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Review of Spinal cord Injuries & Treatment

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Question
Answer
Lumbar Level of Most Common SCI   L1-L2  
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Define Spinal Shock   Temporary phenomenon that occurs after trauma to SC in which cord ceases to function below lesion; usually resolves within 24 hrs of injury  
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Designation of spinal level   Defined as the most caudal level of SC that exhibits intact sensory & motor function; muscles must have grade 3+/5 strength  
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Define Complete Lesion   Total & permanent functional disruption of SC more than 3 segments below level of lesion  
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Define Incomplete Lesion   SC is not totally disrupted at level of injury; preservation of some function more than 3 levels below lesion  
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Describe presentation of Brown-Sequard Lesion   Hemisection of cord; IPSI motor weakness/paralysis, loss of proprioception, two-point touch and CONTRA loss of pain & temperature  
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Describe presentation of Anterior Cord Lesion   Results from ant trauma to SC or ant spinal artery; loss of motor function & pain & temperature below level of lesion  
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Describe presentation of Central Cord Lesion   Most common cause hyperext injuries; effects UE sensation & motor function with normal LE function  
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Describe presentation of Posterior Cord Lesion   Very rare; deficits of stereognosis, proprioception, 2-point discrimination; Ataxic gait with wide BOS  
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Describe presentation of Cauda Equina Lesion   Injury below L1 segments: Sensory loss, paralysis, loss of B/B function; bc damage to peripheral nerve roots regeneration possible  
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The Diaphragm is innervated by which nerve & it's cord segments.   Phrenic Nerve; C3-C5  
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General effects on Respiratory System following SCI   Decreased Tidal Volume & Vital Capacity; accessory muscles of inhalation may be used more  
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General effects on Cardiac System following SCI   When symp input lost, parasym input remains causing bradycardia, peripheral vasodilation, & hypotension  
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Pressure relief guidelines to prevent pressure sores   Should take place 3-4xs/hr OR every 15-20 minutes regardless of material under pt  
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The most common cause of death following SCI is due to...   Respiratory dysfunction  
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Techniques to prevent DVTs in SCI population   A regular turning program, PROM exercise, elastic stockings & proper positioning of LEs  
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Define Autonomic Dysreflexia   A medical emergency characterized by increase in BP, bradycardia, pounding HA, profuse sweating, and anxiety  
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What is the most common cause of Autonomic Dysreflexia?   Bladder Distention  
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Immediate things to do if pt is experiencing Autonomic Dysreflexia   Check bladder drainage system & open up if necessary. If lying flat, pt should be brought to sitting position to lower BP.  
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Treatment for Postural/Orthostatic Hypotension   Slow progression to vertical while monitoring vitals, use of compression stockings & abdominal binder to minimize effects of hypotension  
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Key muscles in C1-C3 injury   Face & Neck muscles  
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Clinical picture of pt with C1-C3 injury   Capable of talking, mastication, sipping, blowing; Protable ventilator or phrenic stimulator, power "tilt-in-space" WC with mouth control & seatbelt for trunk control  
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Key muscles in C4 injury   Diaphragm & Trapezius  
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Clinical picture of pt with C4 injury   Capable of respiration & shoulder elevation; Chin control WC, adaptive eating equipment, head and mouth stick etc, limited feeding & ADLs, uses glossopharyngeal breath to cough  
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Key muscles in C5 injury   Biceps, Brachialis, Brachioradialis, Deltoids, Infraspinatus, Rhomboids, & Supinator  
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Clinical picture of pt with C5 injury   Power chair with hand controls for community, manual WC with rim projections 200-300 ft indoors, mobile arm supports to assist UEs, needs assistance for manual cough  
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Key muscles in C6 injury   Extensor carpi radialis, Infraspinatus, Lats, Pec Major, Serratus Ant, Teres Minor  
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Clinical picture of pt with C6 injury   Manual WC with projections or friction hand rims, May require power WC for community, can drive auto with hand controls, Tenodesis grip, uses manual cough ind  
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Key muscles in C7 injury   Extensor pollicus longus & brevis, Extrinsic finger extensors, Flexor carpi radialis, Triceps  
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Clinical picture of pt with C7 injury   Capable of elbow ext, wrist flex, finger ext; Manual WC for community with some difficulty on rough terrain, able to get WC in/out car, button hook may be necessary for dressing  
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Key muscles in C8 injury   Extrinsic finger flexors, flexor carpi ulnaris, flexor pollicus longus & brevis  
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Clinical picture of pt with C8 injury   Capable of full use UEs except intrinsic mm of hand; Ind at home except with heavy work, May need tub seat, grab bars etc for full ind at home, Manual WC, Able to work in building free of barriers  
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Key muscles in T1-T5 injury   Top half of intercostals, long back extensors, intrinsic finger flexors  
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Clinical picture of pt with T1-T5 injury   Capable of full use UEs, improved trunk control & resp reserve, Standing table for physiological standing, Manual WC, able to wheelie & participate in WC sports  
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Key muscles in T6-T8 injury   Long muscles of back including sacrospinalis and semispinalis  
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Clinical picture of pt with T6-T8 injury   Capable of improved trunk control, increased respiratory reserve; Ind in swing-to gait parallel bars with Bilat KAFOs & walker/crutches; WC for community amb  
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Key muscles in T9-T12 injury   Lower abdominals & all intercostals  
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Clinical picture of pt with T9-T12   Capable of incr endurance & improved trunk control; Ind floor-WC transfers, swing-to/thru gait with bilat KAFOs & forearm crutches level surfaces, may be ind home amb, may use WC for community & energy conserv  
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Key muscles in T12-L3 injury   Gracilis, Iliopsoas, QL, Rectus femoris, & Sartorius  
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Clinical picture of pt with T12-L3 injury   Capable of hip flex, ADD, & knee ext; Ind home ambulator, Ind swing-to/thru or 4point with bilat KAFOs & forearm crutches level surfaces, WC for energy conserv, may be ind n community  
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Key muscles in L4-L5 injury   Lowback mms, Medial hamstring(weak), Post Tib, Quadriceps, Tib Ant  
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Clinical picture of pt with L4-L5 injury   Capable of strong hip flex, knee ext, weak knee flex, improved trunk control; Ind home ambulators, can be community ambulators, may use WC for convenience or energy conserv  
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Cord segments of Abdominal Innervation   T5-T12  
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Cord Segments of Intercostal Innervation   T1-T12  
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