastic Hypertonia

Occurs below lesion level after spinal shock resolves

Spasticity

velocity dependent

Spasticity

motor disorder

Spasticity

more common in cervical lesions

Hypertonia

Resistance to passive motion

Hypertonia

not velocity-dependent

Spastic Hypertonia

Characterized by

• Spasticity

• Muscle spasms

• Hypertonia

• Hyperactive stretch reflexes

• Clonus

first 6 months

when Spastic Hypertonia increases

1 year

Spastic Hypertonia plateaus after

• certain positional changes

• Environmental temperatures

• Tight clothing

• Bladder or kidney stones or infection

• Fecal impaction

• Catheter blockage

• UTI

• Decubiti

• Emotional stress

9 things that can trigger spasticity