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585-19
Spinal Cord Injury
| Term | Definition |
|---|---|
| types of SCI | Traumatic (55%) Non-traumatic (45%) |
| types of non-traumatic SCI | Scoliosis (developmental) Spondylosis (degen) Tumor (neoplastic) Aneurysm (vascular) MS, NMD (neurologic) Myelopathy |
| myelopathy | Severe compression of the spine In athletes, weightlifters, picking stuff up incorrectly Needs surgery |
| tetraplegia/ quadriplegia vs. paraplegia | Damage to cervical segments of the spinal cord vs. Damage to thoracic, lumbar, or sacral segments of the spinal cords Have complete functions of UE, but proximal and LE function affected |
| complete vs. incomplete classification | Total loss of motor & sensory function in S4-S5 vs. Partial preservation of sensory &/or motor function below neurological level & must include sacral segments Most common |
| spinal shock | Acute phase, 1st several weeks post SCI Often above T6 Transient physiologic reflex depression No function & reflexes below injury level; loss of sensorimotor functions Increase BP Flaccid paralysis, inc bladder & bowel Tx posture & safety |
| neurogenic shock (part of spinal shock) | Disruption of sympathetic flow from T1-L2 Spinal sympathetic neuron originated from intermediolateral nuclei of T1-L2 Loss of supraspinal cntrl Low BP & HR Neurogenic shock can lead to organ dysfunction & need immediate tx |
| autonomic dysreflexia | Chronic Life-threatening, in SCI above T5-T6 Imbalanced reflex sympathetic discharge From noxious stimulus, usually full bladder Medical emergency, sit them upright |
| signs and symptoms of autonomic dysreflexia | Pounding headache Sudden increase in BP Sweating above injury level Flushed face Runny nose Chest tightness |
| autonomic dysreflexia tx | 1. Check HR & BP for 5 minutes 2. Sit pt up 3. Loosen constrictive clothing & devices 4. Check urinary drainage |
| spinothalamic tract vs. lateral CST | Pain, temp, protective sensations vs. Motor info Proximal side is cervical, then moves laterally to sacral |
| posterior spinal tract | Proprioception Fine touch Vibration 2 point discrimination |
| central cord syndrome | Cervical region injury Greater weakness in UE Sacral sparing- can perceive anal sensation/ contract voluntary In older age due to hyperextension injury Motor will be affected depending on how far it'll extend into motor tract |
| good prognostic factors for central cord syndrome | Younger than 50 yo Ambulation is ok Bladder Can upper/ lower dress |
| anterior cord syndrome | Injury to anterior cord to ventral 2/3 of spinal cord Loss of pain & temp sensation Proprioception, kinesthesia, vibration intact Loss of motor & poor prognosis |
| common causes of anterior cord syndrome | Infarct Traumatic bending Narrowing the vertebral canal (spinal stenosis) |
| posterior cord syndrome | Posterior spinal artery to dorsal column Loss of proprioception, fine touch, vibration, 2 point discrimination, proproception Poor prognosis for ambulation |
| brown-sequard syndrome | 2-4% Ipsilateral motor & proprioception loss (flaccid paralysis at injury lvl, spastic below lesion) Contralateral pain/ temp sensation loss Good prognosis for ambulation (90%), ADL independence,(70%) bladder (85%) |
| sensory/ dorsal columns affect | Ipsilateral sensory loss at lesion level Ipsilateral loss of proprioception, vibration, 2 point discrimination below lesion level |
| spinothalamic tract lesions | Pain, temp, light touch Contralateral loss of pain & temp sensation below level of lesion |
| conus medullaris syndrome | Injury to L1-L2 Bladder, bowel, & sexual dysfunction- affects QoL more than motor More often in complete Less severe pain Poor prognosis |
| cauda equina syndrome | Injury to dorsal & ventral nerve roots in cauda equine, L2-sacrum Loss of sensation, flaccid paralysis, loss of sympathetic & parasympathetic pelvis responses Loss of bladder & bowel cntrl Severe pain, in incomplete. May recover 12-18 months |
| physical ax | American spinal cord injury association examination Functional independence measure Modified barthel index Walking index for SCI |
| ASIA | Ax person's level of incompleteness Motor- Look at where there is 3+ MMT, severity based on how many areas are affected. Calculate total motor score Sensory- light touch & pin prick scores for complete & incomplete |
| ASIA impairment scale (A, B, C) | A- complete, no motor/ sensory function is preserved S4-S5 B- incomplete, sensory but no motor function below neurological level incl S4-5 C- incomplete, motor function preserved below neurological level. More than half of key muscles below are below 3 |
| ASIA impairment scale (D, E) | D- incomplete, motor function preserved below neurological level, at least half of key muscles below have grade 3 or more E- normal, motor and sensory function are normal |
| neurological level | Lowest part of SC at which muscles at grade 3 or above Sensation is intact Level above must have normal strength & sensation Functional level May be different from skeletal level- area of greatest vertebral damage |
| medical management in acute phase | Corticosteroid use to reduce damage to nerves & decrease inflammation Immobilize to align. Incl traction, braces, body harness, collar Surgery to remove bone fragments (discectomy, corpectomy- remove portion of vertebra for decompression) |
| immobilization complications | Ulcers over bony prominences DVT Contractures |
| other complications | Autonomic dysreflexia Postural hypotension Respiratory difficulties Thermal regulation Spasticity Sexual dysfunction |
| early phase immobilization | Orthoses- resting Environmental controls w/ devices and AT Joint mobility Sensory & motor stimulation to help nerve recover Control & learned helplessness |
| rehabilitation | Physical- ROM, strength, spasticity, tenodesis, endurance, pain Mobility & transfers Self care (bowel & bladder) Productivity/ RTW Leisure & social life Home visit and d/c Prevention of infection |
| bladder continence | Bladder dysfunction High risk of serious complications 40% of SCI pts consider this priority Management: catharize and medications |
| intermittent catheterization | Every 4-6 hours routinely to keep volume below 600cc Initiated in 1st few weeks in acute Need good hand function & cognition to independently do Have them master technique & offer tenodesis orthosis Undergo bladder function testing annually 1st 5 yrs |
| neurogenic bowel dysfunction | Varying levels & degrees in paralysis of voluntary muscle Impairment of sensory afferent nerves & autonomic function Bowel program 39-62% of SCI pts rate it as significant |
| hand exercises & activities | Armeo system Rejoyce Use exercises with FES |
| breathing independence | Screening ax conducted for those L1 and above Early depths in 1st month due to resp complications Obstructive sleep apnea (15-83%), risk of stroke & heart attack, high tetraplegia Look for complications, endurance, diff breathing, thoracic muscle weak |
| respiratory intervention | Exercise training Specific training of resp muscles Abdominal binding Bronchodilators Secretion removal techniques |
| skin integrity | Prevent & manage pressure ulcers Sensation often diminished or absent Untx pressure ulcers lead to re-hopsitalization, significant fluid loss, sepsis Smart e-Pants- provides stimulation |
| wound ax tools | Bates jenson wound ax tool Pressure ulcer stages Spinal cord injury pressure ulcer scale measure Pressure maps |
| SCI-related spasticity | Abnormal increase in muscle of stiffness Sometimes may be beneficial for mobility & transfers Can be source of pain, hygiene difficulties, seating problems, sleep disturbance due to spasticity or pain |
| ameliorate neuropathic pain | Painful sensations of heat, cold, and electric-like shock Normal sensations like breeze or light touch can be severely painful too 40% of pts, 2/3 develop chronic pain Can occur anywhere below lvl of injury |
| ameliorate neuropathic pain tx | Acupuncture TENS Biofeedback Desensitization Medication Specialty pain clinic |
| sublesional osteoporosis | Unique to SCI Osteoclasts break down tissue in bones. Ca from bone tissue to blood Lifetime increase risk of LE fragility # In complete SCI ~3-4%/ month decline in hip and knee region bone mineral density in first year after injury |
| sublesional osteoporosis tx | Standing while doing activities Cycling FES Walking Body weight support treadmill training |
| c4 functional expectations | Unable to cough Have cntrl on diaphragm, trapezius Communication w/ mouthstick, env control unit, page turner, computer Transportation & access Still need 24h care |
| c5 functional expectations | Biceps, supinator, deltoid, brachialis, elbow flexors, shoulder abduction Can flex elbows & supinate Eat w/ universal cuff, plate guard, cup holder, straw Can assist w/ UE dressing & grooming Indp w/ eating, drinking, face wash, brushing, shaving |
| c7 functional expectations | Triceps, finger extensors, wrist flexion Elbow extensors Same as c6 Manual w/c more realistic Transfers, w/c push ups, pressure relief Less adaptive equipment needed Still fatigue easily |
| t7-t12 functional expectations | Paraplegic ambulation Capable of walking Increase tummy control- can bend over Improved pulmonary & cough cntrl Increased ability to perform unsupported seating activities |
Created by:
craftycats_
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