Spinal Cord Injury Overview and Management

Neuroanatomy

Study of nervous system structure and function.

Spinal Cord Injury (SCI)

Damage to spinal cord affecting motor/sensory functions.

Conus Medullaris

Terminal end of spinal cord at L1-L2.

Cauda Equina

Bundle of spinal nerves below conus medullaris.

ASIA Scale

Classification system for spinal cord injury severity.

DCML

Dorsal Column Medial Lemniscus pathway for proprioception.

ALS

Anterolateral system for pain and temperature sensation.

Corticospinal Tract

Descending tract controlling voluntary motor movements.

Posterior Cord Syndrome

Loss of proprioception and vibration; iatrogenic cause.

Anterior Cord Syndrome

Loss of pain/temperature and motor function; hyperflexion injury.

Central Cord Syndrome

Variable motor/sensory loss due to small/large lesions.

Brown Sequard Syndrome

Hemi-section injury causing ipsilateral and contralateral symptoms.

Ipsilateral Symptoms

Symptoms occurring on the same side as injury.

Contralateral Symptoms

Symptoms occurring on the opposite side of injury.

Vibration Sensation

Ability to perceive oscillating stimuli; tested via tuning fork.

Proprioception

Awareness of body position and movement.

Crude Touch Sensation

Basic sense of touch without fine discrimination.

Pain Sensation

Perception of harmful stimuli; mediated by STT.

Temperature Sensation

Ability to perceive heat and cold; mediated by STT.

Lumbar Puncture

Procedure performed at L3-L4 to avoid spinal cord injury.

Vertebral Level

Specific location of vertebrae in the spinal column.

Spinal Nerve Root

Nerves exiting spinal cord through intervertebral foramen.

Conus Medullaris

End of spinal cord at L1-L2 vertebrae.

Cauda Equina

Bundle of spinal nerves below L2.

Sensory Distribution

Pattern of sensory loss in injury.

Motor Distribution

Pattern of motor loss in injury.

UMN

Upper Motor Neuron; affects voluntary movement.

LMN

Lower Motor Neuron; affects reflexes and muscle tone.

Complete Injury

No sensory or motor function at S4-S5.

Incomplete Injury

Some function below neurological level remains.

Anterior Cord Syndrome

Loss of motor function, preserved proprioception.

Posterior Cord Syndrome

Loss of proprioception, preserved motor function.

Brown-Sequard Syndrome

Hemisected spinal cord; unilateral symptoms.

Central Cord Syndrome

Motor impairment greater in upper limbs.

C5 Muscle Group

Elbow flexors; key muscle for C5 level.

C6 Muscle Group

Wrist extensors; key muscle for C6 level.

C7 Muscle Group

Elbow extensors; key muscle for C7 level.

C8 Muscle Group

Finger flexors; key muscle for C8 level.

T1 Muscle Group

Fifth finger abductors; key muscle for T1.

L2 Muscle Group

Hip flexors; key muscle for L2 level.

L3 Muscle Group

Knee extensors; key muscle for L3 level.

L4 Muscle Group

Ankle dorsiflexors; key muscle for L4 level.

L5 Muscle Group

Long toe extensors; key muscle for L5 level.

S1 Muscle Group

Ankle plantar flexors; key muscle for S1 level.

ASIA A

Complete injury; no function at S4-S5.

ASIA B

Incomplete; sensory function below NLI.

ASIA C

Incomplete; less than half key muscles ≥3.

ASIA D

Incomplete; at least half key muscles ≥3.

ASIA E

Normal function; motor and sensory intact.

Motor Function Preservation

More than half key muscles below injury grade

Orthostatic Hypotension

Drop in blood pressure upon standing up

Autonomic Dysreflexia

Severe hypertension due to noxious stimuli

Respiratory Dysfunction

Impaired breathing function post-spinal injury

Urinary Retention

Inability to empty bladder completely

Bowel Retention

Inability to evacuate bowels effectively

Pressure Ulcers

Skin sores from prolonged pressure on skin

Contracture

Shortening of muscles/tendons affecting movement

Muscle Weakness

Reduced strength in affected muscle groups

Increased Muscle Tone

Higher than normal tension in muscles

Systolic Blood Pressure Rise

Increase of 20-30 mmHg indicates AD

Noxious Stimuli

Painful stimuli triggering autonomic dysreflexia

Signs of Autonomic Dysreflexia

Severe headache, anxiety, flushing, blurred vision

Bladder Distension

Overfilled bladder causing discomfort and complications

Physical Therapy Interventions

Supine/prone strengthening and stretching exercises

Cervical Level Injury

Spinal injury affecting neck region

ASIA Scale

Assessment tool for spinal cord injury severity

Bradycardia

Slowed heart rate often seen in AD

Tachycardia

Increased heart rate potentially indicating distress

Hypotension

Abnormally low blood pressure, opposite of hypertension

Flaccidity

Lack of muscle tone, often in lower extremities

Positive Babinski Sign

Reflex indicating neurological impairment in adults