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118 terms

Traumatic spinal cord injury-Myotome-Dermatomes

L1-L2 Myotome
Hip flexors
L3 myotome
Knee extensor
L4 myotome
Ankle dorsiflexors
L5 myotome
Great toe extensors
Knee flexors
Hip extensors
S2 myotome
Toe and knee flexors
C1-2 myotome
Cervical spine flexors
C3 myotome
Cervical spine lateral flexors
C4 myotome
Scapular elevators
C5 myotome
Shoulder abductors
C6 myotome
Elbow flexors and wrist extensors
C7 myotome
Elbow extensors and wrist flexors
C8 myotome
Thumb extensors
T1 myotome
Hand intrinsics (ulnar)
C3 dermatome
C4 dermatome
C5 dermatome
Anterolateral of shoulder
C6 dermatome
C7 dermatome
Middle finger
C8 dermatome
Little finger
T1 medial arm
Medial arm
T4 dermatome
T10 dermatome
T12 dermatome
L1 dermatome
L2 dermatome
Medial thigh
L3 dermatome
Medial knee, anterior thigh
L4 dermatome
Medial ankle and great toe, patella
L5 dermatome
Dorsum of foot
S1 dermatome
Lateral foot
S2 dermatome
Plantar surface of foot
S3,4,5 dermatome
Plantar surface of foot
C1-C3 nerve rt
Face and neck muscles (cranial innervation)
C4 nerve rt
Diaphragm, trapezius
Scapulae elevation
C5 nerve rt
Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboid and supinator
Elbow flexion and supination
Shoulder external rotation
Shoulder abduction to 90
Limited shoulder flexion
C6 nerve rt
ECR, infraspinatus, latissimus dorsi, pectoralis major, pronator teres, serratus anterior and teres minor
Shoulder flexion, extension, IR, and abd
Scapulae abd and UR
Forearm pronation
Wrist extension
C7 nerve rt
EPL & EPB, extrinsic finger extensors, FCR, triceps
elbow extension
wrist flexion
finger extension
C8-T1 nerve rt
extrinsic finger flexors, FCU, FPL & FPB, intrinsic finger flexor
full innervation of UE mm including fine coordination and strong grasp
T4-T6 nerve rt
top half of intercostals, long mm of the back (semispinalis)
improved trunk control
increased respiratory reserve
pectoral girdle stabilization for lifting objects
T9-T12 nerve rt
lower abdominals, all intercostals
improved trunk control
increased endurance
L2-L4 nerve rt
gracilis, iliopsoas, quadratus lumborum, rectus femoris, sartorious
hip flexion
hip adduction
knee extension
L4-L5 nerve rt
extensor digitorum, low back mm, medial hamstrings, post. tibialis, quadriceps, tibialis anterior
Nontraumatic SCI
vascular malformation
vertebral subluxation
infection (meningitis)
neoplasms (tumors)
hysterical paralysis
traumatic SCI
MVA 46%
Falls !9%
acts of violence 18%
recreational sports 11%
SCI demographic variables
82% young men
56% btw 16-30
56% white
29% african american
9% hispanic
how much is the financial impact in one yr for a tetraplegic
financial impact on a paraplegic
what is SCI
trauma to the spinal cord causing partial or complete disruption of the nerve tracts and neurons
ranges of a SCI injury
contusion, laceration or compression of the cord
what happens if there is spinal cord edema
necrosis of the spinal cord can develop as a result of comprised capillary circulation and venous return
what may result from a SCI
loss of motor function, sensation, reflex activity, and bowel and bladder control may result
tetraplegia is a result of
lesions from C1-C8
functional characteristics of a tetraplegia
paralysis of all 4 extremities and trunk including respiratory mm
paraplegia is due to
lesions resulting from T1-S1
functional characteristics of paraplegia
partial or complete paralysis of all or part of the trunk and BLE
in designating the level of the lesions, normal means
3+/5 or Fair+
complete lesions
no sensory or motor function below level of lesion
complete transection, severe compression, extensive vascular impairment to cord
incomplete lesions
preservation of some sensory or motor function below level of lesion
pressure on cord, swelling, partial transection of cord
clinical pictures of incomplete lesions
variable patterns of recovery
early return of function= good prognostic sign
what is a complete transection of the cord
SC is completely severed with total loss of sensation, movement, and reflex activity below the level of injury
what is a partial transection of the cord
the spinal cord is partially damaged or severed
symptoms depend on the extent and location of the damage
C2-C3 injury is usually
lesion above C4 causes
respiratory difficulty and paralysis of all four extremities
diaphragm is innervated by
can a pt w/C3 lesion breath well and why
no because of it's innervation has been affected
a thoracic level lesion causes
loss of control/movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury and completeness of injury
autonomic dysreflexia often occurs with
lesions above T6 and cervical lesions
etiology and symptoms of autonomic dysreflexia
visceral distention from a distented bladder, or impacted rectum
may cause sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh
lumbar and sacral nerve injury
cauda equina has the ability to regenerate
usually incomplete
loss of movement and sensation to the LE
often exhibit root escape- the preservation or return of function of nerve rts at or near the level of the lesion
vertabrae most frequently involved in SCI are
C5,6, and 7
occur mainly at junctions
what is an anterior cord syndrome
damage to the anterior portion of the cord, usually secondary to a flexion injury to C spine
characteristics of anterior cord syndrome
motor function and pain (CS tract), temperature and sensation (ST tract) are lost below the level of injury
what is a posterior cord injury
damage to the posterior portion of the cord
characteristics of posterior cord injury
loss of proprioception, stereognosis, 2pt discrimination, vibration, and graphaesthesia (dorsal columns)
central cord syndrome
occurs from a lesion in the central portion of the SC and often result from hyperextension injuries
cervical tract are located here
characteristics of central cord syndrome
more pronouced loss of motor function in the UE
varying degrees and patterns of sensation remain intact
Brown-Sequard sydrome
results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the cord
ex. gunshot or stab wounds
characteristics of Brown-Sequard syndrome
motor function, proprioception, vibration, and deep touch are lost on the same side of the body as the lesion.
sensations of pain, temperature, and light touch are lost on the opposite side of the body/lesion.
describe sacral sparing
an imcomplete lesion where the most centrally located sacral tracts are spared
often 1st sign of incomplete cervical lesion
what are the clinical signs of sacral sparing
perianal sensation
rectal sphincter contraction
cutaneous sansation in the saddle area
active contraction of toe flexors (S2)
example of flexion injury
head-on collision
blow to back of head or trunk
a flexion injury will result in an _______________ syndrome
anterior cord
example of compression injury
vertical or axial blow to the head
associated with flexion injury
example of hyperextension injury
strong posterior force such as rear-end collision
falls wiht chin hitting stationary object
a hyperextension injury will result in a _________________ syndrome
central cord syndrome
example flexion-rotation injury
posteior to anterior force directed at rotated vertebral column, rear end collision with passenger rotated toward driver
describe shearing mechanism of injury
occurs when a horizontal force is applied to the spine relative to the adjacent segments
disrupts ligaments
associated with fracture dislocations of the thoracolumbar region
describe distraction mechanism of injury
involves a traction force
the least common mechanism
occurs when significant momentum of the head is created (whiplash injuries)
momentum creates a tensile force in the cervical spine as the head is pulled away from the body
what are the clinical manifestations of SCI
spinal shock
motor and sensory impairments
impaired temperature control
respiratory impairment
bowel and bladder dysfunction
sexual dysfunction
describe spinal shock (neurogenic shock)
a sudden depression of reflex activity in the spinal cord below the level of injury (areflexia)
the mm become completely paralyzed and flaccid, sensation is lost , and reflexes are absent
spinal shock occurs
within the first hour of injury and can last hours to weeks
usually subsides w/i 24 hrs
when does spinal shock end
when the reflexes are regained
impaired temperature control occurs due to
the hypothalamus is unable to control cutaneous blood flow or level of sweating
what happens when the temperature control is impaired
the body is unable to shiver, vasodilate/vasoconstrict in response to heat/cold
decreased sweating below lesion level and diaphoresis above
respiratory impairment depends on
the level of lesion
key respiration mm are
name indirect impairments in a SCI
pressure ulcers
autonomic dysreflexia
postural hypotension
heterotopic ossification
renal calculi
how can you prevent pressure ulcers
cushion for p relief
pneumatic beds
turn q2h
pressure relief
avoid activities that tend to cause skin damage
what causes autonomic dysreflexia
caused by visceral distention from a distented bladder or impacted rectum
generally occurs after the period of spinal shock is resolved
occurs w/lesions above T6 and in cervical lesions
what are the signs and symptoms of autonomic dysreflexia
flushing of the face and neck
nasal stuffiness
dilated pupils and blurred vision
what is a trendelenburg position
supine in bed w/leg elevated
what can I do if a pt continues to have postural hypotension while seated
try to elevate blood pressure
move UE (AROM)
use ACE bandage above TED hose on LE to increase BP
elevate BLE
check abdominal binder
recline or tilt w/c
perform effleurage
what can I do if a pt is experiencing symptoms of autonomic dysreflexia
sit pt if lying down
loose tight clothing
check for kinks in catheter if present
ask for bowel program
check skin for cuts or bruises
what are cervical traction used for
used to stabilize fx or dislocations of the cervical or upper thoracic spine
Ex.skull tongs, halo traction
what should you monitor on a pt with a HALO traction
should monitor the client's neurological status for changes in movement or decreased strength
assess for tightness of the jacket by ensuring that one finger can be placed under the jacket
implementation for thoracic and lumbar/sacralinjuries
immobilization with a fiberglass or body cast
use of brace or corset when the pt is out of bed
surgical implementation for thoracic and lumbar/sacral injuries
decompressive laminectomy
spinal fusion and Harrington Rod insertion
decompressive laminectomy
removal of one or more laminae
allows for cord expansion
performed if conventional methods fail to prevent neurological deterioration
spinal fusion and Harrington Rods
used for thoracic spinal injuries
insertion of metal or steel rod to stabilize the thoracic spine
medications for SCI
dexamethasone-anti-inflammatory and edema reducer
dextran- plasma expander, used to increase capillary blood flow within the spinal vord and to prevent or treat hypotension
dantrolene/baclofen- used for clients with UMN injuries, controls mm spasticity
name physical therapy interventions for SCI
respiratory management
ROM and positioning
selective strengthning/stretching- Ex.tight add, HS
orientation to vertical- to avoid ortho hypo
functional training- bed mobility
mobility training- W/C, and/orambulation
respiratory management
diaphragmatic breathing exs
sliding board
boost transfers
hoyer lift
sitting balance
supported static sitting balance using upside down chair and wedge
supported dynamic balance reaching cones or touching objects out of base of support
unsupported sitting balance edge of mat static or dynamic throwing/catching ball, hitting balloon
bed mobility
management of BLE onto mat using leg straps if appropriate
prone for pressure relief and hip flexor stretch
circle/ring sitting
adductor stretch
aids in donning socks and ADLs
long sitting
HS stretch
aids in ADLs
tilt table and standing frame
upright accomodation
BLE wt bearing for bone strength
UE strengthning
shoulder stabs exs
UBE bike for cardio
UE strengthnin w/cuffs wts, wt machines
tricep pushups for strengthning and needed for pressure relief