Spinal Cord Injury Overview and Etiology

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Questions and Answers

Which of the following characteristics is associated with Lower Motor Neuron (LMN) injuries?

Hyperreflexia

Increased tone/spasticity

Flaccidity (correct)

Positive UMN signs

What is a common sign of Upper Motor Neuron (UMN) injuries?

Loss of sphincter control

Flaccid bladder and bowel

Increased tone/spasticity (correct)

Hyporeflexia

In which type of setting do patients relearn daily activities after injury?

Palliative care

Acute care

Long-term acute care hospital (LTACH)

Acute Rehabilitation (correct)

Which of the following is a secondary complication associated with autonomic nervous system dysfunction in spinal cord injuries?

Orthostatic Hypotension Signup and view all the answers

What role does autonomic dysreflexia play in patients with T6 and above injuries?

It can lead to hypertensive crises. Signup and view all the answers

What determines the motor level of injury in a patient?

The lowest myotome with a grade of at least 3 if the one above it is a 5 Signup and view all the answers

If a patient has a grade of 4 at the L3 myotome and a grade of 5 at the L2 myotome, what would the possible injury level be?

L3 or L4 Signup and view all the answers

What functional strength would a person likely still have if the injury is at L3?

Normal strength at L2 Signup and view all the answers

How is the sensory level of injury determined?

By testing light touch and pin prick Signup and view all the answers

What is the grading scale used for assessing motor strength in myotomes?

1-5 scale Signup and view all the answers

What does the neurologic level of injury indicate?

The most caudal level with normal motor and sensory function Signup and view all the answers

Which syndrome is characterized by 'slapping feet' presentation and sensory loss?

Posterior Cord Syndrome Signup and view all the answers

How is the Zone of Partial Preservation defined in relation to incomplete injuries?

It applies to dermatomes and myotomes that remain partially innervated Signup and view all the answers

Which of the following syndromes is most likely caused by whiplash and results in arm deficits?

Central Cord Syndrome Signup and view all the answers

In Brown-Sequard Syndrome, what type of sensory loss occurs?

Contralateral loss of spinothalamic tract and ipsilateral loss of DCML Signup and view all the answers

What type of sensation is primarily carried by the DCML tract?

Proprioception and fine touch Signup and view all the answers

Where does the spinal-thalamic tract cross in the spinal cord?

Immediately upon entering the spinal cord Signup and view all the answers

Which age group has the highest incidence of spinal cord injuries?

Ages 16-30 Signup and view all the answers

What is the most common traumatic mechanism of spinal cord injury?

Motor vehicle accidents Signup and view all the answers

Which condition is NOT considered a non-traumatic mechanism of spinal cord injury?

Falls from height Signup and view all the answers

How does life expectancy differ between incomplete and complete spinal cord injuries?

Incomplete injuries have a longer life expectancy Signup and view all the answers

What spinal condition affects legs more than arms?

Sacral spinal injury Signup and view all the answers

What is a likely reason for lower cervical tetraplegia having a longer life expectancy than higher cervical tetraplegia?

Better respiratory function Signup and view all the answers

What is a critical consideration for patient management in acute care settings?

Early mobility once medically stable Signup and view all the answers

What is a common symptom of autonomic dysreflexia?

Hypertension Signup and view all the answers

Which intervention is specifically aimed at preventing skin issues?

Skin prevention or treatment Signup and view all the answers

In rehabilitation, which aspect can help with functional mobility?

Strengthening exercises Signup and view all the answers

Which of the following is considered a secondary complication related to neurological issues?

Increased spasticity Signup and view all the answers

What examination components are prioritized in the PT management of acute rehab?

ROM, strength, and functional mobility level Signup and view all the answers

What physiological change is associated with flaccid bladder/bowel?

Voiding dependent on gravity Signup and view all the answers

What strategy should be used to manage blood pressure with patient position changes?

Use Reverse Trendelenburg to prevent shear Signup and view all the answers

Which stage of pressure injury is defined as full thickness into the subcutaneous fat layer?

Stage 3 Signup and view all the answers

What is a goal of outpatient management for patients recovering from SCI?

Community reintegration and navigation Signup and view all the answers

What is the leading type of infection following spinal cord injury?

Urinary tract infection Signup and view all the answers

During acute care management, what is the purpose of passive range of motion (PROM)?

To prevent contractures and maintain mobility Signup and view all the answers

Which of the following best describes piloerection?

Goosebumps due to sympathetic response Signup and view all the answers

What should the frequency be for changing a patient's position to prevent complications?

Every 15 minutes Signup and view all the answers

What complication might result from prolonged pressure and shear?

Deep Tissue Pressure Injury Signup and view all the answers

Which of the following symptoms is NOT associated with autonomic dysreflexia?

High blood glucose levels Signup and view all the answers

Study Notes

Spinal Cord Injury (SCI) Overview

SCI is damage to the spinal cord, leading to symptoms below the injury level.
Spinal tracts carry sensory and motor signals.
- Dorsal Column-Medial Lemniscus (DCML): sensory, carrying proprioception, vibration, fine touch, and pressure, crosses at the medulla.
- Spinal-Thalamic Tract: sensory, carrying pain, temperature, and crude touch, crosses immediately.
- Corticospinal Tract: motor, controlling voluntary movement from the neck to the feet, originates at the base of the pyramids in the medulla.
Spinal cord cross-section:
- Cervical: involves the brachial plexus (arms), located medially.
- Sacral: more lateral, affects legs.
Approximately 18,000 new cases occur annually in the USA, with 300,000-2 million people living with SCI in the US.
Most common onset ages are 16-30, with injuries frequently associated with frontal lobe development and myelination.

Etiology of SCI

Injuries can be traumatic (e.g., motor vehicle accidents, falls, violence) or non-traumatic (e.g., AVM, thrombus, embolus, hemorrhage, or infection).
Traumatic injury statistics:
- Motor vehicle accidents (MVA): 38%
- Falls (elderly): 32%
- Violence: 14%
- Sports-related: 9%
Approximately 80% of SCI cases are in males, and 20% in females.

Life Expectancy and Spinal Shock

Incomplete SCI (some sensory or motor function remains) often has a longer life expectancy than complete SCI.
Paraplegia: affects 2 limbs, trunk, and pelvic organs.
Tetraplegia: affects all 4 limbs, trunk, and pelvic organs; lower cervical more than higher.
Mortality rates are highest during the first year after injury.
Spinal shock: a period of areflexia following SCI that typically lasts 24 hours but can last for 1 to 4 weeks.

Neurological Classification (ASIA)

The American Spinal Injury Association (ASIA) International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) assesses motor and sensory function.
Evaluates motor and sensory levels bilaterally and sacral tone/sensation to determine:
- Neurologic level of injury (complete or incomplete)
- Zone of partial preservation
Sensory Scale: assesses light touch and pinprick sensation at key points in the body.
Motor Scale: assesses muscle strength in key muscle groups. This is important for function, not level if the lower or higher level doesn't have functional ability.
Grading of Motor and Sensory levels using the 2,1,0 or NT system.

Secondary Complications

Cardiopulmonary: Pneumonia, aspiration, respiratory muscle impairment, pulmonary embolus/deep vein thrombosis, orthostatic hypotension (important in T6 and above—the autonomic nervous system controls blood pressure)
Neurologic: autonomic dysreflexia, tone/spasticity changes, neuropathic pain, and sensory loss.
Musculoskeletal: motor loss, osteoporosis, secondary overuse injuries, and osteomyelitis (bone inflammation).
Psychological: adjustment to trauma and loss; higher risk of depression.
Gastrointestinal/Genitourinary: urinary tract infections (UTIs), reflexive bladder/bowel issues (UMN or LMN), bowel/bladder problems.
Integumentary: pressure injuries (decubitus ulcers) are a high risk.

Types of Settings

Acute care (ICU, hospital floor) and acute rehab (therapy after acute care) are important in getting function back.
Long-term acute care hospitals (LTACH): for patients with chronic wounds or who need ventilation.
Outpatient care: focuses on community reintegration, return to work/sport, prevention of secondary injuries, and overall strengthening/pain management.

Durable Medical Equipment (DME) Considerations

Patients need equipment like wheelchairs, walkers, and adaptive devices.
The ICF Model helps consider the whole person, including environmental factors, personal factors, functioning, and health.

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Description

Explore the complexities of spinal cord injuries, including their causes and impacts on sensory and motor pathways. This quiz covers key aspects of spinal cord anatomy, common injury statistics, and demographic trends. Perfect for students and professionals in health sciences and rehabilitation fields.