Study Guide Checklist for Exam Week

QUIZ 2 OSCE

Ascending Pathways

Sensory:

• Posterior (dorsal) columns 

• Spinothalamic tracts 

Motor:

• Pyramidal tract 

• Corticospinal tracts 

posterior / dorsal column 

sensory

fibers cross in brainstem

gracile fasciculus: positioned medial- carries fibers from lower body

cuneate fasciculus: positioned laterally- carries fibers from upper body

light touch and proprioception 

fibers cross in the brainstem 

spinothalamic tract

sensory

sit in dorsal horn of spinal tracts

cross near the level they enter the spinal cord

lateral: pain and temperature

anterior: crude touch

pyramidal tract

motor

voluntary control of muscle movements

corticospinal tracts

motor

UMN carry signals from primary motor cortex in brain, down spinal cord to trunk and limbs

~85% cross over to contralateral side in brainstem and travel in lateral tract

~15% cross within the spinal cord (at level they terminate) and are carried within anterior tract

autonomic dysreflexia- symptoms

sudden hypertension 

severe pounding headache 

bradycardia 

blotchy rash/flushing of skin above level 

sweating / goose bumps

SOB, anxiety 

nasal stuffiness, blurred vison 

autonomic dysreflexia - common causes

bladder and bowel

skin- burns, ingrown toenails, pressure injuries

other- fracture, kidney stones, menstrual cramps

common for injuries above T6

autonomic dysreflexia- treatment

medical emergency 

reduce BP

try and find cause

sit patient up, loosen tight clothing, find cause 

SCI- subjective assessment

respiration

• sob, talking, deep breath, cough, sputum, bronchospasm, nicotine use

neurological

• movement, sensation, spasms

pain

• neuropathic / msk

social history

• home, family, education, jobs, activities

SCI- objective

respiratory

circulation

skin

ROM

muscle bulk

spasm

sensation

muscle power

posture

SCI- medical chart review 

personal details

how did the injury occur 

what did they injure

• spinal cord, spinal column, soft tissue damage

other injuries

• fractures, contusions, respiratory 

orthopaedic management 

• surgical vs conservative 

medical history 

SCI- respiratory assessment

respiratory msk

breathing patterns, respiratory rate

effectiveness of cough, sputum

auscultation, palpation

x-ray, ABG’s

quality of voice

SCI- breathing patterns

epigastric rise

anterior / posterior movement

lateral flare

intercostal recession

upper chest movement

paradoxical (opposite)

ASIA - key parts 

sensation 

• light touch 

• pin prick 

motor

• 5 key muscles for UL 

• 5 key muscles for LL

ASIA- A

Complete

no sensory or motor function is preserved in the sacral segments S4/5

ASIA-B

sensory incomplete

sensory but no motor function preserved below the neurological level and includes the sacral segments S4/5

ASIA-C

motor incomplete 

motor function is preserved below the neurological level,

more than half the key muscles below the neurological level of injury have a muscle grade less than 3

ASIA- D

motor incomplete

motor function is preserved below the neurological level,

more than half of the key muscles below the neurological level of the injury have a muscle grade greater than or equal to 3

ASIA- E

normal sensory and motor function

ASIA sensory exam scale

0= absent

1= impaired

2= normal

NT= not testable

0*, 1*, NT*= non-SCI condition present

AISA- light touch

use face as reference point

“am i touching?”

see if there is accurate discrimination between touch and no touch

“does it feel the same?” = 2

“does it feel different?” = 1

can’t feel it= 0

AISA- sharp blunt

use face as reference point

“sharp or blunt?”

discrimination- same vs different

accurate sharp vs blunt, same as face = 2

accurate sharp vs blunt, different from face = 1

cannot accurate;y te;; the difference = 0

ASIA- motor exam

10 key muscles

palpate for flickers of muscle activity (grade 1)

AROM

active = passive (grade 2, 3, 4, 5)

grade 4-5 static muscle test

if less than 50% normal ROM = NT

if spasticity limits ROM= NT

AISA motor exam scale

0= total paralysis

1= palpable or visible contraction

2= active movement, full ROM with gravity eliminated

3= active movement, full ROM against gravity

4= active movement, full ROM against moderate resistance in a muscle specific position

5= (normal) active movement, full ROM against gravity and full resistance in a functional muscle specific position expected from an otherwise unimpaired person

NT= not testable (i.e. due to immobilisation, severe pain such that the patient cannot be graded, amputation of limb, or contracture of >50% of the normal ROM)

0*, 1*, 2*, 3*, 4*, NT* = non-SCI condition present

motor level

the lowest key muscle that has a grade of at least 3/5, providing the key muscle represented by segments above the are tested to be normal (grade 5)

what muscles are intact at different levels of injury?

C3-C5 = diaphragm

T1-T11= intercostals

T5-T2 = abdominals

physio: what to assess in your SCI patient

respiratory function

neurological- ASIA

motor strength - MMT/MLT

AROM, PROM

skin conditions

muscle tone and spasm

posture

balance

functional skills

mobility

assessment of equipment 

education 

discharge planning 

steps in classification of ASIA

1. determine sensory levels for right and left sides

2. determine motor levels for right and left sides (at least grade 3)

3. determine neurological level of injury (intact sensation and antigravity)

4. determine whether the injury is complete or incomplete

   1. voluntary anal contraction=no AND all S4-5 sensory scores= 0 AND deep anal pressure- no = complete

   2. otherwise = incomplete

5. determine ASIA - complete or incomplete