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36 Cards in this Set

  • Front
  • Back
Most common causes of SCI
1) Vehicular
2) Falls
3) Violence
4) Other
5) Sports
Gender ratio of SCI
Males 80.7%
Age 16-30 is most common
Loss of UE and LE motor and sensory function
Caused by damage to cervical spine
Thoracic or lumbar region
LE loss; loss of trunk control
Zone of partial preservation
Area of motor / sensory function remaining below level of injury
Most common mechanism of injury for c-spine
Teardrop fracture
Can cause SCI when broken piece of vertebral body is pushed into spinal cord
Thoracic SCI - Why is it so rare and what are the most common MOI?
Surrounded by a lot of soft tissue. There is less motion due to ribs.
MOI - Trauma directly to the area: Gunshot wound, stabbing, falling out of tree
Conus medullaris
Spinal cord ends here at L1/L2. Injury to this area is still upper motor neuron injury.
Cauda equina
Lower motor neuron injury.
Saddle parasthesias
ASIA key muscle groups
C5 - Biceps
C6 - Wrist extensors
C7 - Elbow extensors
C8 - Finger flexors
T1 - Finger abductors

L2 - Hip flexors
L3 - Knee extensors
L4 - Ankle DF
L5 - Long toe extensors
S1 - Ankle PF
Central cord syndrome
Loss of UE > lower extremity
Tends to occur following extension injury to c-spine & is incomplete.
Anterior cord syndrome
Loss of bilateral pain, temp, and motor control
Retain proprioception & light touch
Posterior cord syndrome
Loss of proprioception & light touch
Brown-Sequard syndrome
Common following penetrating injuries
Loss of movement and proprioception ipsilaterally
Loss of pain on opposite site
Posterior cord syndrome
Very rare
Caused by compression via tumor or infarction
Motor function preserved
Sensory lost below level of injury
Cauda Equina syndrome
Injury to L1 and below can cause this.
Lower motor neuron injury, so there will be flaccidity and atrophy, not spasticity.
Typically a complete lesion
Ambulation is probable due to likely preservation of quadriceps muscles
Conus medullaris syndrome
Injury to sacral cord & lumbar nerve root
Areflexive bowel & bladder function
LE motor and sensory loss
Areflexive Bowel
Disruption of the sacral arc causes loss of parasympathetic defecation reflex. Internal anal sphincter remains active, external sphincter is flaccid.
Lower motor neuron injury, usually T10-12 and below
No sphincter tone.
Managed by timing, fiber intake, and decreased fluid intake
Reflexive Bowel
Sacral reflexes remain intact, but descending input is lost. Reflexive defecation occurs when the rectum fills.
Good sphincter tone, so stool retention is possible
Usually injury is higher than T10-12
Managed with digital stimulation program, or suppository
Bulbocavernosus reflex
Used to determine bowel status. Tug on catheter and look for anal sphincter contraction (+).
Normal bladder physiology
Pressure increases as bladder fills ->
impulses from stretch receptors sent to sacral cord ->
bladder contracts ->
impulses to brain to relax the inhibitory signal ->
external sphincter relaxes ->
Reflexive bladder
UMN injury, T10-12 and above
Voiding is involuntary and incomplete.
External collection devices to measure quantity, intermittent catheterizations, medications.
Condom cath, suprapubic catheter
Areflexive bladder
Lower motor neuron injury.
T10-T12 and below.
Reflex arc is lost that normally voids urine
Bladder overfills and overdistends
Overflow and stress invontinence may occur
Intermittent catheterization, regular emptying schedule
Categories of SCI at discharge
Incomplete tetraplegia (38.3%)
Complete paraplegia (22.9%)
Incomplete paraplegia (21.5%)
Complete tetraplegia (16.9%)
5 Most common levels of injury
C5: 14.9% one of the most mobile
C4: 13.6%
C6: 10.8%
T12: 6.7%
C7: 5.3%
If pt has quadriceps strength of 3+ or greater, they can use AFO instead of KAFO.
Creating bladder program for reflexive bladder
- Voiding is involuntary and incomplete
- Adjust oral liquid intake
- Assess concurrent medical conditions and current medications
- Avoid indwelling catheter because bladder will shrink
- Want a low residual urine volume
- Use external collection devices and intermittent cath.
Creating bladder program for reflexive bladder
Lower motor neuron injury
T12 or below, or spinal shock
Reflex arc is lost, bladder overfills and overdistends
Overflow and stress incontinence may occur.
- Use regular emptying schedule, keep volume below 500cc
Bladder program: functional expectations
C1-C5: Dependant
C6: Min-Mod Assist for males, max assist-dependant for females
C7-C8: min - independant for males, mod to max for females
Male paras: ind
Female paras: modified ind/min-assist
Seating and Mobility
Identify optimal posture for wheelchair
- Flexible vs non-flexible deformities: correct for flexible, accommodate for non-flexible
- Consider pressure distribution
- Promote stability
Wheelchair seating goal
Symmetrical, midline posture
Maximum comfort
Reduce spasticity
Pressure distribution
Improve sitting balance and head control as well as volitional control of extremities
Allow for ADL completion
Ideal pelvic alignment
Neutral to slight anterior tilt
Not rotated
Lower extremity alignment in WC
90 degrees of hip and knee flexion
Neutral ankle DF, inv/ev
Hanger / Hanger angle
Bar that foot plate is attached to
Increasing angle: decreases chair length and turning radius, improves knee flexion angle
Decreasing angle: Increases foot/ground clearance
The small tires
Larger for less rolling resistance, better for rough terrain
Smaller for easier turning