SCI
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| What does lesion level indicate? | Most distal uninvolved nerve root segment with normal function MMT 3+/5
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| Characteristics of UMN lesion. | Hypertonia
Hyperreflexia
Spacticity
CNS
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| Characteristics of LMN lesion. | Hypotonia
Hyporeflexia
Flaccidity
PNS
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| Central Cord losses | UE > LE involvement
Motor > Sensory
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| Central Cord Complete Preservation | Sacral tracts
Normal Sexual Function
B & B
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| Type of injury sustained from Central Cord | Hyperextension (less common)
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| Type of injury sustained from Anterior Cord | Flexion Injury
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| Anterior Cord losses | Motor function (Corticospinal tract)
Pain and Temp (spinothalamic tract)
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| Generally Preserved in Anterior Cord injury | Proprioception
Kinesthesia
Vibration Sense
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| Sign of Corticospinal tract damage | Positive Babinski
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| Level of Cauda Equina | L1 or below
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| Syndrome associated with LMN and potential to regenerate | Cauda Equina (full innervation not typical)
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| Frequently incomplete due to large number of nerve roots | Cauda Equina
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| Cord level associated with tetraplegia/quadraplegia | C1 - C8
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| Cord level associated with Paraplegia | T1 - T12
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| Involving bilateral LE and varying trunk levels | Paraplegia
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| Common SCI mechanisms of injury | Flexion (most Common)
Flexion Rotation (most common cervical injury)
Compression
Hyperextension
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| Mode of injury associated with Brown-Sequard syndrome | Gunshot or stabbing
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| Presents with ipsilateral loss of sensation in corresponding dermatome | Brown-Sequard
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| Decreases associated with Brown-Sequard | reflexes, proprioception, kinesthesia, vibration
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| Lateral Dorsal Column injury | Brown-Sequard
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| Syndrome presenting with clonus and/or positive Babinski | Brown-Sequard
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| Cause associated with Central Cord syndrome | Progressive stenosis or hyperextension injury
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| Cause of Posterior/Dorsal Cord Syndrome | Compression of posterior spinal artery by tumor or vascular infarction (Rare)
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| Intact functions of Posterior Syndrome | Motor, light touch and pain
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| Losses associated with Posterior Syndrome | Proprioception and Somatic sensation i.e. 2 point discrimination and graphesthesia
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| S & S of Sacral Sparing | Perianal Sensation and external anal sphincter contraction
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| 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.
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| Most caudal segment with some sensory or motor function (or both) and applies to complete injuries only. | Zone of partial preservation
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| 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
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| 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
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| Muscles and Functional Expectations C1,2,3 | Facial muscles , SCM, upper traps
I= Power WC
Total dependence ADL's
Requires Ventilator
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| Muscles and Functional Expectations C4 | Diaphragm and Upper Traps
Power WC w/chin cup or mouth stick
Total dependence ADL's
Glossopharyngeal Breathing
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| Muscles and Functional Expectations T4-6 | Top 1/2 of intercostals, erector spine, semispinalis
I in all areas: Bed skills, WC transfers, Housekeeping
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| Muscles and Functional Expectations T9-12 | Abdominals and all intercostals
Household Ambulation with AD - KAFO/crutches/walker
I WC mobility
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