sci
SCI
Safety concerns:
Skin assessments: pressure sores
Balance: fall risk
Seated balance activities
Transfers: sliding board, car/wc/toilet/bed/tub
Education: modified actions, safety, sores
All safer in the bed
Spinal cord anatomy
Just a conduit for nerve impulses, not a computer
From below medulla oblongata to l1,l2
L3,4,5 for cauda equina
Dorsal: motor, down, efferent
Ventral: sensory, up, afferent
Babinski test: nail up foot, toe spread to show info transfer
Long spinal tract damage test
Tracts:
If spinal word is at end: motor
Starts in brain: motor
Starts in spinal cord: sensory
Sympathetic ganglion: fight or flight regulated here
Filum terminale: distal cord to coccyx attach
Brainstem: autonomic functions
Anterior horn cell=motor
PNS
Somatic: below cervical above t1
Autonomic: rest and digest, fight or flight
Cranial nerve X is most important: heart control, etc.
Plexus
Cervical, Brachial, lumbosacral
C5-t1
Axillary: scapula, shoulder muscles
Radial, median, ulnar
Draw the picture from here wk 9 Tuesday
Blood supply
Blood clot in SC can cause these:
Quad: all four
Tetra: everything, trunk included
Paraplegia: legs
Lesions
Upper motor neuron
Increased spasticity
Above anterior horn/C1 cause spasticity
Brain injury usually
Lower motor neuron: below level of injury
Below anterior horn cause flaccidity
SCI usually
SCI
Incomplete/complete
Some damage vs complete cut
For incomplete: anal wink, perianal sensation
Brown-sequard
Anterior cord syndrome
Central cord injury: arms don't work, can walk
Posterior cord syndrome
Cauda equina injury
More common
C1-2,5,7
T12
L2
Name
MMT: lowest level that has a 3/5 or greater
ASIA: spinal cord assessment
Sensory based on dermatomes
Motor based on myotomes
A: worst, NOTHING THERE
B: incomplete but no motor function
C: motor function preserved, more than 1/2 have below 3/5
D: motor function, 1/2 have above 3/5
E: best: normal
KEY MUSCLES slide 22 Tuesday wk 9 & cheat sheet same day
C5: elbow flexors
Can feed themselves with tools
Maybe WC, hard work
C6: wrist extensors
Tenodesis grasp with passive insufficiency
7: elbow extensors
transfers
8: finger flexors
T1: finger abductors
Fine motor, clothes easier
L2: hip flexors
HKAFO Braces for prosthetics, walking
3: knee extensors
KAFO
4: ankle dorsiflexors
walker
5: big toe extensors
Minimal bracing
S1: ankle plantar flexors
Spinal shock
Loss of B&B function
Flaccid
Areflexia: no reflexes at all
Poor temp regulation below level of injury
24 hrs to several weeks
Autonomic dysreflexia: very life threatening
T6 or above
Dizzy when stood up, orthostatic hypotension
Help with compression to keep BP up
Address or they will stroke
Look for noxious stimuli causing it when
BP 200s
Check catheter, ingrown toenails, sitting on wrinkle
Drop the BP: take off the compression
Movement can help release pain
Body handling: move their legs to do what they can independently
Preventative measures: hammer it in
