Spinal Cord Injury General Info

bimodal

SCI have a ____ distribution; two peaks

male

Majority of individuals affected by SCIs are ___

MVA

most common cause of traumatic SCI

Incomplete Tetraplegia

Most common type of SCI

11 days

average acute care stay for individuals with SCI

33 59

Average inpatient rehabilitation stay is ____ days for incomplete paraplegia and ____ days for complete tetraplegia

higher

Individuals with incomplete SCIs and more caudal injuries have a _____ life expectancy

Anterior Cord Syndrome

Syndrome; Loss of motor function and loss of sense of pain and temperature below the level of lesion; proprioception and vibratory sense are generally preserved

flexion

Anterior Cord Syndrome is usually related to ___ injuries in the cervical region

longer

Anterior cord syndrome usually requires a ____ length of stay compared to those with other clinical syndromes

Central Cord Syndrome

most common SCI syndrome

hyperextension

Central cord syndrome typically occurs from ____ injuries to cervical region (falls); also associated with congenital or degenerative narrowing of the spinal canal resulting compression and edema that damages central cord

Central Cord Syndrome

Syndrome; more severe involvement in UEs than LEs, varying degrees of sensory involvement, typically recover ability to ambulate but have distal weakness and loss of fine motor control

Brown-sequard syndrome

Damage to one side of the cord, typically caused by penetration woulnds like gunshot or stab wound

Ipsilateral Contralateral

With Brown-Sequard Syndrome there is _____ paralysis and sensory loss (proprioception, light touch, vibratory sense) and _____ loss of sense of pain and temperature (begins several dermatome levels below injury due to where lateral spinothalamic tracts cross

lower

Cauda equina is a ___ motor neuron lesion

Cauda Equina Syndrome

characterized by areflexic bowel and bladder, saddle anesthesia, lower extremity paralysis or paresis

Spinal Shock

Period of absence of all reflex activity that occurs immediately following a SCI; initial period lasts ~24 hours, gradual return of reflexes up to 1-3 days after injury

1 4

Increasing hyperreflexia lasts ___-___ weeks after SCI

Autonomic Dysreflexia

Acute, excessive sympathetic response triggered by noxious stimuli BELOW the level of lesion; impulses from the vasomotor center in brainstem cannot pass the site of lesion to counteract HTN with vasodilation - can result in seizures, cardiac arrest, SAH, stroke, or even death

Elevated blood pressure

The biggest sign of autonomic dysreflexia is what

above chronic

Autonomic Dysreflexia typically occurs in SCI lesion ____ T6 and is more common in the ____ stage of recovery

bladder and bowel irritaiton

most common cause of autonomic dysreflexia

medical emergency

Autonomic Dysreflexia must be treated as a ___ ____

upright

The first step after autonomic dysreflexia is identified is to move the patient into an ______ posiiton to lower BP

upright position, loosen tight clothing/restrictive devices (ID noxious stimuli), monitor BP and pulse

3 steps in response to autonomic dysreflexia

medical assistance

If Sx of autonomic dysreflexia do not subside with elimination of trigger, seek ____ _____ immediately

vagus

Parasympathetic signals to hear from the ____ nerve , decrease HR and contractility

T1 L2

Sympathetic input comes from spinal segments ___-___ (sympathetic trunk, which runs parallel to spinal cord), increase HR and contractility, peripheral vasoconstriction

sympathetic parasympathetic

Upper SCI will result in loss of ____ communication between brainstem and heart but ____ remains INTACT causing bradycardia and dilation of peripheral vasculature below level of lesion

Orthostatic Hypotension

typically occurs due to imbalance in sympathetic and parasympathetic systems, decrease in active muscle contraction, prolonged time in bed

T6

Orthostatic Hypotension is usually only significant in people with SCI above ____

decreased stroke volume, decreased cardiac output

Exercise capacity is typically reduced after SCI due to these two cardiac changes

loss of internal thermoregulatory responses

Changes in temperature control

shiver

the ability to ____ is lost below the level of the injury (temperature control)

cervical

____ level injuries and complete injuries have more impairment in thermal regulation

Pulmonary

In high cervical injuries, ____ problems are the leading cause of death

T10

Injuries below ____ are likely to have near normal pulmonary function

C1 C2

Level of lesion; phrenic nerve innervation and spontaneous respiration are lost, artificial ventilator is required to sustain life (need assist with airway clearance)

C3 C4

Level of lesion; partial diaphragm innervation, scalenes, levator scapulae, and trapezius, requires mechanical ventilation in acute stage, likely able to breathe on their own with training or may need part-time support, need assist with airway clearance

C5 - C8

Level of lesion; full innervated diaphragm and many accessory muscles, some cough ability preserved but weak, still have impaired function compared to healthy individual

T5-T12

Level of lesion; weak or absent abdominal and intercostal muscles, impaired airway clearance, decreased expiratory efficiency, decreased support of diaphragm causing it to assume a low position in chest which decreases upward force during expiration and expiratory reserve volume

UTIs

____ are a major cause of mortality and morbidity in SCIs; 40-60% of people with SCI report having this in first year after injury

S2 S3 S4

Spinal control for micturition originates from ___ ____ ___

Spastic, Hyperreflexic

Lesions above conus medullairs and sacral segments result in ____ or ____ bladder (UMN)

flaccid areflexic

Lesions of conus medullaris or sacral segments result in ____ or _____ bladder (LMN)

Spastic (Hyperreflexic) bladder

Contracts and reflexively empties in repsonse to certain level of filling pressure, reflex arc is present

hyperreflexive

In a spastic bladder, the detrusor muscle is generally _____; often lack coordination between detrusor and sphincters

Flaccid (Areflexive) bladder

no reflex action of the detrusor muscle, unable to empty bladder sufficiently

Areflexive sphincter, spastic detrusor muscle

Reasons for failure of bladder to store urine

Areflexive bladder, sphincter is unable to relax, dyssynergia between detrusor and sphincter

Reasons for failure of bladder to empty urine

Bowel

People with SCI report that ____ function has a greater impact on daily life than many other impairments after SCI including sexual function, bladder function, pain, spasticity, and skin integrity

spastic

Lesions above conus meduluaris = ____ or reflex bowel (UMN)

flaccid

S2-S4 or cauda equine lesions = ____ or areflexive bowel (LMN)

Reflex bowel

Bowel management; this type of bowel requires the use of suppositories and digital stimulation techniques to cause a reflex defecation

Nonreflex bowel

Bowel management; this type of bowel requires manual evacuation techniques and gentle valsalva

sexual

People with paraplegia report that improved ____ function is the primary factor that would improve their quality of life

UMN

Erectile capacity is greater in ____ lesions and greater in incomplete lesions than complete lesions

Reflexogenic erections

Type of erection; occurs in response to external physical stimulation, intact reflex arc is required, complete injuries above T10

Psychogenic erections

Type of erection; occur through cognitive activity, mediated by cerebral cortex either through thoracolumbar or sacral cord centers, complete injuries that disrupt sacral reflex arc

LMN

Higher incidence in ability to ejaculate with _____ lesions and higher in incomplete versus complete injuries

not

After 4-5 months post SCI, potential for conception is ___ impaired

overuse posture

MSK injuries are often due to ____ or poor ____

spinal cord

Neuropathic pain below the level of the lesion is due to ____ ___ damage

peripheral nerve

Neuropathic pain above the level of the lesion is likely due to ___ ____ damage associated with nerve impingement or compression

contractures

Develop secondary to prolonged shortening of structures across and around joint, resulting in limitation of motion

ankle knee hip elbow shoulder

Contractures of the ___ ____ ____ ____ and ____ joints may have significant negative impact on persons ability to perform ADLs and limit participation

prevention

_____ is most important management of contractures

Pressure sores

Decubitus ulcers of soft tissue caused by unrelieved pressure and shearing forces

Sacrum, heels, ischium

Most common site for pressure sores

Heterotopic Ossification (HO)

Osteogenesis (bone formation) in soft tissues, usually near joints, below level of lesion

Sx: swelling, joint and muscle pain, decreased ROM, erythema, local warmth

4 6

Rapid bone mineral loss in first ___-___ months after SCI

phrenic C3 C4 C5

The diaphragm is innervated by the ____ nerve at spinal levels ___, ___, ___