SCI NPTEFF Book Chapter 6 Page 144-148.pdf

What mechanism of injury causes anterior cord syndrome?

Hyperflexion injury

Anterior cord syndrome results in loss of what?

-Loss of pain and temperature sensation

Loss of motor function

What mechanism of injury causes central cord syndrome?

Hyperextension injury

In central cord syndrome, motor vs sensory is affected how?

Affects motor > sensory

In central cord syndrome, which is affected more UE or LE?

Affects UE > LE

What tracts are affected in central cord syndrome?

Spinothalamic, corticospinal, dorsal column

What mechanism causes Brown-Sequard syndrome?

Stab wound, gunshot wound

Brown-Sequard syndrome causes C/L and I/L loss of what?

-C/L loss of pain and temperature sensation

-I/L loss of vibration, position sense, and motor function (paralysis)

cauda equina syndrome occurs from injury below what level?

Injury below L1

Cauda equina syndrome is what type of injury?

Peripheral nerve injury

What tone and reflex change is seen in cauda equina syndrome? any bowel and bladder changes?

Flaccidity and areflexia; bowel and bladder dysfunction

What causes posterior cord syndrome?

Compression of posterior spinal artery (rare)

Posterior cord syndrome results in loss of what?

Loss of vibration, proprioception, 2-point discrimination, stereognosis

Is motor function affected in posterior cord syndrome?

No, Motor function is preserved

What is spinal shock? how long does it last?

Transient period of reflex depression and flaccidity; can last from several hours to 6 months or more

What are S/S of spinal shock?

Flaccid paralysis, areflexia, vasodilation (↓ HR and BP), ↓ cardiac output (CO), venous pooling

Absence of reflex activity in spinal shock results in what?

Impaired autonomic regulation, which results in hypotension and loss of ability to sweat

What reflex indicates patient is out of spinal shock?

Bulbocavernosus reflex (spinal segments S2-S4)

What does bulbocavernosus reflex involve?

Anal sphincter contraction in response to squeezing of the glans penis or tugging on the Foley catheter

Respiratory issues begin at what level of SCI?

Above C4

Respiratory Issues

What happens with injuries above C3-C5?

Supplies phrenic nerve; assists diaphragm control → need ventilator

Respiratory Issues

What happens below C4 with ventilator?

Patient can normally be weaned from ventilator

Respiratory Issues

What must be taught for breathing below C4?

Must teach assistive coughing to help

Respiratory Issues

When is glossopharyngeal breathing used?

When diaphragm is denervated (increase volume of air that can be inhaled)

Respiratory Issues

Is glossopharyngeal breathing used for clearing secretions?

Not used for clearing secretions; helps with breathing

Respiratory Issues

At what level can patients learn self-assisted coughing?

At C5 and below, patient can learn self-assisted coughing techniques

Respiratory Issues

At C6, which muscles assist coughing?

Use the biceps, subscapularis, and pectoralis muscles to brace abdomen and force secretions out

Below T10, what respiratory function is expected?

Patient is likely to have near-normal ventilatory respiratory functions

Why is breathing near normal below T10?

Abdominal muscles intact

C1-C2 respiratory muscles?

cervical spondylotic myelopathy, upper trap, cervical extensors

What level requires ventilator or phrenic nerve stimulator?

C1-C2

C3-C4 respiratory muscles?

Partial diaphragm, scalenes, levator scapulae

C3-C4 treatment?

Ventilator in acute phase; can be weaned off

C6-C8 respiratory muscles?

Diaphragm, pectoralis major and minor, serratus anterior, rhomboids, latissimus dorsi

C6-C8 treatment?

Assisted coughing

T1-T5 respiratory muscles?

Some intercostals, erector spinae

T6-T10 respiratory muscles?

Intercostals, abdominals

T11 and below respiratory muscles?

All of the preceding muscles

What is autonomic dysreflexia? occurs with injuries at which levels?

Occurs with injuries at or above T6 → disruption of sympathetic response

is Autonomic dysreflexia a medical emergency?

yes

Autonomic dysreflexia causes what vascular response due to massive sympathetic response?

vasoconstriction occurs, leading to hypertension (HTN) and decreased HR

Why does autonomic dysreflexia occur in SCI?

Brain is not able to send descending inhibitory signals (blocked)

What are S/S of autonomic dysreflexia?

-↑ BP

-↓ HR

-headache

-flushing

-profuse sweating

-anxiety

-constricted pupils

-blurred vision

-piloerection (goosebumps)

How much does SBP increase in autonomic dysreflexia?

20 to 30 mmHg

What is typical SBP in SCI patients?

SCI patients typically have lower SBPs of 90 to 110 mmHg

autonomic dysreflexia

Vasoconstriction _____ level of injury and vasodilation _____ level

below; above

What are common triggers of autonomic dysreflexia?

-Bowel and bladder distension

-infection

-impaction

-catheterization blocked,

-abdominal binder

-skin breakdown

-pressure sores

-ingrown toenail

-similar stimuli

First step in treating autonomic dysreflexia?

Sit patient up and immediately remove noxious stimuli, loosen clothing, unclamp catheter, loosen abdominal binder, and so on (remove stimulus)

Why sit patient upright in autonomic dysreflexia?

Sit patient up and lower legs in order to decrease BP

2nd step in treating autonomic dysreflexia?

Check vitals and give anti-hypertension drugs, if unable to find any triggering factor

What medications are used for autonomic dysreflexia?

Nifedipine, nitrates, captopril

What is the third step in treatment of autonomic dysreflexia?

Get help

What is neurogenic shock occurs at what level?

above T6

What are S/S of neurogenic shock?

-↓ BP

-↓ HR

-cyanosis

-warm and dry extremities

-decreased CO

-peripheral vasodilation

-venous pooling

spasticity after SCI

-______-dependent

-stretch reflex pathway with loss of ____ inhibition

Velocity; descending

tone and spasticity with SCI

hyper or hypo reflexia? hyper or hypotonia? clonus?

Hyperreflexia, hypertonia, clonus

When is spasticity seen after SCI? at what level?

Seen with injuries above T10 after resolution of spinal shock

how can we use tone and spasticity to patient's benefit?

-Assist with motion

-sustain muscle activity

-assist with blood flow (pump mechanism)

Negatives of increased tone and spasticity?

-Pain

-contracture

-interference with transfers

-interference with ADLs

What cardiovascular issue is common with SCI above T6?

Orthostatic hypotension

What are symptoms of orthostatic hypotension?

Blurred vision, ringing in ears, light-headedness, fainting

How should orthostatic hypotension be managed?

Slow progression to vertical position; elevate head of bed and progress to reclining wheelchair with elevating leg rests; use tilt table

What devices can help minimize orthostatic hypotension?

Can use abdominal binder and compression stockings to minimize effects

Temperature control

_____ can no longer control ____ blood flow or level of ___

Hypothalamus; cutaneous; sweating

What thermoregulation issue occurs after SCI?

Loss of internal thermoregulatory responses

spastic bladder (neurogenic) is seen in what level?

Seen in injury above S2 sacral segment

How does a spastic bladder function?

Bladder contracts and reflexively empties in response to certain level of filling pressure

Is reflex present in spastic bladder?

Reflex action present

What complication occurs with spastic bladder? how do u treat?

Bladder sphincter dyssynergia due to detrusor muscle hyperreflexia → treat with intermittent catheterization every 3 to 6 hours

What medications help spastic bladder? how do they work?

Anticholinergic drugs can help decrease bladder spasm and leaking by blocking acetylcholine and relaxing the muscles

How can spastic bladder be emptied?

-Manual stimulation techniques (eg, stroking or tapping the suprapubic area, which is referred to as suprapubic tapping)

- timed voiding schedule

What level is flaccid bladder (autonomous) seen?

Seen in injury at or below S2 sacral segment

Is reflex present in flaccid bladder?

No reflex action present

is flaccid bladder repsonsive to medications? how do u treat?

Poor response to medications → treat with intermittent catheterization every 3 to 6 hours

How can flaccid bladder be emptied?

-Credé maneuver: manual compression of the lower abdomen

-Valsalva maneuver: increased intra-abdominal pressure

-timed voiding schedule

true or false: Individuals with an incomplete SCI have an increased risk of UTIs and often require catheterization

true

What reflex allows urination in SCI for flaccid bladder?

Micturition reflex (S2-S4) is what allows urination

What level does spastic bowel happen?

Injury above S2

What is intact in spastic bowel?

Parasympathetic and internal sphincter connections from S2 to S4 are intact

How does defecation occur in spastic bowel?

Reflex defecation can occur when rectum fills with stool

Treatment for spastic bowel?

-Suppositories and digital stimulation (manual stretching of anal sphincter)

-valsalva maneuver and abdominal massage

flaccid or areflexic bowel happens at what level?

Injury at S2-S4 or cauda equina (peripheral nerves)

What is impaired in flaccid bowel?

Parasympathetic connections are not intact; no reflexive emptying will occur

Treatment for flaccid bowel?

Manual evacuation techniques and Valsalva maneuver

Where is heterotopic ossification common in SCI?

Generally near large joints

What is key precaution with heterotopic ossification?

No aggressive stretching!