SCI

Young adults

What is tetraplegia?

• AKA quadriplegia

• Paralysis (of any degree) of all 4 limbs & trunk

What is paraplegia?

• Paralysis of BLE with involvement of trunk or hips, depending on level of lesion

• Thoracic injury to vertebrae T1-T12

• Lumbar injury to vertebrae L1-L5

• Lumo-sacral canal injury AKA cauda equina syndrome

Types of spinal cord injury

• Contusion- brusing with bleeding. Blood flows into extradural, subdural, & subarachnoid spaces

  • Leads to edema, ischemia, hypoxia

  • Secondary events result in destruction of myelin & axons

• Laceration

• Compression of cord substance (tumor)

• Transection of cord

Motions available at each level of SCI

C4- shoulder shrugs/ elevation

C5- resisted shoulder abduction & elbow flexion

C6- wrist extension

C7- resisted wrist flexion, triceps

C8- resisted thumb extension

T1- finger abduction & adduction

L1-L2- resisted hip flexion

L3- resisted knee extension

L4- resisted great toe extension

S1-S2- plantar flexion

Complete vs. incomplete injuries

• Complete: total paralysis & loss of sensation in all ascending & descending spinal tracts below level of injury

• Incomplete: some preservation of sensory or motor nerve pathways below level of lesion

ASIA impairment scale

A: complete- no motor or sensory function preserved

B: incomplete- sensory function to S4-S5, but no motor function

C: incomplete- more than half of key muscles below neurological level of injury have a grade <3

D: incomplete- half or more of key muscles below neurological level of injury have a grade >_3

E: normal- all components are normal

What is Brown-Sequard syndrome?

• A type of incomplete spinal cord injury

• Loss of pain and temperature sensation contralateral to injury

• Loss of fine touch, pressure, and position sensation ipsilateral to injury

• Loss of motor function ipsilateral to injury

What is anterior cord syndrome?

• A type of incomplete spinal cord injury

• Loss of motor function, pain and temperature sensation bilaterally

• Fine touch, pressure, vibration, and proprioception remain intact

What is posterior cord syndrome?

• A type of incomplete spinal cord injury

• Loss of fine touch, pressure, vibration, and proprioception sensation bilaterally

• Motor, pain, and temperature sensation remain intact

What is central cord syndrome?

• A type of incomplete spinal cord injury

• Paralysis greater in hands & arms than in feet & legs

• Sensory loss below level of injury

• Bladder dysfunction

• Painful sensations

What is conus medullaris syndrome?

• A type of incomplete spinal cord injury

• Injury of sacral cord & lumbar nerve roots

• Areflexic bladder, bowel, & lower extremities

What is spinal shock?

• 24hr to 6wks after injury

• Bowel & bladder atonic, deep tendon reflexes (DTR) decreased, sympathetic functions disturbed (low BP & HR, no perspiration below injury)

• After shock, may develop increased DTR, spasticity, muscle spasms. D/t loss of CNS inhibition to reflex arc

Bowel & bladder function in SCI

• Spastic bladder & bowel injuries above T12 (sphincters & muscles)

• Flaccid bowel & bladder in injuries L1 and lower

• C6 and lower can use digital bowel simulator & suppository inserter

Stages of pressure injury

1. Nonblanchable erythema. May be warmer, cooler, firmer, softer, than surrounding

2. Partial thickness skin loss (erosion or blister). Includes skin tears, tape burns, maceration

3. Full-thickness skin loss including subcutaneous tissue

4. Full-thickness skin loss w/ tissue necrosis & involving muscle, tendon, or bone

What is orthostatic hypertension?

• Sudden decrease in BP d/t loss of muscle tone in abdomen and LE

• Treat: recline & elevate LE

• Prevent: bind abdomen, compression stockings

What is autonomic dysreflexia?

MEDICAL EMERGENCY

• Reflex reaction of ANS in response to bladder or bowel irritation, injury, pain stimulus. Increased BP.

• Severe headache, perspiration, chills, nausea, congestion, red face, anxiety, tachycardia

• Treat: keep upright, remove restrictive clothes, drain catheter, check for other physical problems

What is decreased vital capacity?

• Seen in cervical & high thoracic injuries. Limited chest expansion and decreased ability to cough

• Decreased endurance

• Risks: respiratory infections

• Treatment: avoid infections, keep good pulmonary “toilet”

What is heterotopic ossification?

• Ectopic bone- forms in abnormal locations like soft tissue around hip & knee, sometimes elbow

• Early signs/ symptoms: swelling, warmth, decreased ROM

• Treat: medications, cautious PROM, surgery

What is osteoporosis?

• Decreased bone density or bone mass

• Increased risk of fracture, deformity, & loss of height

• Prevention: weight bearing in standing frame