Spinal Cord Injury Lecture Notes

Flashcards about Spinal Cord Injury

How many new cases of spinal cord injury occur annually?

Approximately 17,730 new cases of spinal cord injury (SCI) occur annually

What are the most common causes of SCIs in the United States?

Motor vehicle accidents, falls, acts of violence, sports and recreation related injuries, and medical and surgical complications

What are some examples of vascular dysfunction that can cause nontraumatic SCIs?

Arteriovenous malformation, thrombosis, embolus, or hemorrhage

What is Syringomyelia?

A neurological disorder in which a fluid-filled cyst (syrinx) forms within the spinal cord

What does AFP stand for, and what does it indicate?

Alpha-fetoprotein, a blood test, that when at a high level might mean that the baby has spina bifida

What structures are involved in the Arnold-Chiari type II malformation?

Involves the cerebellum, the medulla, and the cervical part of the spinal cord

What is the purpose of a ventriculoperitoneal shunt?

Drains excess CSF into the peritoneal cavity

Why is SCIWORA more common in the pediatric population?

Increased ligamentous laxity and increased head to body ratio in children

What is the definition of Tetraplegia?

Motor and/or sensory impairment of all four extremities and trunk, including the respiratory muscles, and results from lesions of the cervical cord

What is the definition of Paraplegia?

Motor and/or sensory impairment of all or part of the trunk and both lower extremities (LEs), resulting from lesions of the thoracic or lumbar spinal cord or cauda equina

What does the dorsal column tract convey?

Conveys proprioception, vibratory sensation, deep touch, and discriminative touch

What is the function of the lateral corticospinal tract?

Voluntary movement

What standardized examination method is used to determine the extent of motor and sensory function loss after a SCI?

ISNCSCI

According to ASIA 2019, what is the definition of the Neurologic level?

Most caudal segment of the cord with intact sensation and antigravity (3 or more) muscle function strength, provided that there is normal (intact) sensory and motor function rostrally respectively

What key muscle is associated with the C5 level?

Elbow flexors

What defines a Complete SCI?

sensory and motor function will be absent below the level of the injury and in the lowest sacral segments of S4 and S5 (no sacral sparing)

What is Sacral sparing?

Sensory function at S4–5 dermatome, ability to feel deep anal pressure, or voluntary anal sphincter contraction

What defines ASIA Impairment Scale Grade D?

Motor function is preserved below the neurologic level, and at least half of key muscle functions below the neurologic level have a muscle grade of 3 or greater.

What functions are lost in Brown-Séquard syndrome?

Motor function, proprioception, and vibration on the same side as the injury. Pain and temperature sensations are absent on the opposite side of the injury

What is the cause of anterior cord syndrome, and what functions are affected?

Flexion injury with fracture-dislocation of the cervical vertebrae. Loss of motor, pain, and temperature sensation bilaterally below the level of the injury. Position and vibration sense intact

What typically causes Central cord syndrome, and what are its characteristics?

Progressive stenosis or hyperextension injuries. Upper extremities are more severely involved than the lower extremities; cervical tracts are located more centrally in the gray matter. Damages three different motor and sensory tracts: spinothalamic tract, the corticospinal tract, and the dorsal column

What causes Cauda equina injuries?

Direct trauma from a fracture-dislocation below the L1 vertebrae or can be complete transections. often results in an incomplete lower motor neuron lesion

What happens in injuries to the conus medullaris?

Back pain, flaccid paralysis, and areflexic bowel and bladder function; Sacral sensation is decreased

What are the causes for Dorsal column or posterior cord syndrome and the symptoms?

Compression of the posterior spinal artery by tumor or vascular infarction. Loss of proprioception and vibration bilaterally

What happens in Cervical flexion and rotation injuries?

Posterior spinal ligaments rupture, uppermost vertebra is displaced over the one below it, rupture of the intervertebral disc and anterior longitudinal ligament

What happens in Cervical hyperflexion injuries?

Anterior compression fracture of the vertebral body with stretching of the posterior longitudinal ligaments

What is a cause of Compression injuries?

Diving accidents.

What is the effect on outcomes after early surgical stabilization?

Early surgical stabilization of patients with unstable spinal columns

What is Spinal Shock?

Is characterized by absence of all reflex activity and impairment of autonomic regulation

What is the Immediate treatment measures by the physical therapist assistant for Autonomic Dysreflexia?

Monitoring the BP, loosening tight clothing or constrictive devices (eg, binder, stockings, or leg strap), getting the patient into the sitting position, making sure urine flow is unimpeded, and notifying the physical therapist, nurse, and physician

What does skin care Prevention entail?

Entails positioning, consistent and effective pressure relief, skin inspection, and education

What is the sensory level?

The most caudal dermatome with normal (intact) sensation for both pinprick and light touch.

What is the motor level?

The most caudal myotome with a muscle function of 3 or greater, provided that the key muscle functions represented by segments above that level are graded 5.

What key muscle is associated with the C5 level?

Elbow flexors

What key muscle is associated with the C6 level?

Wrist extensors

What key muscle is associated with the C7 level?

Elbow extensors

What key muscle is associated with the C8 level?

Finger flexors

What key muscle is associated with the T1 level?

Finger abductors

What key muscle is associated with the L2 level?

Hip flexors

What key muscle is associated with the L3 level?

Knee extensors

What key muscle is associated with the L4 level?

Ankle dorsiflexors

What key muscle is associated with the L5 level?

Long toe extensors

What key muscle is associated with the S1 level?

Ankle plantar flexors

What muscles of respiration are available at C4?

Diaphragm, trapezius, sternocleidomastoid

What muscles of respiration are available at T6?

As above, plus intercostals and pectoralis major

What muscles of respiration are available at T12?

As above, plus abdominals

What functions are lost in Brown-Séquard syndrome?

Motor function, proprioception, and vibration on the same side as the injury. Pain and temperature sensations are absent on the opposite side of the injury

What is the cause of anterior cord syndrome, and what functions are affected?

Flexion injury with fracture-dislocation of the cervical vertebrae. Loss of motor, pain, and temperature sensation bilaterally below the level of the injury. Position and vibration sense intact

What typically causes Central cord syndrome, and what are its characteristics?

Progressive stenosis or hyperextension injuries. Upper extremities are more severely involved than the lower extremities; cervical tracts are located more centrally in the gray matter. Damages three different motor and sensory tracts: spinothalamic tract, the corticospinal tract, and the dorsal column

What causes Cauda equina injuries?

Direct trauma from a fracture-dislocation below the L1 vertebrae or can be complete transections. often results in an incomplete lower motor neuron lesion

What happens in injuries to the conus medullaris?

Back pain, flaccid paralysis, and areflexic bowel and bladder function; Sacral sensation is decreased

What are the causes for Dorsal column or posterior cord syndrome and the symptoms?

Compression of the posterior spinal artery by tumor or vascular infarction. Loss of proprioception and vibration bilaterally

What happens in Cervical flexion and rotation injuries?

Posterior spinal ligaments rupture, uppermost vertebra is displaced over the one below it, rupture of the intervertebral disc and anterior longitudinal ligament

What happens in Cervical hyperflexion injuries?

Anterior compression fracture of the vertebral body with stretching of the posterior longitudinal ligaments

What is a cause of Compression injuries?

Diving accidents.

What is Spinal Shock?

Is characterized by absence of all reflex activity and impairment of autonomic regulation

What is the Immediate treatment measures by the physical therapist assistant for Autonomic Dysreflexia?

Monitoring the BP, loosening tight clothing or constrictive devices (eg, binder, stockings, or leg strap), getting the patient into the sitting position, making sure urine flow is unimpeded, and notifying the physical therapist, nurse, and physician

What is Autonomic Dysreflexia?

A syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in spinal cord injuries at or above the T6 level. It is caused by a noxious stimulus below the level of the injury that triggers a massive sympathetic response.

What is Spastic Hypertonia?

An increase in muscle tone or stiffness which prevents normal movement. This is caused by an imbalance of signals from the brain and spinal cord to the muscles.

What is an example of compensation in PT management?

Using tenodesis grip for functional grasp

What is the effect on outcomes after early surgical stabilization?

Early surgical stabilization of patients with unstable spinal columns

Why is there Sacral Sparing?

The sacral region has a unique blood supply and anatomical arrangement. The spinothalamic, and corticospinal tracts are located more peripherally in the spinal cord which means that in incomplete injuries, sacral sensation and motor control may be preserved due to the location of the lesion.

Why is there Autonomic Dysreflexia?

AD develops due to the disruption of the autonomic pathways. The sympathetic nervous system below the level of the lesion responds excessively to stimuli because it can no longer communicate with the brain to regulate the response.