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OTH 5224 SCI

Terms in this set (59)

What is part of the CNS?
the brain and spinal cord
What protects the spinal cord? What is it made up of?

What are the distinct sections of the vertebrae?
vertebral column, 33 vertebrae

7 Cervical (C1-C7)
12 Thoracic (T1-T12)
5 Lumbar (L1-L5)
5 Sacral (S1-S5)
Coccyx (Tail bone) with 4 fused
Spinal Nerves and Function~

How many pairs of spinal nerves?

Spinal cord receives __________ (_____________) information from _________.

Motor (___________) information travels from __________ through the _________ _______ to the __________.

________ _______: input enters directly through dorsal nerve root, synapse, and exit through ventral nerve root
31 pairs

sensory (afferent); PNS

efferent; cortex; spinal cord; PNS

reflex arc
What is the reflex arc?
input enters directly through dorsal nerve root, synapse, and exit through ventral nerve root
Dermatomes~

What are they?

They relay ____________ from (what?) to (what?).
Area of skin mainly supplied by a single spinal nerve

sensation from particular region of skin to the brain
Spinal Nerves and Function~

Cervical: what body parts?
Thoracic: what body parts?
Lumbar: what body parts?
Sacral: what body parts?
Cervical: head, neck, diaphragm, arms, hands

Thoracic: chest, abdominal structure

Lumbar: legs, portion of foot

Sacral: portion of foot, bowel, bladder, s function
Etiology~

What is the leading cause of SCI?

-Sports injuries
-Diving accidents
-Gunshots
-What are non-traumatic conditions that can cause SCI?
car accidents, then falls (with elderly), and then violent acts

tumors, multiple sclerosis, amyotrophic lateral sclerosis (ALS), spina bifida
Injury Mechanism~

-________ with ____________
-_____________
-___________ with ________________
-______________
flexion with rotation
hyperextension
flexion with compression
compression
Terminology~

Quadriplegia (also called?)
-(Motor/Sensory?) impairment in (which?) segments
-What degree of paralysis? What is involved?

Paraplegia
-(Motor/Sensory?) impairment in (which?) segments
-What degree of paralysis? What is involved?
tetraplegia
motor AND/OR sensory
cervical
Any degree of paralysis in four limbs and trunk musculature

motor AND/OR sensory; thoracic, lumbar, sacral
Paralysis of LE with some involvement of the trunk
What is the difference between complete and incomplete lesions?
Complete have total paralysis and loss of sensation while incomplete has some degree of preservation of the sensory or motor nerves below the lesion
Classifications~

Complete Lesion
(Partial/total?) paralysis and loss of ____________. There is an interruption in what?

Incomplete Lesion
Has some degree of preservation of the sensory or motor nerves __________ the lesion
Total; sensation
Interruption of ascending and descending nerve tracts below level of the injury

below
Describe each part of the ASIA scale.
Level A - Complete ; No motor No sensory
• Level B - Sensory Incomplete ; No motor function
• Level C - Motor Incomplete; Motor function preserved below neurological level; key muscles below level have muscle grade less than 3
• Level D - Motor incomplete; Motor function preserved below neurological level; Key muscles below level have muscle grade equal or greater than 3
• Level E - Normal motor & sensory function
What are some examples of incomplete lesions (4 of them)?
Anterior Cord Syndrome

Brown-Sequard Syndrome

Central Cord Syndrome

Cauda Equina
Which incomplete injury?

Damage to 2/3 aspect of cord (anterior spinal artery or anterior spinal tissue).
Anterior Cord Syndrome
Which incomplete injury?

Loss of motor function, thermal and pain sensations below the level of injury. Proprioception is preserved.
Anterior Cord Syndrome
Anterior Cord Syndrome~

What is damaged?
Is there a loss of anything?
Is something preserved?
Damage to 2/3 aspect of the cord (anterior spinal artery or anterior spinal tissue)

Loss of motor function below level of injury and loss of thermal and pain sensations below the level of injury

Proprioception is preserved
Which incomplete injury?

Ipsilateral loss of motor function below level of injury
Brown-Sequard
What does ipsilateral mean? What is the opposite?
Means same side, as in same side as injury

contralateral
Which incomplete injury?

Ipsilateral reduction of deep touch and proprioception
Brown-Sequard
Which incomplete injury?

Proprioception preserved.
Anterior Cord Syndrome
Which incomplete injury?

Loss of thermal, pain, touch sensations on the contralateral side.
Brown-Sequard
Which incomplete injury?

Challenge: extremities with greatest strength have least sensation
Brown-Sequard
Brown-Sequard~

What is seen with this syndrome?
What is special about it?
Ipsilateral loss of motor function below the level of injury. Ipsilateral reduction of deep touch and proprioception. Contralateral loss of thermal, pain, and touch sensations.

Extremities with greatest strength have least sensation
Which incomplete injury?

UE more involved than LE
Central Cervical Cord Syndrome
Which incomplete injury?

Hyperextension of the neck and narrowing of the spinal canal
Central Cervical Cord Syndrome
Which incomplete injury?

Arthritic changes in older adult (spinal stenosis)
Central Cervical Cord Syndrome
Which incomplete injury?

Loss of motor function more involved in the UE
Central Cervical Cord Syndrome
Which incomplete injury?

Potential for flaccid paralysis of UE
Central Cervical Cord
Central Cervical Cord~

The ________ is more involved than the ________.

________________ of the _________ and narrowing of the ________ ___________.

_____________ changes in older adults (called?)

Loss of ____________ function more involved in the __________.

Potential for __________ ____________ of the UE.
UE; LE

Hyperextension; neck; spinal canal

arthritic; spinal stenosis

flaccid paralysis
Which incomplete injury?

Damage to spinal nerve that extend below the end of spinal cord.
Cauda Equina
Which incomplete injury?

Direct trauma from fractures or dislocations lower T or upper L.
Cauda Equina
Which incomplete injury?

Loss of motor function and sensation below level of injury. Bowel and bladder involvement.
cauda equina
Which incomplete injury?

Absence of reflex arc
cauda equina
Which incomplete injury?

Possibility of some nerve regeneration and function recovery
cauda equina
Cauda Equina~

Damage to? What can cause this?

Loss of ___________ function and ___________ below level of injury.

___________ and _____________ involvement.

Absence of _________ ________.

Possibility of some __________ _____________ and __________ recovery.
damage to spinal nerves that extend below the end of spinal cord

can be caused by direct trauma from fractures and dislocations lower T or upper L

motor; sensation

Bowel and bladder

reflex arc

nerve regeneration; function
Upper Motor/Lower Motor Neuron?

Reflex arcs intact below level of injury
upper motor neuron
Upper Motor/Lower Motor Neuron?

Loss of voluntary function below level of injury
Both
Upper Motor/Lower Motor Neuron?

Spastic paralysis
upper motor
Upper Motor/Lower Motor Neuron?

NO muscle atrophy
upper motor
Upper Motor/Lower Motor Neuron?

Hyperactive reflexes
upper motor
Upper Motor/Lower Motor Neuron?

No reflex arc
lower motor
Upper Motor/Lower Motor Neuron?

Flaccid paralysis
lower motor
Upper Motor/Lower Motor Neuron?

Muscle atrophy
lower motor
Upper Motor/Lower Motor Neuron?

Absence of reflexes
lower motor
For both upper and lower motor neuron, tell the:

-Reflex arc status?
-Loss of what below level of injury?
-Type of paralysis?
-Muscle atrophy status?
-Reflexes status?
Reflex Arc~
Upper: reflex arcs intact below level of injury
Lower: no reflex arc

Loss of voluntary function for both.

Type of Paralysis~
Upper: spastic paralysis
Lower: flaccid paralysis

Muscle Atrophy~
Upper: no muscle atrophy
Lower: muscle atrophy

Reflexes~
Upper: hyperactive reflexes
Lower: absence of reflexes
Complications~

Spinal Shock: period of ___________ __________ activity

Respiratory Complications: injuries above __________ (this is a common cause of what?)

Autonomic Dysreflexia: ________ or _________ response usually to a __________ stimulus. Also called?

Postural (_____________) hypotension: _______ decreases, lightheadedness, dizziness, weakness, unresponsiveness

Deep Vein ____________: swelling in ________, low grade ____________, redness
altered reflex

T12; death

fight; flight; noxious; hyperreflexia

orthostatic; BP

Thrombosis; LE; fever
Which complication?

Period of altered reflex activity.
Spinal shock
Which complication?

Occurs with injuries about T12.
respiratory complications
Which complication?

Common cause of death.
respiratory complications
Which complication?

Fight or flight response to noxious stimulus
autonomic dysreflexia
What is autonomic dysreflexia?
Fight or flight response to noxious stimulus, also called hyperreflexia
Which complication?

Low-grade fever
DVT
Which complication?

Swelling in LE
DVT
Which complication?

BP decreases, unresponsiveness, lightheadedness, dizziness, weakness
postural/orthostatic hypotension
Which complication?

Problems maintaining appropriate body temperature.
thermal regulation
Which complication?

Abnormal formation of bone deposits on muscles, joints, tendons
Heterotopic Ossification (HO)
Which complication?

Stage 1 (redness) ---> Stage 4 (bone decay and surgical intervention)
Decubitis ulcers
Complications~

___________ regulation: maintaining appropriate body temperature

______________

_____________ _______________: abnormal formation of bone deposits on muscles, tendons, joints

______________

____________ _____________: stage 1 (___________) ---> stage 4 (what is seen here?)

High rates of depression
thermal

spasticity

heterotopic ossification

UTIs

Decubitis ulcers; redness; bone decay and surgical intervention
OT Interventions~

-Instruction is use of _____________ equipment and ___________ devices as appropriate
-Patient/caregiver education (Why is this important?)
-Environmental adaptations for access and safety
-________________ to prevent ___________ and ______________
-____________ and _____________ devices
-______________, ____________, and ____________ exercises
-Functional mobility and _________ mobility training
-Occupation-based intervention to improve independence in ADLs
adaptive; assistive

The patient needs to be able to direct their care.

Positioning; decubiti and contractures

splinting; orthotics

AROM, AAROM, PROM

W/C
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