Spinal Cord Injury (SCI): Part One

What are the leading causes of death in individuals with SCI since 1973?

Pneumonia and septicemia.

What developmental disorders can cause SCI?

Meningomyelocele (spina bifida) and cerebral palsy.

How does SCI affect life expectancy?

It decreases with higher-level injuries and further decreases if ventilator-dependent.

What does BLT stand for in spinal precautions?

No bending, lifting, or twisting.

What are the main goals of the acute phase of SCI management?

Life-saving measures, spine stabilization, and prevention of secondary damage such as hemorrhage, edema, and ischemia.

What medication is often used in acute SCI to reduce inflammation?

Corticosteroids.

What is spinal (neurogenic) shock?

A temporary loss of all neurological activity below the injury level.

What are key characteristics of spinal shock?

Flaccid paralysis, areflexia, loss of autonomic control, and absent reflexes.

How long can spinal shock last?

Hours to weeks, sometimes permanently.

When can SCI prognosis be determined?

After reflexes return and spinal shock resolves.

What are the main phases of SCI recovery?

Secondary phase and chronic phase.

What happens in the secondary phase of SCI recovery?

Continued damage, apoptosis, and lesion expansion.

What happens in the chronic phase of SCI recovery?

Demyelination, spasticity, pain, and neural reorganization.

What is tetraplegia?

Paralysis of arms, trunk, legs, and pelvic organs due to cervical injury (C1–T1).

What is paraplegia?

Paralysis of the lower extremities due to injury at T2 or below.

What tool is used to assess neurological level of injury (NLI)?

The ASIA Impairment Scale (AIS).

What determines the neurological level of injury?

The lowest segment with muscle grade ≥3/5 and intact sensation.

What are the five grades of the ASIA Impairment Scale?

A: Complete, B: Incomplete sensory, C: Incomplete motor (<3/5), D: Incomplete motor (≥3/5), E: Normal.

What is a complete SCI injury?

No motor or sensory function in the lowest sacral segments (S4–S5).

What is an incomplete SCI injury?

Partial preservation of motor or sensory function below the level of injury.

What is the Zone of Partial Preservation (ZPP)?

Some innervation below the injury, seen only after spinal shock resolves.

How many dermatomes are there?

31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal.

What is a dermatome?

An area of skin innervated by a single spinal nerve.

What is a myotome?

A group of muscles innervated by a single spinal nerve.

What muscle is controlled at C4?

The diaphragm.

What muscle function is associated with C5?

Elbow flexion.

What muscle function is associated with C6?

Wrist extension.

What muscle function is associated with C7?

Triceps (elbow extension).

What muscle function is associated with C8?

Finger flexion.

What muscle function is associated with T1?

Intrinsic hand muscles.

What muscle function is associated with L2?

Hip flexion.

What muscle function is associated with L3?

Knee extension.

What muscle function is associated with L4?

Ankle dorsiflexion.

What muscle function is associated with L5?

Great toe extension.

What muscle function is associated with S1?

Ankle plantarflexion.

What are sensory grading scores on the ASIA exam?

0 = absent, 1 = impaired, 2 = normal.

What are common structural causes of SCI?

Fractures, vertebral displacement, tumors, and spinal stenosis.

What is a dis-complete lesion?

Clinically complete but with residual neural activity detectable by EMG.

What is the Brain Motor Control Assessment (BMCA)?

A surface EMG tool that measures motor unit activity during passive and active movement.

What is Central Cord Syndrome?

UE > LE weakness with bilateral pain and temperature loss, often from cervical hyperextension or stenosis.

What is Anterior Cord Syndrome?

Loss of motor, pain, and temperature sensation with intact proprioception and touch; caused by flexion injury or anterior artery compression.

What is Brown-Séquard Syndrome?

Ipsilateral motor loss and contralateral pain/temp loss due to penetrating trauma or tumor.

What is Posterior Cord Syndrome?

Loss of proprioception and vibration sense; caused by posterior spinal artery infarct or B12 deficiency.

What is Anterior Horn Cell Syndrome?

Bilateral flaccidity, often caused by viral infections like poliomyelitis.

What is Conus Medullaris Syndrome?

Mixed UMN and LMN lesion with bowel/bladder dysfunction and perianal anesthesia.

What is Cauda Equina Syndrome?

LMN lesion affecting peripheral nerves with good regeneration prognosis.

What is Tethered Cord Syndrome?

Cord traction causing UMN or LMN symptoms, often congenital.

What SCI level requires a ventilator for breathing?

C4 and above.

What are respiratory issues for SCI at C4–T6?

Independent breathing but weak cough.

What is autonomic dysreflexia?

A life-threatening sympathetic overreaction caused by stimuli below the level of injury.

At what level does autonomic dysreflexia most commonly occur?

Above T6.

What are causes of autonomic dysreflexia?

Full bladder, bowel impaction, pain, ingrown toenail, sexual stimulation, or uterine contractions.

What are symptoms of autonomic dysreflexia?

Severe headache, hypertension, bradycardia, flushed skin, sweating above lesion, and possible fainting.

What is the emergency response for autonomic dysreflexia?

Sit patient upright, loosen clothing, and check catheter or bowel.

What is orthostatic hypotension?

A sudden drop in blood pressure when moving upright, common in injuries above T6.

What are symptoms of orthostatic hypotension?

Dizziness, pallor, sweating, blurred vision, fainting.

What is poikilothermy?

Loss of temperature regulation causing body temperature to match the environment.

What percentage of SCI patients develop pressure sores?

About 30–56%.

What are common pressure sore risk areas?

Sacrum, ischia, trochanters, heels, knees, scapulae, elbows.

How often should SCI patients reposition to prevent pressure sores?

Every 2–3 hours (up to 6 hours with monitoring).

What are OT goals for pressure management?

Train self-checks, maintain hygiene, provide adaptive seating, and promote high-protein diet.

What is Deep Vein Thrombosis (DVT)?

A blood clot due to immobility and loss of muscle tone, which can lead to pulmonary embolism.