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