SCI

  • What are the causes of non-traumatic spinal cord injury?

    • Congenital and genetic disorders

    • Degenerative spine disease

    • Vascular disease

    • Inflammatory autoimmune disease

    • Neoplasm

    • Infection

  • What is the life expectancy of people with SCI?

    Mortality in first year is greatest and highest in cervical SCI however overall life expectancy has significantly increased since establishment of SCI units

  • What are the sensory tracts in the spinal cord?

    • Dorsal columns: ascend on the ipsilateral side of the spinal cord it arises from and crosses int he medulla to provide info on light touch and proprioception

      • DCML

    • Spinothalamic tracts: ascends on the contralateral rise of the spinal cord it arises from and therefore crosses in the spinal cord to deliver info on pain and temperature

      • Anterolateral system

  • What are the motor tracts in the spinal cord?

    • Lateral corticospinal tract: crosses in the medullary pyramids to descend on the contralateral side of the spinal cord to initiate voluntary movement in the limbs

    • Anterior corticospinal tract: remains ipsilateral in medulla and spinal cord to voluntary control the trunk

  • What is central cord syndrome?

    Most common type of incomplete SCI resulting commonly from hyperextension injury from a fall in older people causing compression, hypoxia and haemorrhage of the central cord. See deficits more in upper limb than lower due to cervical tracts being closer to the centre of the cord.

  • What is Brown Sequard syndrome?

    Hemisection of cord from penetrating injury or gun shot

    • Ipsilateral: motor and proprioceptive/light touch loss

    • Contralateral: pain and temperature loss

  • What is anterior cord syndrome?

    Damage to anterior 2/3 of spinal cord often associated with flexion injuries from insult to anterior spinal artery. Causes alteration to motor function, pain and temperature. The posterior column remains intact enabling information about light touch and proprioception.

  • What is cauda equine syndrome?

    A lower motor neuron injury generally below L1 resulting in flaccid paralysis. May be mixed UMN and LMN if clonus involvement

  • What is the difference between quadriplegia and paraplegia?

    Quadraplegia/tetraplegia results from a SCI in the cervical region with impaired motor and sensory function affecting all 4 limbs whereas paraplegia results from a SCI in the thoracic, lumbar or sacral region with impaired motor and sensory function affecting the lower limbs

  • How is SCI diagnosed?

    Radiological imaging and clinical examination including the international standard for neurological classification of SCI (ISNCSCI)

  • What are the benefits vs limitations of the ISNCSCI?

    Benefits

    • Facilitates accurate and consistent communication among clinicians and patients

    • Guides development of individualised rehab programs

    • Predicts outcomes

    • Document neurologic recovery

    • Evaluate effectiveness of interventions

    • Clinical research

    Limitations

    • Exhausting for patient

    • Sensory scoring is on ordinal rather than quantitative scale

    • Only 10 muscle groups included

    • Not sensitive to change

  • When is ISNCSCI used?

    Completed at admission to acute and/or admission to subacute spinal rehabilitation and discharge

  • How is sensation examined?

    Testing light touch and pin prick for each of the specified dermatome points starting at C2

    Dorsal columns: am I touching you —> does this feel the same as this

    Spinothalamic tracts: is this sharp or blunt —> using a sharp tip, does this feel the same as this

    Scoring: 0=absent, 1=altered, 2=normal

  • How is motor examined?

    Testing in supine beginning testing at grade 3

    Screenshot 2025-10-27 at 3.10.31 pm.png

  • How is the neurological level of injury determined?

    1. Determine sensory levels for right and left sides

      • Most caudal, intact dermatome for both pin prick and light touch tests

    2. Determine motor levels for right and left sides

      • Defined by lowest key muscle function that has grade of at least 3 providing segments above that level are judged to be intact

    3. Determine NLI

      • Most cephalad of the sensory and motor levels determined in steps 1 and 2

    4. Determine whether the injury is complete or incomplete

    5. ASIA scale

    6. Determine zone of partial preservation

  • When is a SCI complete vs incomplete?

    Complete if there is no voluntary anal contraction, all S4-5 scores are 0 and no deep analysis pressure - otherwise incomplete

  • What is the ZPP?

    Refers to dermatomes and myotomes caudal to the sensory and motor levels that remain partially innervated. Non applicable when sacral sensory or motor sparing is present - only used in complete SCI

  • What is the difference between neurogenic shock and spinal shock?

    Neurogenic shock is caused by disruption to sympathetic activity and unopposed vagal tone (T6 and above) whereby vasodilation, hypotension, temperature dysregulation, bradycardia and decreased cardiac output result.

    Spinal shock however is a neurological phenomenon whereby there is a temporary loss of reflexes, strength and sensation below the level of the lesion that can last for minutes or weeks post injury

  • How is respiratory management conducted for SCI?

    • Respiratory muscle weakness: may require ventilation

    • Secretion clearance: manual assisted coughing, mechanical insufflation-exsufflation

    • Positioning effects: supine lying better for SCI patients as gravity pulls diaphragm flat due to lack of abdomen tone making it harder to breath upright

  • How is SCI managed acutely?

    • Assessment/diagnosis/imaging

    • Stabilisation of spine; surgical or non-surgical

    • Early surgical intervention <24 hours

    • Haemodynamic instability

    • neurogenic bladder/bowel

    • Pressure care

    • Postural hypotension

    • Management of other injuries

    • Pain management

    • Psychological adjustment (including family and friends)

  • What are the goals of acute SCI?

    • Medically stabilise

    • Stabilise respiratory management

    • Early mobilisation

    • Development of bowel routines and bladder management

    • Prognosis/prediction of outcome

    • Establishing discharge destination

    • Funding status and relevant applicaiotns

    • Early rehabilitation

  • What is the evidence for lung volume and respiratory muscle strength?

    STRONG

    • Positioning in supine should be favoured to improve lung volumes in SCI patients with abdominal paralysis or weakness

    • Intermittent application of positive pressure devices to improve LV in non-ventilated patients with respiratory muscle weakness

    • Intermittent application of positive pressure devices to improve LV in ventilated patients who are medically stable

    • Targeted postural drainage should provided to improve secretion clearance

    • Manually assisted and/or mechanically assisted cough should be provided to improve secretion clearance

    WEAK

    • Respiratory muscle training may be provided to improve respiraotry muscle strength in people with SCI who have respiratory muscle weakness

    • Abdominal binders in sitting may be provided to improve lung volume in people with SCI who have abdominal muscle weakness or paralysis

  • What is autonomic dysreflexia?

    • Sudden hypertension

    • Pounding headache

    • Bradycardia

    • Flushing/blotching of skin above spinal injury level

    • Profuse sweating above spinal injury level

    • Skin pallor and piloerection below spinal injury level

    • Chills without fever

    • Nasal congestion

    • Burred vision

    • SOB

    • Irritability or combative behaviour

  • What outcome measures can be used for SCI?

    • Tardieu or Modified Ashworth

    • Berg Balance Scale

    • 10minute walk test (10MWT)

    • Timed up and Go (TUG)

    • 6 minute walk test (6 MWT)

    • High Level Motor Assessment Tool (HiMAT)

    • Falls Efficacy Scale International (FESI)

    • Functional Independence Measure (FIM)

    • Spinal Cord Independence Measure SCIM

    • Walking Index for Spinal Cord Injury (WISCI–II)

    • Wheelchair Users Shoulder Pain Index (WUSPI)

    • Wheelchair Circuit Test (WCT)

    • Wheelchair Skills Test (WST)

    • 6 minute push test (6MPT)

    • Spinal Cord Injury Falls Concern Scale (SCI-FCS)

  • What helps us predict function?

    • Knowledge about possible outcomes at each NLI with complete injuries

    • Research outcomes

    • Prediction tools

    • Exposure and experience

    • People with lived experience

  • What are the cervical level outcomes?

    Screenshot 2025-10-27 at 4.02.33 pm.png

    C1-4: complete quadriplegia

    C5: biceps - able to reach hand to mouth

    C6: write extensors - able to eat and drink independently

    C7: triceps - full independence to perform transfers and manual wheelchair mobility and personal care

    C8-T1: hand function - reduced fine motor use of hand

  • What are the thoracic and lumbar level outcomes?

    Screenshot 2025-10-27 at 4.02.58 pm.png

  • What are other factors influencing outcome?

    • Age

    • Existing conditions

    • PMM

    • Complications or other associated injuries

    • Body proportions

    • Motivation

    • Psychological support system

    • Adjustment process

  • What are the broad goals of SCI rehab?

    • Re-establish ways to function and move

    • Learn new movement skills to maximise independence (ie wheelchair skills and transfer techniques)

    • Re-establish a day- to- day routine

    • Maximise independence in activities of daily living or to direct carers to complete or assist

    • Learn how to be mobile in the community

    • Learn to manage and minimize complications

    • Manage medical issues

    • Return to work/study

    • Re-establish or explore new leisure activities

  • What are the physiotherapy interventions for SCI?

    • Muscle Strengthening and Endurance

    • Bed Mobility skills and re-education

    • Upper limb functional retraining

    • Upper limb care

    • Transfers skills and re-education

    • Balance Re-Education

    • Wheelchair Skills

    • Gait Retraining

    • Management of Posture and Pressure

    • Equipment prescription

    • Cardiovascular fitness

    • Pain management

    • Patient, Relative and Carer Education

  • What are the VSCS spinal community services?

    • Spinal community integration service: first 12 months

    • Spinal outreach service

    • Spinal outpatient physiotherpay

    • Spinal urology nurse

    • Posture pressure and seating service

    • Spinal outpatient nurse

    • Surveillance clinics

    • Issue based clinics

    • Upper limb team

    • Sexual health