Spinal Cord Injury - Introduction
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Questions and Answers

Which of the following is NOT a function of the Lateral Spinothalamic tract?

  • Temperature
  • Touch (correct)
  • Pain
  • Pressure
  • The Artery of Adamkiewicz is a major blood supply to which part of the spinal cord?

  • All of the spinal cord
  • Middle third
  • Upper half
  • Lower half (correct)
  • Which of the following tracts is responsible for carrying information about proprioception, kinesthesia, and vibration?

  • Spinotectal
  • Ant spinothalamic
  • Lateral spinothalamic
  • Dorsal column (correct)
  • Which type of neuron is responsible for connecting the motor neurons to sensory neurons in the spinal cord?

    <p>Interneuron (C)</p> Signup and view all the answers

    Which level of the spinal cord typically represents the watershed zone, meaning it has a decreased blood supply?

    <p>T4-T6 (D)</p> Signup and view all the answers

    Which of the following is the primary function of the rubrospinal tract?

    <p>UE flexion, LE extension (D)</p> Signup and view all the answers

    Which of the following tracts is responsible for carrying information about touch and pressure to the brain?

    <p>Ant spinothalamic (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the descending tracts?

    <p>Involved in sensory information processing (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the Cauda Equina?

    <p>It is located in the spinal cord. (D)</p> Signup and view all the answers

    What is the function of the Clarke's Dorsal Nucleus?

    <p>Balance. (B)</p> Signup and view all the answers

    Where does the spinal cord end in an adult?

    <p>At the level of the L1 vertebra. (C)</p> Signup and view all the answers

    Which of the following is a characteristic of the Posterior Spinal Artery?

    <p>It is composed of two arteries. (D)</p> Signup and view all the answers

    In the context of the Bell-Magendie Law, what does 'Dorsal' represent?

    <p>Sensory. (C)</p> Signup and view all the answers

    Which of the following sites is most commonly affected by Heterotopic Ossification (HO) following a stroke or traumatic brain injury (TBI)?

    <p>Shoulder (C)</p> Signup and view all the answers

    What is the most common complication associated with Deep Vein Thrombosis (DVT) in individuals with respiratory impairments?

    <p>Pulmonary infarction (A)</p> Signup and view all the answers

    Which of the following structures is characterized as having a 'horse tail' appearance?

    <p>Cauda Equina. (D)</p> Signup and view all the answers

    What is the primary function of Rexed Lamina VIII and IX?

    <p>Motor control. (A)</p> Signup and view all the answers

    Which of the following is not a part of Virchow's Triad, a set of factors that contribute to the development of Deep Vein Thrombosis (DVT)?

    <p>Increased blood flow (C)</p> Signup and view all the answers

    Which of the following is NOT considered a VERTICAL artery of the spinal cord?

    <p>Great Anterior Segmental Artery. (D)</p> Signup and view all the answers

    What is the most common cause of death in individuals with respiratory impairments?

    <p>Pneumonia (C)</p> Signup and view all the answers

    Which of the following activities is not considered a pressure relief activity to assist in the prevention of pressure ulcers?

    <p>Sitting upright for extended periods (D)</p> Signup and view all the answers

    Which of the following is a common site for pressure ulcers in individuals who are lying on their side?

    <p>Lateral malleolus (D)</p> Signup and view all the answers

    What is the primary management strategy for a patient experiencing respiratory complications, such as pneumonia or atelectasis?

    <p>Intubation and mechanical ventilation (D)</p> Signup and view all the answers

    Which of the following is not a common management technique for individuals with respiratory impairments?

    <p>Muscle strengthening exercises (C)</p> Signup and view all the answers

    What does the acronym ASIA stand for?

    <p>American Spinal Cord Injury Association (C)</p> Signup and view all the answers

    A patient with a complete spinal cord injury has a score of 0/5 for the anal contraction portion of the ASIA scale. What does this indicate?

    <p>The patient has a complete spinal cord injury and has lost anal function. (A)</p> Signup and view all the answers

    A patient has a sensory level of T10 and a motor level of T12. What is their Neurologic Level of Injury (NLI)?

    <p>T10 (C)</p> Signup and view all the answers

    What is the difference between a complete and incomplete spinal cord injury?

    <p>A complete spinal cord injury involves complete damage to the spinal cord, resulting in complete loss of function below the level of injury. (D)</p> Signup and view all the answers

    How is the motor level determined in the ASIA scale?

    <p>By identifying the most caudal segment with at least 5/5 muscle strength with 5/5 strength above the level. (B)</p> Signup and view all the answers

    Which of the following is a TRUE statement about Spinal Shock?

    <p>Spinal Shock is a temporary condition that can occur after a Spinal Cord Injury (SCI). (B)</p> Signup and view all the answers

    Which of the following is a common complication associated with Spasticity after a Spinal Cord Injury?

    <p>Hip Dislocation (D)</p> Signup and view all the answers

    Which of these neurotransmitters is NOT used in pharmacologic management of spasticity?

    <p>Dopamine (B)</p> Signup and view all the answers

    Which of the following is a CORRECT statement about Autonomic Dysreflexia?

    <p>Autonomic Dysreflexia can be managed by sitting the patient upright. (B)</p> Signup and view all the answers

    Which of the following is a symptom of Autonomic Dysreflexia?

    <p>Profuse sweating (D)</p> Signup and view all the answers

    In the management of Orthostatic Hypotension, what does the acronym 'TAE CO' stand for?

    <p>Tilt table, Ankle pumps, Elevate legs, Compression stockings (D)</p> Signup and view all the answers

    Which of the following is a TRUE statement about the Bulbocavernosus Reflex?

    <p>The Bulbocavernosus Reflex is assessed by pinching the glans penis or clitoris. (D)</p> Signup and view all the answers

    Which surgical procedure involves cutting the nerve root?

    <p>Rhizotomy (C)</p> Signup and view all the answers

    A patient with a C7 level spinal cord injury can perform which of the following activities independently without assistive devices?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following activities can be performed by a patient with a C6 level spinal cord injury with assistive devices?

    <p>Driving (D)</p> Signup and view all the answers

    A patient with a T12-L2 spinal cord injury can perform which of the following?

    <p>Swing-through gait (C)</p> Signup and view all the answers

    What is the primary function of the Balance FA orthosis (BFO) as outlined in the content?

    <p>Feeding assistance (C)</p> Signup and view all the answers

    What kind of wheelchair is recommended for a individual with a C5 level spinal cord injury?

    <p>Joystick wheelchair control (C)</p> Signup and view all the answers

    Which of the following activities would NOT be considered a 'Self care' activity as mentioned in the content?

    <p>Driving (B)</p> Signup and view all the answers

    What is the main reason that wrist and finger extension should be avoided during tenodesis exercises for a patient with a C6 spinal cord injury?

    <p>To protect the tendons from further injury (A)</p> Signup and view all the answers

    Why is it significant that a patient with a C7 level spinal cord injury can perform 'Self ROM (7)'?

    <p>It suggests the patient has good potential for functional independence (D)</p> Signup and view all the answers

    Flashcards

    Spinal Cord

    Continuation of medulla oblongata; transmits signals between brain and body.

    Conus Medullaris

    Tapered end of the spinal cord; related to upper motor neuron lesions.

    Cauda Equina

    Collection of lumbosacral nerve roots; corresponds to lower motor neurons.

    Bell Magendie Law

    Describes the functional distinctions of spinal roots: ventral for motor and dorsal for sensory.

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    Rexed Laminae

    Regions of gray matter in the spinal cord defined by functions like pain and proprioception.

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    Anterior Spinal Artery (ASA)

    Supplies the anterior two-thirds of the spinal cord.

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    Posterior Spinal Artery (PSA)

    Composed of two arteries, it supplies the posterior one-third of the spinal cord.

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    Segmental Arteries

    Also known as radicular arteries; enhance blood supply to the spinal cord.

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    Spinal Shock

    Areflexia after spinal cord injury lasting 1-3 days.

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    Bulbocavernosus Reflex

    Reflex involving anal sphincter contraction when genital area is stimulated.

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    Spasticity

    Increased muscle tone potentially leading to scoliosis and hip dislocation.

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    Autonomic Dysreflexia

    Autonomic dysregulation in response to stimuli, mainly above T6 level.

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    Signs of Autonomic Dysreflexia

    Includes pounding headache, profuse sweating, and facial flushing.

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    Management of Autonomic Dysreflexia

    Elevating the head and checking for irritants to reduce symptoms.

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    Orthostatic Hypotension

    Drop in BP upon head elevation, common in paralysis patients.

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    Management Strategies for OH

    Includes tilt tables, ankle pumps, and compression stockings to improve circulation.

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    Radicular Artery

    Also known as the Artery of Adamkiewicz, it supplies blood to the lower half of the spinal cord from T6-L3.

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    Watershed Zone

    Area between T4-T6 that receives less blood supply due to fewer segmental arteries.

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    Sensory Neuron

    Ascending neuron with three orders: 1st in dorsal root ganglion, 2nd in interneuron to thalamus, 3rd from thalamus to sensory cortex.

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    Motor Neuron

    Descending neuron with three orders: 1st from UMN in cortex to anterior horn, 2nd in interneuron, 3rd to spinal nerves.

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    Interneuron

    Most numerous neurons that connect motor to motor, sensory to sensory, and motor to sensory.

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    Autonomic Neurons

    Neurons that control involuntary muscles like cardiac and smooth muscle, with pre and post ganglionic pathways.

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    Lateral Spinothalamic Tract

    An ascending tract responsible for transmitting pain and temperature sensations.

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    Lateral Corticospinal Tract

    A descending tract that is key for fine and skilled movements.

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    ASIA Scale

    A classification system for spinal cord injuries based on sensory and motor functions.

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    Complete SCI

    Defined as no sensory or motor function in the sacral segments S4-S5.

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    Incomplete SCI

    Presence of some sensory or motor function below the injury level, including S4-S5.

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    Neurologic Level of Injury (NLI)

    The most caudal segment with normal sensation and motor function.

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    Motor Level (ML)

    The most caudal segment with at least ⅗ MMT and 5/5 above this level.

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    Respiratory Impairments

    Impairments related to breathing efficiency due to spinal cord injury above C4.

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    Heterotopic Ossification (HO)

    Abnormal bone growth in non-skeletal tissues, common after SCI.

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    C5 Functionality

    Refers to capabilities such as powered arm support and joystick controls for mobility.

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    Pressure Ulcers

    Injuries to skin and underlying tissue due to prolonged pressure.

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    C6 Self-Care

    Individuals can perform self-care activities such as ADL transfers and self-driving with assistive devices.

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    Deep Vein Thrombosis (DVT)

    Blood clot that forms in a deep vein, often due to immobility.

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    Cardiopulmonary Complications

    Serious complications affecting heart and lungs after injury.

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    C7 Independence

    C7 allows for activities of daily living independently, without assistive devices.

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    C8 Standard Wheelchair

    Users with C8 level can perform self-care and maneuver a standard wheelchair without assistance.

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    Management of Pressure Ulcers

    Includes regular turning and pressure relief activities.

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    T4-T6 Standing

    Individuals achieve physiological standing capability between T4 and T6 spinal injury levels.

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    Management of DVT

    Involves use of anticoagulants like Heparin and Warfarin.

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    Virchow’s Triad

    Three factors that contribute to DVT: hypercoagulability, venous stasis, and intimal wall damage.

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    Swing to Gait (T6-T9)

    Movement style for individuals with T6-T9 injuries, emphasizing swing to gait.

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    Household Ambulation (T9-T12)

    Refers to ambulation capabilities in the household environment with T9-T12 injury levels.

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    Community Ambulation (L3)

    Individuals at L3 level can perform community ambulation, reaching public areas.

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    Study Notes

    Spinal Cord Injury - Introduction

    • Spinal cord is a continuation of the medulla oblongata
    • Carries signals from the brain to the body
    • Starts at the medulla oblongata (MO)
    • Ends at L1 (below) in adults, and L3 (above) in children
    • Lumbar puncture is performed between L3-L4 due to the widest space
    • Conus medullaris is the tapered end of the spinal cord
    • Cauda equina is a collection of lower lumbar and sacral nerve roots
    • Filum terminale is a pia mater prolongation attached to the 1st coccygeal vertebra.

    Bell-Magendie Law

    • Ventral: Efferent (motor)
    • Dorsal: Afferent (sensory)

    Peripheral

    • White matter contains myelinated axons.
    • Gray matter contains unmyelinated axons.

    Rexed Laminae

    • I-IV: Pain, touch, temperature
    • III & IV: Proprioception, tactile discrimination, vibration
    • V: Noxious stimulus from viscera
    • VI: Noxious stimulus from skin/mechanoreceptor
    • VII: Clarke's Dorsal Nucleus (Balance)
    • VIII & IX: Anterior Horn Cell (Motor)
    • X: Central gray commissure

    Blood Supply

    • Anterior Spinal Artery (ASA): Composed of 1 artery, supplying anterior aspect of spinal cord (most of the SC's blood supply)
    • Posterior Spinal Artery (PSA): Composed of 2 arteries, supplying posterior aspects of the spinal cord
    • Segmental Arteries (AKA Radicular Arteries): Enhance blood supply
    • Great anterior radicular artery (AKA artery of Adamkiewicz): Found at T6-L3 or T12-L2; Left and anterior; lower half of spinal cord supply
    • Watershed Zone: Region lacking segmental arteries; Between roots T4-T6; Reduces blood supply

    Neurons

    • Sensory (ascending):
      • 1st order: Dorsal root ganglion
      • 2nd order: Interneuron (posterior horn to thalamus)
      • 3rd order: Thalamus to sensory cortex
    • Motor (descending):
      • 1st order: Upper motor neuron (UMN) (cortex to anterior horn)
      • 2nd order: Interneuron
      • 3rd order: Lower motor neuron (LMN) (anterior horn to spinal nerves)
    • Interneuron: Connects motor and sensory neurons.

    Tracts

    • Ascending:
      • Lateral spinothalamic: pain, temperature
      • Anterior spinothalamic: touch, pressure
      • Dorsal column: proprioception, kinesthesia, vibration (PKV)
      • Anterior and posterior spinocerebellar: balance
      • Spinotectal: visual reflex
      • Spino-reticular: wakefulness, arousal
    • Descending:
      • Lateral corticospinal: skilled movement
      • Anterior corticospinal: skilled movement
      • Tectospinal: visual reflex (efferent)
      • Reticulospinal:

    Autonomic Neurons

    • Carry signals to:
      • Cardiac muscle
      • Smooth muscle
      • Visceral organs ("involuntary muscles")
      • Pre-ganglionic neurons (in brain/spinal cord): signals from brain or spinal cord to ganglion
      • Post-ganglionic neurons (in ganglion): signals from the ganglion to glands or organs

    Spinal Cord Injury - Epidemiology, Etiology

    • Epidemiology: Age (16-30, average 26), more common in males, high in summer months
    • Etiology:
      • Traumatic: 70%, most common cause is motor vehicle accidents (MVAs), also falls, assaults, and sports
      • Non-traumatic: tumors, toxins, infections, and congenital abnormalities

    Clinical Syndromes

    • Incomplete SCI:
      • Anterior cord syndrome: worst prognosis
      • Posterior cord syndrome

    Other details include:

    • Types of spinal cord injuries
    • Complications such as Heterotopic ossification (HO)
    • Fractures and osteoporosis, pressure ulcers, Deep Vein Thrombosis (DVT)
    • Cardiopulmonary complications (e.g., pneumonia, heart disease)
    • Spinal shock, Spasticity, Spasticity
    • ASIA Scale for classification (Sensory and Motor)

    Clinical Manifestations

    • Includes time frame for spinal shock (1 day-3 days), reflexes, and bulbocavernosus reflex tests, and other relevant information on the impact on spasticity, scoliosis, and hip dislocation.

    Assessment

    • Includes ASIA scale definitions complete, sensory incomplete, motor incomplete etc
    • Includes sacral sparing details.

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    Spinal Cord Injury PDF

    Description

    This quiz covers the fundamental aspects of the spinal cord, including its anatomy, the functions of the different spinal regions, and the significance of the Bell-Magendie Law. It also explores the structure and functionality of the white and gray matter, along with the Rexed Laminae. Test your knowledge on spinal cord injuries and their implications.

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