notes from lecture
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| sci causes- traumatic | falls, violence & sports related
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| 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
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| quadriplegia, quadriparesis, tetraplegia | injury to cervical region of spine
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| paraplegia, paraparesis | injury to thoracic spine, usually have UE funtion
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| 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
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| oblique injuries | some mm innervated by more than one segment-look for lowest level w/function
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| complete | sensory & motor function absent below level of injury & also S4 & S5
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| incomplete | some sensory or motor function below level of injury & also in S4 & S5
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| 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
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| ant cord syndrome | front- cv flex injury- sudden jerk to head-lose motor, pn & temp bilaterally-proprioception & vibration intact
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| post cord syndrom (dorsal column syndrome) | rare-lose proprioception & vibration bilaterally-tumor or vascular cause
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| 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
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| SCI incomplete classifications | sacral sparing, cauda equina, root escape
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| sacral sparing | intact perianal sensation, can flex big toe, rectal sphincter control
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| cauda equina | below L1 vertebra-incomplete or motor neuron lesion
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| root escape | return of some nerve root function- peripheral nerve not spinal cord function
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| 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
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| SCI damage- tissue damage | compression, stretch, tear, shear, transection (prob that includes destruction of gray and white matter). secondary-inflammation, edema, hemorrhage
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| 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
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| 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
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| SCI damage mechanisms hyperextension | from being rear ended or if fall & hit chin- ruptures ant longitudinal lig & disc- results in central cord inj
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| SCI damage mechanisms compression | diving or falling-causes compression fx- burst fx
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| 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
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| spasticity | increases w/cv injury or incomplete- ext tone dominant, synergies, rx same as other spasticity
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| 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
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| autonomic | sypethetic instability, vasodilation/ constriction, sweating
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| loss of bowel & bladder control S2,3,4 | bladder spastic or flaccid (initially flaccid due to spinal shock), bladder trning (goal-free of cath)
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| bladder trning indwelling | suprapubic (inserted thru abd wall), leg bags. trning may be intermittent.
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| crede maneuver | application of manual pressure over bladder to empty
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| emptying schedules | inj abv S2 spastic-bladder empties reflexively bc sacral reflex intact/injury S2,3,4 flaccid- requires manual
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| bowel- S4 & S5 innervate bowels | may need suppositories, hi fiber diet, adequate fluid intake, digital stimulation
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| male sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) | reflex erection, poor ejaculation, poor fertility
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| female sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) | mensis preserved, fertility preserved, C-section
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| emergency care | ID possible SCI & immobilize
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| 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)
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| 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
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| 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
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| SCI acute management sx | fusion/bone graft, decompression laminectomy, ORIF w/ Harrington rods, wires, screws
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