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TBI/SCI

NPTE Neuromuscular

QuestionAnswer
Diffuse axonal injury disruption/tearing of axions and small blood vessels from shear strain of angular acceleration
Focal injury contusions, lac, mass effect from hemorrhage and edema
Coup-contracoup injury injury at point of impact and opposite side of impact
Hypoxic-ischemic injury systemic problems that compromise cerebral circulation
Loss of consciousness resulting from blow to head concussion
Mild concussion syndrome momentary LOC, maybe retrograde amnesia
Classic concussion LOC transient within 24h, retrograde and post traumatic amnesia
Severe concussion LOC for >24hr, diffuse axonal injury & coma
Glasgow Coma Scale 3-8 severe, 9-12 moderate, 13-15 mild
Primary injury in SCI interruption of blood supply
Secondary injuries in SCI ischemia, edema, demyelination, necrosis of axons, progressing to scar tissue formation
Lesion level indicates most distal uninvolved nerve root segment with normal function (3+/5)
Tetraplegia C1-C8, all extremities and trunk
Paraplegia T1-T12/L1, B LEs and trunk
Complete SCI no sensory or motor function below level of lesion
Incomplete SCI preservation of sensory or motor fxn below level of injury, spotty sensation and motor fxn
ASIA A complete, no motor or sensory fxn preserved in S4-5
ASIA B Incomplete, sensory but not motor fxn preserved below level and includes S4-5
ASIA C Incomplete, motor fxn preserved below level, most key muscles below level have grade <3/5
ASIA D Incomplete, motor fxn preserved below level, most key muscles below level have grade > or = 3/5
ASIA E Normal, motor and sensory function normal
Anterior cord syndrome loss of motor, pain, temperature. Preserved light touch, proprioception, position sense
Brown-Sequard syndrome IL weakness and loss of position & vibratory sense, CL pain and temperature a few segments below level of lesion
Central cord syndrome loss of centrally located cervical and arm tracts with preservation of more peripheral lumbar, sacral, leg tracts. Early loss of pain and temperature
Cauda Equina below L1. Sensory loss and paralysis with some capacity for regeneration. LMN. Autonomous or nonreflex bladder.
Sacral sparing sparing of tracts to sacral segments, preserves perianal sensation, rectal sphincter tone, active toe flexion
Respiratory insufficiency or failure occurs in lesions above C4 , phrenic nerve, C3-5 innervates diaphragm
Spinal shock transient period of reflex depression and flaccidity, hours up to 24wk
Autonomic dysreflexia EMERGENCY. Noxious stimuli PPT an autonomic reflex. S/S paroxysmal HTN, bradycardia, HA, diaphoresis, flushing, diplopia, convulsions
Immediate tx for Autonomic dysreflexia examine for stimuli, check catheter, elevate head
W/C for C1-C4 electric W/C, tilt in space, microswitch or puff&sip, respirator can be attached
W/C for C5 Shoulder fxn and elbow flexion intact
W/C for C6 Has radial wrist extensors. Manual w/c with friction hand rims, independent
W/C for C7 has triceps. Manual w/c, same as C6 but more propulsion
W/C for C8-T1 and below has hand function. Manual w/c with standard rims
Amb/orthotics for T6-9 sup amb for short distances, bilat KAFOs & crutches, Swing To gait
Amb/orthotics for T12-L3 ind in amb on all surfaces/stairs. Swing through or 4-pt gait, Bilat KAFOs and crutches. May also use RGOs. Ind HH amb, w/c use for community.
Amb/orthotics for L4-5 Indep amb with Bilat AFOs and crutches/canes. Ind commun amb
CV endurance training precautions with SCI tetraplegia and high para’s have blunted tachycardia, lack of pressor response, low VO2 peak
Contraindications to exercise with SCI Autonomic dysreflexia, skin infected, hypotension, UTI, uncontrolled spasticity or pain, unstable Fx, hot/humid environ
Created by: Jenwithonen on 2009-08-08



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