1
Q
Describe Tetraplegia.
A
Impairment or loss of motor and/or sensory function in the cervical segments of SC l/t impairment of function in arms, trunk, legs, and pelvic organs
2
Q
Describe Paraplegia.
A
Impairment or loss of motor and/or sensory function in thoracic, lumbar, or sacral segments of SC l/t Trunk, legs, and pelvic organs involved
3
Q
What is a dermatome?
A
Area of skin innervated by the sensory axons within each segmental nerve (root)
4
Q
What is a myotome?
A
Collection of muscle fibers innervated by the motor axons within each segmental nerve (root)
5
Q
Describe the innervation of an UMN injury.
A
Begins in the prefrontal motor cortex, travels through the internal capsule and brainstem, and projects into the spinal cord
6
Q
Describe clinical findings of an UMN injury.
A
Hyperreflexia
Pathologic reflexes
Detrusor sphincter dyssynergia (depending on level of lesions)
7
Q
Describe the innervation of an LMN injury.
A
Begins with the anterior horn cells of the spinal cord and includes the peripheral nerves
8
Q
Describe clinical findings of an LMN injury.
A
Hyporeflexia
Flaccid weakness
Significant muscle atrophy
Areflexic/hypotonic bladder
9
Q
How many dermatomes are tested during an ASIA exam?
A
28 key dermatomes
10
Q
Describe the 3-point scale is used to score light touch sensation.
A
0: Absent sensation
1: Impaired—light touch is felt but less than on the face
2: Normal—same as on the face
11
Q
Describe the 3-point scale is used to score pinprick sensation.
A
0: No sensation at all or unable to differentiate between the sharp and dull edge
1: The pin is not felt as sharp as on the face, but able to differentiate sharp from dull
2: Pin is felt as sharp as on the face
12
Q
What levels distinguish b/w neurologic complete and incomplete injury?
A
S4–S5 dermatome for light touch and pinprick sensation
13
Q
How is the sensory level of injury determined?
A
Most caudal segment of the spinal cord with normal (2/2 score) sensory function on both sides of the body for both pinprick and light touch sensation
14
Q
How is the motor level of injury determined?
A
Most caudal key muscle group that is graded ≥3/5 with all the segments above graded 5/5 in strength. Motor level can be determined for each side of the body.
15
Q
How is the neurologic level of injury determined?
A
Most caudal segment of the spinal cord with both normal sensory and motor function ≥ 3/5 with cephalad segments graded 5/5 on both sides of the body
16
Q
How is the neurologic level of injury determined if there is no corresponding testable motor function?
A
NLI is that which corresponds to the sensory level, if testable motor function above that level is also normal
17
Q
What is the zone of partial preservation (ZPP)?
A
Used with neurological complete lesions and refers to the dermatomes and myotomes caudal to the NLI that remain partially innervated
18
Q
Describe an ASIA A SCI.
A
Complete
No motor or sensory function is preserved in the S4–S5 segments
19
Q
Describe an ASIA B SCI.
A
Incomplete
Sensory but not motor function is preserved below the neurological level and includes intact S4–S5 segments and no motor function is preserved more than 3 levels below the motor level on either side of the body.
20
Q
Describe an ASIA C SCI.
A
Incomplete
Motor function is preserved below the neurological level and more than half of the key muscles below the neurological level have a muscle grade <3 (grades 0–2)
21
Q
Describe an ASIA D SCI.
A
Incomplete
Motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade >3.
22
Q
Describe an ASIA E SCI.
A
If sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the patient had prior deficits, then the AIS grade is E
23
Q
What is spinal shock?
A
Temporary loss or depression of all spinal reflex activity below the level of the lesion
24
Q
Describe a delayed plantar response.
A
Stroking the sole of the foot with deep pressure and delayed toes flex and then relax slowly
25
Q
What is a persistent delayed plantar response associated with?
A
High correlation with complete injuries with poor prognosis for lower extremity (LE) recovery.
26
Q
Describe a Bulbocavernosus reflex.
A
Squeezing the tip of the penis, the cl*tor*s or tugging on a Foley catheter and noting stimulation of anal sphincter contraction
27
Q
What does a Bulbocavernosus reflex or Perianal sphincter reflex indicate?
A
UMN injury and that reflex innervation of bowel and bladder is intact
28
Q
What does an absent Bulbocavernosus reflex or Perianal sphincter reflex indicate after 24 hours from injury?
A
LMN injury may be suspected
29
Q
Describe a Perianal sphincter reflex (anal wink).
A
Perianal stimulation causes contraction of the anal sphincter
30
Q
What is the typical duration of spinal shock?
A
24 hours
31
Q
What is the typical order of reflex return after spinal shock?
A
Delayed plantar response
Bulbocavernosus reflex and anal wink
Muscle stretch reflexes return after 2 to 3 weeks
32
Q
What is the MC incomplete SCI syndrome?
A
Central cord syndrome
33
Q
Describe Central cord syndrome.
A
Sacral sensory sparing
Motor weakness in the upper>lower limbs
Variable loss of sensation, bowel, and bladder function
34
Q
What is the MC population of Central cord syndrome?
A
Older patients with cervical spondylosis who sustain a hyperextension injury, usually from a fall.
35
Q
Describe the order of recovery of Central cord syndrome.
A
LEs recover first and to a greater extent
Bladder function
Proximal UE
Intrinsic hand function
36
Q
What age indicates a positive prognostic indicator for recovery in central cord syndrome?
37
Q
What causes Brown-Séquard Syndrome?
A
Hemisection of the spinal cord classically with stabbing
38
Q
Describe the presentation of Brown-Séquard Syndrome.
A
Ipsilateral motor, sensory and proprioceptive loss, and contralateral loss of pain and temperature
39
Q
What causes an anterior Cord Syndrome?
A
A lesion affecting the anterior 2/3 of the spinal cord while preserving the posterior columns
40
Q
Describe the presentation of anterior Cord Syndrome.
A
Loss of motor function, sensitivity to pain/temp, and pinprick sensation, with preservation of proprioception and light touch and deep pressure sensation
41
Q
Describe Posterior cord syndrome.
A
Injury to the posterior columns results in proprioceptive loss with muscle strength, pain, and temperature modalities spared
42
Q
What is the level of injury of Conus Medullaris syndrome?
A
T12–L1–L2 vertebral level injury of sacral cord and lumbosacral nerve roots
43
Q
What are cause of Conus Medullaris syndrome?
A
- T12–L1 fracture
- Tumors, gliomas
- Vascular injury
- Spina bifida, tethering of the cord
44
Q
What is the clinical presentation of Conus Medullaris syndrome?
A
- Normal motor function of LEs unless S1–S2 motor involvement. LMN lesion with lumbar root.
- Saddle anesthesia
- Pain is not a significant factor
- Symmetric ABN
- Bowel, bladder, and sexual dysfunction may occur.
- If a high conus lesion, bulbocavernosus reflex may be present
- May be hyperreflexic.
45
Q
What is seen on EMG in Conus Medullaris syndrome?
A
Normal EMG (except for external sphincter or S1, S2 involvement)
46
Q
What is the level of injury of Cauda equina syndrome?
A
Below L1–L2 to sacrum vertebral level injury of lumbosacral nerve roots
47
Q
What are cause of Cauda equina syndrome?
A
- Fracture at L1–L2 or below
- Sacral fractures
- Fracture of pelvic ring
- Can be associated with spondylosis
48
Q
What is the clinical presentation of Cauda equina syndrome?
A
- LMN lesion, Flaccid paralysis and areflexia of involved lumbosacral nerve roots
- Sensory loss in root distribution
- Pain is a more significant feature
- ABN asymmetric
- High cauda equina lesions (lumbar roots) spare bowel and bladder.
Lower lesions (S3–S5) causes areflexic bowel, bladder, and sexual dysfunction. - Bulbocavernosus reflex is absent (in low cauda equina [sacral] lesions)
- Hyporeflexia or areflexia in affected muscle groups
49
Q
What is seen on EMG in Cauda equina syndrome?
A
Findings show multiple root level involvement Prognosis: Good
50
Q
Describe Functional potential outcomes of ADL’s for C1-C4 SCI.
A
Feeding: DependentGrooming: DependentUBD: DependentLBD: DependentBathing: DependentB/B: Dependent
51
Q
Describe Functional potential outcomes of transfers for C1-C4 SCI.
A
Bed mobility: Dep
Weight shifts: Indep in power WC, Dep in manual WC
Transfers: Dep
52
Q
Describe Functional potential outcomes of mobility for C1-C4 SCI.
A
WC: Indep in power WC, Dep in manual WC
Driving: unable
53
Q
Describe Functional potential outcomes of ADL’s for C5 SCI.
A
Feeding: mod I w/ equip and set upGrooming: min A w/ equip and set upUBD: assistanceLBD: DepBathing: max-mod AB/B: Dep
54
Q
Describe Functional potential outcomes of transfers for C5 SCI.
A
Bed mobility: max-mod A
Weight shifts: assist unless power WC
Transfers: max-mod A
55
Q
Describe Functional potential outcomes of mobility for C5 SCI.
A
WC: Indep in power; Mod-I in manual w/ adaptations on level surfaces
Driving: Mod-I w/ adaptations
56
Q
Describe Functional potential outcomes of ADL’s for C6 SCI.
A
Feeding: Mod-I w/ equipGrooming: CG to Mod-I w/ equipUBD: Mod-I LBD: some assisatnceBathing: Min A w/ equipB/B: Mod-I w/ equip
57
Q
Describe Functional potential outcomes of transfers for C6 SCI.
A
Bed mobility: CG
Weight shifts: indep
Transfers: CG on level surfaces
58
Q
Describe Functional potential outcomes of mobility for C6 SCI.
A
WC: Indep w/ manual WC w/ coated rims on level surfaces
Driving: mod I w/ adaptations
59
Q
Describe Functional potential outcomes of ADL’s for C7 SCI.
A
Feeding: IndepGrooming: mod I w/ adaptationsUBD: IndepLBD: Mod I to CGBathing: CG to mod IB/B: Indep
60
Q
Describe Functional potential outcomes of transfers for C7 SCI.
A
Bed mobility: Mod I
Weight shifts: Indep
Transfers: Indep w/ or w/o board for level surfaces
61
Q
Describe Functional potential outcomes of mobility for C7 SCI.
A
WC: Independent except for curbs and uneven terrain
Driving: Car with hand controls or adapted van
62
Q
Describe Functional potential outcomes of ADL’s for C8-T1 SCI.
A
Feeding: IndepGrooming: IndepUBD: IndepLBD: usually IndepBathing: mod IB/B: Indep
63
Q
Describe Functional potential outcomes of transfers for C8-T1 SCI.
A
Bed mobility: Indep
Weight shifts: Indep
Transfers: Indep
64
Q
Describe Functional potential outcomes of mobility for C8-T1 SCI.
A
WC: Indep
Driving: Car w/ hand control or adapted van
65
Q
Describe ambulation potential for T2-T9 SCI.
A
Standing in frame
Tilt table
Standing wheelchair
Exercise only
66
Q
Describe ambulation potential for T10-L2 SCI.
A
Household ambulation with orthoses
Can trial ambulation outdoors
67
Q
Describe ambulation potential for L3-L5 SCI.
A
Community ambulation is possible
68
Q
Describe braces for T2-T9 SCI.
A
Bilateral KAFO forearm crutches or walker
69
Q
Describe braces for T10-L2 SCI.
A
KAFOs forearm crutches or walker
70
Q
Describe braces for L3-L5 SCI.
A
Possibly KAFO or AFOs, with canes/crutches
71
Q
What is the highest complete SCI that can live independently w/o aid of an attendant?
A
C6 in an extremely motivated patient
72
Q
What is the usual level of SCI for achieving independence?
A
C7 SCI
