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What does lesion level indicate? Most distal uninvolved nerve root segment with normal function MMT 3+/5
Characteristics of UMN lesion. Hypertonia Hyperreflexia Spacticity CNS
Characteristics of LMN lesion. Hypotonia Hyporeflexia Flaccidity PNS
Central Cord losses UE > LE involvement Motor > Sensory
Central Cord Complete Preservation Sacral tracts Normal Sexual Function B & B
Type of injury sustained from Central Cord Hyperextension (less common)
Type of injury sustained from Anterior Cord Flexion Injury
Anterior Cord losses Motor function (Corticospinal tract) Pain and Temp (spinothalamic tract)
Generally Preserved in Anterior Cord injury Proprioception Kinesthesia Vibration Sense
Sign of Corticospinal tract damage Positive Babinski
Level of Cauda Equina L1 or below
Syndrome associated with LMN and potential to regenerate Cauda Equina (full innervation not typical)
Frequently incomplete due to large number of nerve roots Cauda Equina
Cord level associated with tetraplegia/quadraplegia C1 - C8
Cord level associated with Paraplegia T1 - T12
Involving bilateral LE and varying trunk levels Paraplegia
Common SCI mechanisms of injury Flexion (most Common) Flexion Rotation (most common cervical injury) Compression Hyperextension
Mode of injury associated with Brown-Sequard syndrome Gunshot or stabbing
Presents with ipsilateral loss of sensation in corresponding dermatome Brown-Sequard
Decreases associated with Brown-Sequard reflexes, proprioception, kinesthesia, vibration
Lateral Dorsal Column injury Brown-Sequard
Syndrome presenting with clonus and/or positive Babinski Brown-Sequard
Cause associated with Central Cord syndrome Progressive stenosis or hyperextension injury
Cause of Posterior/Dorsal Cord Syndrome Compression of posterior spinal artery by tumor or vascular infarction (Rare)
Intact functions of Posterior Syndrome Motor, light touch and pain
Losses associated with Posterior Syndrome Proprioception and Somatic sensation i.e. 2 point discrimination and graphesthesia
S & S of Sacral Sparing Perianal Sensation and external anal sphincter contraction
Explain Sacral Sparing Occurs in incomplete injuries. Because sacral tracts run most medially within spinal cord, they are often salvaged. Patients may be able to flex great toe and have B&B control.
Most caudal segment with some sensory or motor function (or both) and applies to complete injuries only. Zone of partial preservation
Asia Scale Level and Key Muscles C5 Elbow Flexors C6 Wrist Extensors C7 Elbow Extensors C8 Finger Flexors T1 Finger Abductors L2 Hip Flexors L3 Knee Extensors L4 Dorsiflexors L5 Big Toe Extensors S1 Ankle Plantar Flexors
Asia Impairment Scale A = Complete - no motor/sensory S4-5 B = Incomplete - sensory in S4-5 C = Incomplete - Motor preserved,> 50% key muscles have grade < 3 D = Incomplete - Motor preserved, 50% key muscles grade 3 or more E = Normal
Muscles and Functional Expectations C1,2,3 Facial muscles , SCM, upper traps I= Power WC Total dependence ADL's Requires Ventilator
Muscles and Functional Expectations C4 Diaphragm and Upper Traps Power WC w/chin cup or mouth stick Total dependence ADL's Glossopharyngeal Breathing
Muscles and Functional Expectations T4-6 Top 1/2 of intercostals, erector spine, semispinalis I in all areas: Bed skills, WC transfers, Housekeeping
Muscles and Functional Expectations T9-12 Abdominals and all intercostals Household Ambulation with AD - KAFO/crutches/walker I WC mobility
Created by: ginainfusino