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N SCI

notes from lecture

TermDefinition
sci causes- traumatic falls, violence & sports related
non-trauma congenital-spina bifida, tumor, vascualar (hemorrhage or clot), protruding disc, infection (transverse myelitis), neurological dx, jt subluxation 2nd to RA/OA, severe scoliosis
quadriplegia, quadriparesis, tetraplegia injury to cervical region of spine
paraplegia, paraparesis injury to thoracic spine, usually have UE funtion
level of lesion ways to remember what functional impairment pt is at. different levels- usually determined by dermatome test- most caudel segment w/ normal sensory & motor function. 3/5 =normal
oblique injuries some mm innervated by more than one segment-look for lowest level w/function
complete sensory & motor function absent below level of injury & also S4 & S5
incomplete some sensory or motor function below level of injury & also in S4 & S5
Brown Sequard one side- like stabbing or gunshot wound- motor, proprioception & vibration lost on ipsilateral (same) side, on contralateral (opposite side)- pn & temp perception lost
ant cord syndrome front- cv flex injury- sudden jerk to head-lose motor, pn & temp bilaterally-proprioception & vibration intact
post cord syndrom (dorsal column syndrome) rare-lose proprioception & vibration bilaterally-tumor or vascular cause
central cord syndrome caused by hyperext or compression injury- have more deficit in UE than LE-typically have bowel, bladder & sexual function intact-most common
SCI incomplete classifications sacral sparing, cauda equina, root escape
sacral sparing intact perianal sensation, can flex big toe, rectal sphincter control
cauda equina below L1 vertebra-incomplete or motor neuron lesion
root escape return of some nerve root function- peripheral nerve not spinal cord function
SCI damage - boney fx, subluxation, dislocation, most common: C1 & C2, C5-C7, T12-L2-spinal cord larger in those areas and have more rotation so not as stable
SCI damage- tissue damage compression, stretch, tear, shear, transection (prob that includes destruction of gray and white matter). secondary-inflammation, edema, hemorrhage
SCI damage mechanisms flex/rotation usually cv area-most common MVA- head goes fwd & turns-rupture post spinal lig & disc- cork transection usually-usually complete lesion
SCI damage mechanisms flexion result of head on MVA or getting hit in back of head- stretches post ligament & usually causes ant compression fx-often incomplete
SCI damage mechanisms hyperextension from being rear ended or if fall & hit chin- ruptures ant longitudinal lig & disc- results in central cord inj
SCI damage mechanisms compression diving or falling-causes compression fx- burst fx
SCI clinical pic/ below the level of lesion loss of voluntary mm control, spasticity, loss of sensation, respiratory, autonomic, loss of bowel & bladder control S2,3,4, sexual dysfunction
spasticity increases w/cv injury or incomplete- ext tone dominant, synergies, rx same as other spasticity
respiratory C1-3 phrenic nerve (diaphragm not functioning), ventilator, internal/external intercostals (need for inspiration-may or may not have, depends on level of lesion), forced exp/cough (ext intercost, abd), accessory breathing, trauma, infection
autonomic sypethetic instability, vasodilation/ constriction, sweating
loss of bowel & bladder control S2,3,4 bladder spastic or flaccid (initially flaccid due to spinal shock), bladder trning (goal-free of cath)
bladder trning indwelling suprapubic (inserted thru abd wall), leg bags. trning may be intermittent.
crede maneuver application of manual pressure over bladder to empty
emptying schedules inj abv S2 spastic-bladder empties reflexively bc sacral reflex intact/injury S2,3,4 flaccid- requires manual
bowel- S4 & S5 innervate bowels may need suppositories, hi fiber diet, adequate fluid intake, digital stimulation
male sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) reflex erection, poor ejaculation, poor fertility
female sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) mensis preserved, fertility preserved, C-section
SCI Clinical Pic Secondary Complications (partial list) pressure sores, respiratory (ventilator, tracheostomy, need RT, postural drng, infection, not much coughing), urinary, UTI (most common recurring prob), loss of kidney function (kidney failure & stones), contractures, osteoporosis
SCI Clinical Pic Secondary Complications (autonomic dysreflexia) injury abv T6, sudden severe HTN 2nd to: bladder distention, bowel impaction, pressure sore, kidney malfunction, abn position of body part, pn
S&S of autonomic dysreflexia severe HA, restless, HTN, decreased HR, c/o chest tightness, face flushed, pupils constricted, blurred vision, runny nose, sweating, chill bumps (piloerection), vasodilation above, constriction below
Rx of autonomic dysreflexia ID cause (often kinked/blocked cath or position) and rx, monitor BP, sit up, notify medical staff-may require medication to decrease BP
SCI Clinical Pic Secondary Complications (cont) orthostatic HTN, hetertrophic ossification, DVT's, sharp acute pn & chronic pn, phantom pn, pn from overuse, reaction to disability
Hetertrophic ossification bone dev in soft tissue, most likely in hip, pn w/mvmt, acute inflammation, fever, get x-ray to look for extra bone, rx w/didronel, keep moving, sx
emergency care ID possible SCI & immobilize
skeletal tx (CV)- halo-12 weeks, special bed (stryker, rotobed) bed they can lay in & be turned (strapped in-can go all the way to prone)
CV brace halo x 12 wks, don't adjust screws or take off, leads to rigid cv collar- may or may not have, depends on severity
Thoracic/lumbar brace body jacket x 3 months (like a shell)- precautions-bed flat- if sitting up, need jacket on, tee shirt under, log roll, monitor for pressure sores
SCI acute management sx fusion/bone graft, decompression laminectomy, ORIF w/ Harrington rods, wires, screws
Created by: jessigirrl4