Deficiets in the LE and possbile the trunk

Lesion at the thoracic or lumbar region

Involvement of all 4 limibs and the trunk

Lesion: Cervical region

Prevalence: proportion of population sample with pathology at given point in time

Incidence: number of new cases of pathology in a given period of time

period of time not point of time like prevalence

What is the %  SCO that are men?

What is the % of imcomplete tetraplegia?

80.9%

39.5%, this is the highest of all the injuries

T

Traumatic: Damage caused by traumatic event: falls, sports injury, violence, vehicular accidents

Atraumatic: Damage caused by a pathology. Vascular problem: Impaired blood flow to SC, cancers,  Vertebral subluzation (RA, degenerative joint disease), infections (encephalitis, Guillain Barre), Hysterical paralysis( no structural issue but caused potientially by psychological stress), Neurological conditions (MS/ALS)

61 - 75 yoa (48.7%)

76-98 yog i (61.2%)

Central Cord

Brown Sequard

Anterior Cord

Conus Medullaris

Cauda Equina

Posterior Cord

Damage to central portion of the SC with sparing of peripheral portion of the cord

Hyperextension injuries to the cervical spine

Narrowing of spinal canal- congenital or degenerative

Damage to sulcar arteries (those that run in the sulci of the SC)- hemorrhage and edema

More pronounced weakness in UE than LE

Motor Deficits more severe than sensory

Often sacral sparing

What is the damage to the SC in Brown Sequard Syndrome?

Mechanism of Injury?

Hemisection of the SC- damage to one side of SC?

Mechanisms: penetration wound gunshot, stab

Clinical Characteristics:

Asymmetrical clinical features

Ipsilateral loss of sensation, motor deficits, decreased reflexes, spasticity, clonus, + babinski

Ipsilateral: Loss of proprioceptions, kinesthesia, vibratory sense

Contralateral: Loss of pain and temperature sensations (spinothalamic tract, located anterior laterally)

What is the mechanism of injury for a posterior cord SCI?

Is the posterior SCI rare or common?

Infection

Rare

Clinical presentations:

Preservatino of light touch, motor fuction, pain sensation

Loss of proprioception and two point discrimination, stereognosis( perception of the form of an object by touch)

This makes sense bc the Dorsal Column carries descriminative touch and properioception

Anterior Cord Syndrome:

MOI?

Clinical Characteristics?

Flx injury of cervical spine

Compression of the anterior cord from fracture, dislocation or cervical disk protrusion

CC: Loss of motor function (Corticospinal Tract)

Loss of Pain and Temperature sensations (spinothalamic T)

Preserved proprioception, kinesthesia, vibratory sense

At what level does the SC typically end at?

Is this absolute?

L1

Not absolute can have some variation of whether or not the SCI will manifest UMN or LMN lesions, note that there are also UMN and LMN lesion here

At L1 what anatomical structure of the SC is found?

Below L2 below what anatomical structure is found?

Conus Medullaris

Cauda Equina

When the Conus Medullaris is damaged:

What parts of the SC are damaged?

Is this considered an UMN or LMN lesion?

SC damaged: damage to the Sacral cord and lumbar nerve roots

Shows signs of both UMN and LMN injury

What are the perserved reflexes that persist when the conus medullaris is injuried and some sacral segments are spared?

des this occur with a higher or lower lesion?

Micturition (urination) and bulbocavernosus

Higher lesion

Injury to Cauda Equina:

Damage to what parts of the SC?

PNS or CNS?

LMN or UMN

Damage to the Lumbar and scacral roots(not cord*)

PNS

LMN sings ONLY

Flaccid paralysis of LE (if complete lesion)

Areflexic (w/o reflex) bowel/Bladder (no reflex to empty bladder)

Absence of refleogenic erection

An injury above the Conus Medullaris (~L1) the bladder will be?

Why is this?

Below the conus meduallris or cauda equina the bladder will be?

Spastic or reflexive

Bc of spastic or reflex(automatic ) bladder

Flaccid or non-reflexive (autonomous) bladders

What is the first indicators that spinal shock is resolving?

What are the important muscle for breathing and the nerve roots that innervates these muscle?

Diaphram: C345 (C1-C3 Vertebrae)

Intercostals: (T1-T12)

Abdominal: T7-12

Pectorals (C5-T1)

Serratus (C5-C7)

Scalenes (C3-C8)

SCM (CN IX, C1-C4)

Erector Spinae (C1 down)

Areflexia (Absence of reflexs)

Flaccidity

Loss of sensations

What are the results of the loss of internal thermoregulatory response?

What system is this a dysfunction of?

Loss of: shiver, vasoconstriction (cold), vasodilation (heat)

Excessive diaphoresis (sweating) above the level of the lesion

Sympathetic Nervous System

What is autonomic dysreflexia?

what is the issue with the vessels in Autonomic dysreflexia?

will spasticity be increased?

No vasodilation to readjust peripheral resistance

Yes as well as blurred vision and constriction of the pupils

Why does the HR slow but BP says elevated in Autonomic dysreflexia?

what might be a complaint of the patient due to the increased BP?

what will be seen above the lesion

Baroreceptors detect high BP--> parasympathetic activity of the vagus nerve slows HR--> however this does not effectivly compensate for the severe vasoconstriction.

headache

Sweating and flushed skin

Sit the patinet up to lower BP if they are laying down

remove any noxious stimuli: catheder, have they gone phoop recently, are you stretching to hard

What is a normal RR?

Phonation skills?

12-20 breaths/min

8-10 syllables/breath (voice can tell a lot about Respiration)

What does a FIM score of >44 mean?

What does a FIM score of <29 mean?

 pt can be discharged to their home

pt cannot return home

What do these scores on teh modified Barthel Index represent?

60-100

<40

<20

60-100= Independence (may still need assistance with more complex skills not represented in MBI)

<40: severe dependence

<20: total dependence