SCI Review Slides ISNCSI and SCI Classification/System Review

• Severity (complete vs. Incomplete)
• NLOI and ASI Impairment Scale
• Traumatic versus non traumatic
• Clinical pattern (syndromes

SCI Classification Review

what are the 4 steps of ISNCSCI classification?

• sensory level

• motor level

• neurologic level of injury (NLOI)

• AIS impairment scale

what is sensory level ?

Lowest segment with intact (2/2)
scores for both Light Touch (LT) and Pinprick (PP)

what is motor level ?

Lowest key muscle with grades 3/5,
provided all key muscles above are 5/5

what is neurologic level of injury (NLOI) ?

• The single most rostral (highest) segment among the 4 individual
  sensory and motor levels

• The most caudal segment of the spinal cord with normal
  sensory and motor function bilaterally

what is AIS impairment scale?

Categorizes completeness (A through E) based on sacral sparing (S4–S5) and motor
preservation

o Right Sensory: Lowest level where LT = 2 and PP = 2
o Left Sensory: Lowest level where LT = 2 and PP = 2
o Right Motor: Lowest muscle greater than or equal to five if all above are 5/5
o Left Motor: Lowest muscle greater than or equal to 5 if all above are 5/5
o NLOI: The most rostral of the 4 levels above.

NLOI rule breakdown

AIS Impairment Scale

• Autonomic
• Cardiac
• Muscle
• Skeletal
• Spasticity
• Skin Integrity
• Respiratory
• Bladder/Bowel

Systems Impact and Complications from SCI

what is the lead cause of death in SCI?

pulmonary issues, reduced
expiratory efficiency

Decreased cough all levels up to?

T10

High tetraplegia will require

ventilator or phrenic nerve
stimulator

what type of exercises should be prescribed for the respiratory system?

pulmonary exercises

Glossopharyngeal breathing is a

specialized technique that uses
the lips, tongue, and throat muscles to "gulp" air into the lungs,
and can help individuals with high cervical SCI breathe
independently for short periods without vent or increase their
vital capacity,

how to maintain skin integritY?

• Daily skin checks
• Consistently document health of skin
• Pressure relief every 15-20 minutes
• Avoid shear and friction
• Use appropriate cushion
• Keep skin clean and dry
• Document the location, size, shape and stage of any wound
• If they are getting pressure find out WHY they are getting
pressure!!!

what are other systems involved?

• Bladder and Bowel Management

• DVT and respiratory care

• SCI affects multiple body systems

what occurs with Bladder and Bowel Management?

Implement scheduled programs, monitor
for retention or incontinence,
and refer to specialists as needed

what occurs with DVT and respiratory care ?

Use prophylaxis, encourage deep breathing, and
monitor for pulmonary issues

what occurs with SCI affects multiple body systems ?

mobility, daily function, and social
participation

what is autonomic dysreflexia (AD)?

Sudden increase in systolic blood pressure of at
least 20 mmHg above the individual's usual
baseline. It is severe it is 40 mmHg above
baseline

AD typically occurs in ?

T6 and above LOI

Hyperexcitability of sympathetic reflexes to the noxious stimulus below the

LOI

If you don't remove the noxious stimuli during AD, it is a ?

medical HTN emergency
that could lead to stroke, seizures or death.

what are common causes of AD?

full/kinked bladder/catheter, constipation, pressure
areas, restrictive clothing, injury

what are common symptoms of AD?

HTN, bradycardia, HA, sweating, piloerection,
flushed skin, blurred vision, constricted pupils, nasal congestion. Below
the level of injury the patient may have chills, feel clammy, cool or pale

what is AD management?

1. Stop activity and sit the patient up or raise head to 90 degree's
2. Attempt to locate noxious stimulus (check catheter, clothing, ask about bowel/bladder, look for pressure areas)
3. Monitor BP and pulse every 2-3 minutes a rise of 20-40 mmHg above baseline is diagnostic for AD
4. Identify noxious stimulus and remove it
5. If BP remains elevated or noxious stimuli cannot be located call 911 and/or notify physician. Some patients with frequent AD episodes have nitropaste that they may administer themselves if prescribed.

Prioritize Upper Limb Function:

Especially in tetraplegia,
restoring/optimizing arm and hand use is critical for ADLs

• C6 tetraplegia (who lack active finger flexors/extensors,

o Preserve Tightness: Do NOT fully stretch finger flexors when the wrist is extended.
o Proper Positioning: Range motion with finger extension ONLY when the wrist is fully flexed.

Promote Mobility

Train in wheelchair skills, transfers, and, if
appropriate, ambulation

Address Psychosocial Needs

Support social participation,
mental health, and patient/caregiver education for long-term
adjustment

ABC's:

• Always assess and support respiratory and cardiovascular function, especially in high cervical injuries (C5 and above)

• Spinal Precautions: Maintain spinal alignment during all transfers and repositioning until cleared

Autonomic Dysreflexia (AD):

Know signs (sudden ↑BP,
headache, sweating) and act immediately—sit patient
up, find and remove triggers (e.g., blocked catheter,
tight clothing

Orthostatic Hypotension:

Monitor vitals with position
changes; manage with slow progression to upright,
compression (abdominal binders/ace wraps), and