Nbcot Review Ch 5: Spinal Cord Injury

Front 1

What is the ASIA Impairment Scale?

Back 1

A scale that grades the degree of impairment and severity of injury of a patient.

Front 2

What is ASIA A?

Back 2

Complete SCI, no sensory or motor function preserved in the sacral segments S4-S5.

Front 3

What is ASIA B?

Back 3

Incomplete SCI, sensory but no motor function preserved below the neurological level, and extends through the sacral segments.

Front 4

What is ASIA C?

Back 4

Incomplete SCI, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade level than 3/5.

Front 5

What is ASIA D?

Back 5

Incomplete SCI, motor function preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade greater than or equal to 3/5.

Front 6

What is ASIA E?

Back 6

Normal, no SCI. Sensory and motor function are normal.

Front 7

Discuss 8 key symptoms that often arise with SCI.

Back 7

1. Spinal shock (4-8 weeks), all reflex activity obliterated below level of injury presenting as flaccid paralysis
2. Sensory deficits may be partial loss or complete
3. Loss of bowel/bladder control
4. Loss of temperature control below the lesion
5. Decreased respiratory function.
6. Sexual dysfunction
7. Changes in muscle tone
- Spasticity in UMN lesions
- Flaccidity in lesions below L1
8. Loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia; may be complete or incomplete

Front 8

Discuss complications that arise with SCI.

Back 8

1. Respiratory, decreased vital capacity, pneumonia
2. Decubitus ulcers
3. Orthostatic Hypotension: excessive fall in BP when assuming upright position, light-headedness, dizziness, sudden weakness (usually occurs at T6 and above)
4. DVT
5. Autonomic Dysreflexia: exaggerated response of ANS, body's way of telling something is wrong below level of injury: resulting in extreme rise in BP, pounding headache, profuse sweating. A medical emergency if not reversed quickly.
6. UTI
7. Heterotopic ossofication: formation of bone in abnormal anatomical locations.

Front 9

List the types of SCI disease.

Back 9

Central cord syndrome
Brown-Sequard syndrome
Anterior cord syndrome
Conus medullaris syndrome
Cauda equina syndrome

Front 10

Central Cord Syndrome (Syringomyelia)

Back 10

- Most common form of Incomplete SCI
- Commonly occurs in elderly with narrowing/stenotic changes in the spinal canal (of the neck) related to arthritis and hyper extension of the neck
- Bilateral loss of pain and temperature
- Flaccidity of the UE (affects UE more than LE)

Front 11

Brown-Sequard Syndrome.

Back 11

- Hemi-section of the cord resulting in ipsilateral (same side) spastic paralysis and loss of position sense and contralateral (opposite side) loss of pain and thermal sense.

Front 12

Anterior Cord Syndrome.

Back 12

- caused by flexion injuries
- occurs when 2/3 of the anterior cord is lost
- motor function, pain, and temperature sensation lost bilaterally below the lesion (flaccidity below the lesion)

Front 13

Conus Medullaris Syndrome.

Back 13

- of the sacral cord and lumbar nerve roots
- results in LE motor and sensory loss and reflexic bowel and bladder (ability to void only possible by reflex)

Front 14

Cauda Equina Syndrome.

Back 14

- Injury at the L1 level and below
- results in LMN lesion
- flaccid paralysis with no spinal reflex activity

Front 15

Upper Motor Neuron Lesion

Back 15

- Includes all SCI injuries and diseases that affect the cord between the levels of C1 - T12.

Front 16

Signs of UMN Lesion.

Back 16

Below the lesion level:
- Spasticity
- Clonus
At the lesion level:
- Flaccidity

Front 17

Lower Motor Neuron Lesion

Back 17

- Carries motor information to skeletal muscles.
- Lesions at the L1 vertebra and lower are LMN injuries.
- All lesions to peripheral nerves are also considered LMN injuries.

Front 18

Signs of LMN Lesion.

Back 18

- Flaccidity
- Hyporeflexia
- Within a few weeks of LMN injury, muscles begin to atrophy.

Front 19

Group the levels of SCI as they are grouped according to functional ability.

Back 19

C1-C3
C4
C5
C6
C7
C8-T1
T1-T6
T6-T12
T12-L4
L4-L5

Front 20

Sexual function in SCI

Back 20

- Mediated by S2-S4 segments of SC.
T11-L2 responsible for sexual arousal due to mental stimulation (psychogenic response)
S2-S4 responsible for sexual arousal due to touch (reflexogenic response)
*In T12/L1 or higher SCI (UMN injury):
- Pt still has sexual arousal due to touch but not mental stimulation
*In L2-S1 (LMN injury):
- Pt has sexual arousal from touch (cannot feel erection/lubrication) and mental stimulation

Front 21

Disorders of Bladder Function in SCI

Back 21

UMN Lesion:
- Spastic bladder: no voluntary control of voiding but can still have involuntary voiding reflexes, which can cause incontinence and inability to completely empty the bladder
LMN Lesion:
- Flaccid bladder: cannot void voluntarily or involuntarily, urine leakage occurs

Front 22

Disorders of Bowel Function in SCI

Back 22

SCI above S2-S4:
- Pt has spastic defecation reflex
- loses voluntary control of the external anal sphincter but can still defecate with involuntary stimulation
SCI at the S2-S4 level
- Pt has flaccid defecation reflex (peristaltic movements cannot evacuate the stool)
- loses anal sphincter tone

Front 23

Medical management for SCI.

Back 23

1. Prevention of further cord damage by stabilization
2. Traction, rest for unstable injuries
3. Surgery with IF
4. Diuretic prescription to decrease inflammation
5. Bladder care
6. Decubiti prevention
7. Control of Autonomid Dysreflexia and OH
8. Prevention of thrombus (blood clot) formation
9. Treatment for heterotopic ossification