Spinal Cord Injury pt 1 & 2

Traumatic Injury ( Falls, MVA, Sports)

Traumatic Injury ( Falls, MVA, Sports)

Where do we see the highest incidence of spinal injuries occurring?

Due to soft tissue and high level of pressure

Why is it possible for spinal cord issues/injuries to occur without trauma/fracture?

Syrinx

What is the diagnosis for a fluid cyst in the spinal cord, an injury from the inside-out?

Spinal Shock

What is the diagnosis that is associated with autonomic dysfunction and is characterized by hypotension, relative bradycardia, peripheral vasodilation and hypothermia?

24- 48 hours

How long can the effects of spinal shock be seen in a patient

L1 (cauda equina injury)

Below what level is injury only affecting spinal roots?

Lower Motor Neurons

Anterior horn cells that project to skeletal muscles are (LMN or UMN)

Upper Motor Neurons

Arise in the CNS and stay in the CNS and descends to act on anterior horn cells and the “final common pathway” (UMN or LMN)

Reciprocal Inhibition

What is the response that decreases the activity of the antagonist when the agonist is voluntarily recruited?

Spasticity

What does the lack of descending inhibition from the cortex which leads to contractures?

Clonus

Repeated movement of a joint, elicited by a quick stretch where both antagonist and agonist work at the same grade causing a quick back and forth motion …is referred to as?

Anterior Cord

The loss of motor function, sensation of pain and temp is a lesion or damage to the….

Posterior Cord

Lack of proprioception/no coordination and sensory input ( they are still able to feel pain, but with all stimuli they interpret it as painful), is a lesion or damage to the ….

Brown-Sequard

When an injury results in ipsilateral loss of motor and somatosensory dysfunction w/ contralateral loss of pain temperature, this is the the pattern of what injury?

Outer regions

Based on somatotopic organization of the spinal cord, where are nerve tracts to the sacral region found?

Towards the center regions

Based on somatotopic organization of the spinal cord, where are nerve tracts to the cervical region found?

Arms and Hands

Damage to the cervical region will show where?

Bowel and Bladder

Damage to the sacral region will show where?

Most distal segment of the spinal cord with normal motor/sensory function bilaterally

How are spinal injuries named/the neurological level is defined as what?

Sacral Sparing

What is it referred to when there is an incomplete lesion of the spinal cord and the sacral fibers/tract remain intact?

Sacral Sparing

Sensation of the saddle region, movement of the toe flexors and rectal sphincter contraction are signs and symptoms of what?

No sensory or motor function in sacral segments S4-5

What is considered a (level A) complete SCI according to the ASIA?

Sensory only at S4-5 segments and no motor function preserved 3 levels below the motor level on either side

What is considered a (level B) sensory incomplete SCI according to the ASIA?

Motor only at S4-5 segments or there is sensory incomplete and less than half of the mm groups have a grade of a least 3

What is considered a (level C) motor incomplete SCI according to the ASIA?

Half or more of the mm function have at least a grade of 3

What is considered a (level D) sensory incomplete SCI according to the ASIA?

This is given to a patient who has had prior deficits

What is considered a (level E) Normal according to the ASIA?

Driving adaptation of the nervous system

When we can’t maximize on plasticity the focus shifts to …

Repetitive, attended practice of functional activities

How is Neural Adaptation achieved in our patients?

Increasing function of the affected muscles through desired functional activity

What is the focus of Impairment-based training?

• Increased Age

• Spared Sensation

• Injury Classification

• LE Motor return

• Hemorrhage in cord

What are the 5 factors impacting recovery?

Score > 33 (predicts functional ambulation)

Based on Clinical Prediction Rules/Algorithms (CPR) a score of what is considered a good prognosis?

Autonomic Dysreflexia

What occurs when stimuli below the injury causes an elevated BP that can not inhibited ?

Sympathetic Fibers

Which fibers promote relaxation of the bladder for filling and closure of the internal sphincter?

Parasympathetic

Which fibers control detrusor muscle contraction and opening of internal sphincter

Acute central lesion

Presentation of flaccid, acontractile bladder with continued reflex contraction of urethral sphincter. Overflow incontinence…the bladder doesn’t empty completely points toward (acute or chronic central lesion)

Chronic central lesion

Presentation of hyperreflexic (spastic bladder), urinary frequency and urge incontinence…the bladder has spasms at low urine volume points towards (acute or chronic central lesion)

Peripheral lesion

Presentation of areflexic bladder, overflow incontinence and stress incontinence…pressure due to laughing,sneezing and coughing causes leaking of bladder points towards what type of lesion?

Osteopenia following an SCI

Following a SCI there is a disruption in the bone remodeling process, there is increased bone reabsorption w/out osteoblast-mediated bone construction. This is a description of what process?

Muscular atrophy affecting the areas below the lesion

What MSK-changes do you see following an SCI?

Enhance blood flow → enhance bone vasculature

To combat Osteoporosis muscular training is used to enhance _______ → _______

Anti-resorptive medications

What pharmaceuticals are used to combat osteoporosis ?