Where do we see the highest incidence of spinal injuries occurring?
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Due to soft tissue and high level of pressure
Why is it possible for spinal cord issues/injuries to occur without trauma/fracture?
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Syrinx
What is the diagnosis for a fluid cyst in the spinal cord, an injury from the inside-out?
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Spinal Shock
What is the diagnosis that is associated with autonomic dysfunction and is characterized by hypotension, relative bradycardia, peripheral vasodilation and hypothermia?
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24- 48 hours
How long can the effects of spinal shock be seen in a patient
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L1 (cauda equina injury)
Below what level is injury only affecting spinal roots?
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Lower Motor Neurons
Anterior horn cells that project to skeletal muscles are (LMN or UMN)
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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)
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Reciprocal Inhibition
What is the response that decreases the activity of the antagonist when the agonist is voluntarily recruited?
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Spasticity
What does the lack of descending inhibition from the cortex which leads to contractures?
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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?
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Anterior Cord
The loss of motor function, sensation of pain and temp is a lesion or damage to the….
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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 ….
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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?
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Outer regions
Based on somatotopic organization of the spinal cord, where are nerve tracts to the sacral region found?
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Towards the center regions
Based on somatotopic organization of the spinal cord, where are nerve tracts to the cervical region found?
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Arms and Hands
Damage to the cervical region will show where?
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Bowel and Bladder
Damage to the sacral region will show where?
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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?
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Sacral Sparing
What is it referred to when there is an incomplete lesion of the spinal cord and the sacral fibers/tract remain intact?
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Sacral Sparing
Sensation of the saddle region, movement of the toe flexors and rectal sphincter contraction are signs and symptoms of what?
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No sensory or motor function in sacral segments S4-5
What is considered a (level A) complete SCI according to the ASIA?
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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?
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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?
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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?
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This is given to a patient who has had prior deficits
What is considered a (level E) Normal according to the ASIA?
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Driving adaptation of the nervous system
When we can’t maximize on plasticity the focus shifts to …
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Repetitive, attended practice of functional activities
How is Neural Adaptation achieved in our patients?
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Increasing function of the affected muscles through desired functional activity
What is the focus of Impairment-based training?
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* Increased Age * Spared Sensation * Injury Classification * LE Motor return * Hemorrhage in cord
What are the 5 factors impacting recovery?
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Score > 33 (predicts functional ambulation)
Based on Clinical Prediction Rules/Algorithms (CPR) a score of what is considered a good prognosis?
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Autonomic Dysreflexia
What occurs when stimuli below the injury causes an elevated BP that can not inhibited ?
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Sympathetic Fibers
Which fibers promote relaxation of the bladder for filling and closure of the internal sphincter?
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Parasympathetic
Which fibers control detrusor muscle contraction and opening of internal sphincter
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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)
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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)
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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?
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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?
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Muscular atrophy affecting the areas below the lesion
What MSK-changes do you see following an SCI?
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Enhance blood flow → enhance bone vasculature
To combat Osteoporosis muscular training is used to enhance _______ __→__ _______
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Anti-resorptive medications
What pharmaceuticals are used to combat osteoporosis ?