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General structure of the spinal cord
Cylindrical mass of nerve tissue extending from the foramen magnun in skull continuous with the medulla to the lower border of the first lumbar vertebra in the conus medullaris
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Segments of the Spinal Cord
30
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
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Classification A of SCI (Complete)
no sensory or motor function is preserved in S4-S5
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Classification B of SCI (incomplete)
Sensory but no motor function is preserved below the neurological level and extends through the sacral segments
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Level C SCI (incomplete)
Motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade less than 3/5
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Level D SCI (incomplete)
Motor function is preserved below the neurolgical level and the majority of key muscle groups below the level hage a muscle grade greather than of equal to 3/5
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Level E SCI (normal)
Snesory and motot function are normal
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Central cord syndrome
- form of incomplete spinal cord injury characterized by impairment in hands and arms, to a lesser extent in legs
- AKA reverse paraplegia
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Anterior cord syndrome
- Below the injury motor control, pain sensation and temperature sensation is lost
- vibration, touch and proprioception stays intact
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Upper motor neuron
- info from cortex or subcortical regions to:
- -the cranial nerve nuclei in the brainstem
- -interneurons that synapse with motor cell bodies in the ventral horn
- Results in Spasticity in Flexors OR Extensors
- decreased voluntary control
- Difficulty moving muscles on ONE side of body
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Lower Motor Neuron
- Information from the motor cell bodies in the ventral horn to skeletal muscles
- Include:
- - cranial nerves
- - Conus Medularis (L1-L2)
- - Cuady Equina
- Results in Flaccidity
- Hyporeflexia
- Atrophy of muscles
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Dorsal column lemniscus tract
- Vibration, propreoception and touch sensory pathway
- Enters spinal cord and the dorsal column and ascends to the lower medulla
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Anteriolateral system
- pain and temperature sensory pathway
- becomes spinothelamic tract
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C1-C4 tetraplegia
- Require assistance to breath (ventilators)
- C4 will increase diaphragm strength and may not need devices after time
- OT: family training, positioning, mouth sticks
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C5 tetraplegia
- Weakened deltoids and biceps
- paralysis of wrists and hands- use of universal cuff, ball bearing feeder and mobile arm is reccomended
- decreased trunk control
- mostly dependent in ADL's
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C6 and C7 tetraplegia
- Have radial wrist extension and can use tenodesis for grasp
- More fully inervated scapular and shoulder muscles = increased UE strength and endurance
- Pts able to roll in bed and arms can cross midline more forcefully
- C7- Triceps inervation= pt can reach above thier head and easier transfers
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C8 tetrablegia
- extrinsic finger muscle function and thumb flexors
- lacks intrinsic finger muscle functions
- Claw / intrinsic minus grasp Uses MCPs in extension; Proximal and distal IP joints in flexion
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