clinical patho week 5 material

pain and temperature

touch, pressure, consciouse muscle joint sense

touch, pressure, conscious muscle joint sense

proprioception

provides input to the cerebellum

voluntary skilled movement

reflex postural movement in response to visual stimuli

facilitates activity of the flexor muscles and inhibits extensors

under the influence of the ear and cerebellum in the maintenance of balance

• Results from abrupt withdrawal of connection between brain and spinal cord
• Occurs immediately following an injury
• Absence of all reflexes, flaccidity, loss of sensation and motor function below the level of the injury
• DTR Loss
• Last 24-48 hours (Can last days or weeks)
• 1st indication of resolution is anal sphincter reflex

• VARY & DEPEND ON THE LEVEL OF INJURY
• žHyper-reflexes
• žMotor loss
• žSensation loss
• žAltered somatic nervous system function
• Paralysis (Paraplegia or tetraplegia)

• Complete Injury
• NO sensory or motor function below the level of the lesion
• Very Rare

• Incomplete
• Preservation of some motor & sensory below the level of the lesion

Occurs with acute disc herniation, tumors, and when the head is forced into cervical flexion

• More loss of movement and sensation in the arms than in the legs.
• žOccurs with hyperextension injury, degenerative bone changes in the spine, or stenosis
• žPreservation of bowel/bladder and sexual function

• Hemi-section of the spinal cord
• žTypically due to penetration injury
• See problems on both ipsilateral and contralateral sides

• Extremely Rare
• žProprioceptive Loss is biggest limiting factor
• Altered gait
• Increased BOS

• Injury below L1 (adult), LMN injury, part of the PNS
• žIf myelin is intact, regeneration is possible
• žSome signs and symptoms
• Saddle paresthesia (perineum)
• Weakness, loss of sensation, or pain in one or both legs
• Bowel and bladder control issues

• 1.Long distance to travel
• 2.Axial regeneration can “get lost or go off path”
• 3.As axon regenerates, scar tissue can block progress
• 4.Tissue may no longer function if regeneration takes too long
• 5.Because regeneration take so slow – the body gets tired of doing it and stops!

• This is LIFE THREATENING
• žSome sort of noxious stimulus sends the patient into “fight or flight”:
• Full or distended bladder
• Bowel regulation issues
• Sexual activity or child birth
• Leg is pinched on leg rest
• Awkward positioning that stimulates GTO
• žOnce the stimulus is removed, the patient is fine
• Lesions above T5-T7
• žSit the patient down, but keep head elevated & Find/Remove the stimulus

¡HTN

¡Bradycardia

¡Severe and sudden HA

• ¡Profuse sweating (above the level of
• the lesion)

¡Increased spasticity

• ¡Vasoconstriction above level of the
• lesion and dilation below

¡Constricted pupils

¡Blurred vision

• ¡Pooling of blood
• ¡Pallor
• ¡Dizziness
• ¡HA
• ¡Possible fainting
• ¡BP Bottoms Out

• žCaused by lack of
• communication between the hypothalamus to cutaneous blood flow or sweat

¡“lack of hypothalamic control”

žNever Shiver

• žNo vasoconstriction
• or dilation to regulate temperature

• žDo no sweat below the
• level of the lesion

• žProfuse sweating
• above the level of the lesion

žC1-C3

• ¡No innervation of the
• diaphragm

¡Ventilator dependent

žTetra C4-T1

• ¡All 4 extremities
• & trunk involved

• ¡Decreased chest
• expansion

• ¡Decreased innervation
• of intercostal, decreased respiration volume, increase activation of innervated
• accessory muscles

• žPara (Depends on the
• Level)

¡LE & Trunk

žT10-T12

• ¡Abdominals and
• external intercostal still intact

• žResults from a
• release of an intact reflex arc from CNS

• žActin and Myosin are
• always firing

• žHyper-reactive to
• stretch reflex

• žChanges below the
• level of the lesion

• žCan HELP or HINDER a
• patient