SCI Intro

• MVA
• Violence
• Falls
• Sports injury
• other

American Spinal Injury Association (ASIA)

• sensory evaluation (28 dermatomes)
• motor evaluation (tested by myotomes)

sensory only

biceps/brachialis

Extensor carpi radialis L and B

Triceps

flexor digitorum profundus (middle finger)

Abductor digiti minimi

sensory level

Iliopsoas

quadriceps

tibialis anterior

extensor hallicus longus

gastrocneumius/soleus

sensor level

neck mm

diaphragm

deltoid (shoulder)

wrist

triceps

fingers

hand

T1

intercostals (trunk)

abdominals

ejaculation

Hips

quadriceps

hamstring - knee

foot

penile erection

bowel and bladder

• designate R v L if function is different
• designate sensory v motor if function is different
• SCI is named by the last NORMAL level of function

impairment or loss of motor and/or sensory function in UE and LE, trunk, and pelvic organs

cervical cord

impairment or loss of motor and/or sensory function due to damage in the thoracic, lumbar, or sacral segments of the spinal cord. Function may be impaired in the trunk and/or LE

an injury resulting in a total absence of sensory and motor function in the lowest sacral levels (4-5)

• by inserting a finger into the rectum
• if the pt feels it, sensation is intact
• if the pt can squeeze the anal sphincter, motor is intact

• complete severing of the cord
• transection of the cord
• vascular impairment to the cord

48 hours

to allow pt to recover from spinal shock

4

• complete loss or weakening of all reflexes below the level of injury
• usually lasts 24-48 hours
• SC loses descending facilitation
• neurons in reflex arcs normally receive a basal level of excitatory stimulation from the brain
• after SCI, these cells lose this input, the neurons become hyperpolarized, and less responsive to stimuli

• occurs over 2-3 days
• some return of some reflexes
• 1st reflexes to reappear are polysynaptic
• monosynaptic reflexes that only involve SCI are not restored until phase 3
• restoration of reflexes proceeds from polysynaptic to monosynaptic

• 1-4 weeks for phase 3
• 1-12 months for phase 4
• characterized by hyperreflexia, or abnormally strong reflexes usually produced w/ minimal stimulation
• phase 3 - hyperreflexia is due to axon-supported synapse growth

yes, every pt will have spasticity

• often damaged as they exit the foramen
• frequently happens at site of lesion
• function of mm innervated by these can be expected to return w/in 6 months of injury
• nerve roots can escape injury

there is no prognosis at this point

• used only w/ complete injuries
• refers to partial preservation of motor or sensory function below the neurological level of injury

one in which there is partial preservation of sensory and/or motor function below the neurological level and in the lowest sacral segment

innervating more distal segments

• spinal cord
• --this includes hemorrhage, edema, ischemia, and hypoxia

w/in 24-72 hours post trauma

enhance the flow of blood to injured cords, preventing some of the associated hypoxia and ischemia

only if given less than 8 hours after the injury

• central cord syndrome
• anterior cord syndrome
• brown sequard syndrome
• conus medularis lesions
• cauda equina lesions

central cord syndrome

• anterior and/or posterior cord compression
• acute hyperextension injury
• chronic or congenital condition that results in progressive stenosis
• spondylosis
• osteophytes can create a pincher effect
• damage is from microvascular compromise of the center of the cord

• central gray matter is compromised first b/c its metabolic and perfusion needs are greater, thus is more at risk during periods of comprised circulation
• central white matter is also compromised
• any hemorrhage or edema begin in the center of the cord and spread to the periphery
• resolution occurs in the opposite manner

• sacral tracts in all but the posterior (dorsal) columns
• followed by lumbar, thoracic, and lastly cervical

• bilateral flaccid paralysis and sensation loss due to loss of the grey matter AT the level of the injury
• BELOW the level of injury, the client will have spastic paralysis
• clients can re-gain motor and sensation and will do so first in the sacral, then lumbar, then thoracic and finally cervical tracts
• progress may stop at any time

• 77% regain ambulation
• 53% regain bowel, bladder, and sexual function
• 42% regain hand function

extremely poor for return of motor function, bowel, bladder, or sexual function

• flexion injuries
• bone or cartilage compromises the integrity of the anterior spinal artery
• frequently caused by teardrop or burst fractures of the vertebral body

• anterior spinal artery vascularizes the entire anterior 2/3 of the spinal cord
• the posterior spinal AA only vascularize the posterior columns -- which carry conscious proprioception, stereognosis, deep pressure, etc.

• bilateral flaccid paralysis and sensation loss due to loss of the gray matter AT the level of the injury
• BELOW the level of the injury, the client will have spastic paralysis w/ voluntary motor and sensory loss
• posterior column function remains intact on both sides

• stabbing wounds, gunshot wounds, or penetrating injuries
• unilateral facet lock injuries
• burst fractures at the lateral body of the vertebrae

one half of the spinal cord is damaged

• ipsilateral flaccid paralysis and sensation loss due to loss of the grey matter AT the level of the lesion
• BELOW the level of the lesion
• - white matter damage leads to ipsilateral loss of motor and posterior column function. The paralysis will be spastic.
• - white matter damage also leads to contralateral loss pain and temperature, sensation several levels below the level of the injury

• very good
• nearly all pts are able to walk (some w/ orthotics and cane)
• 80% regain hand function
• 100% regain bladder function
• 80% regain bowel function

injury to the bottom of the spinal cord and lumbar nerve roots

results in flaccidity and a lack of return of bowel, bladder, or sexual function

if the bottom of the cord is damaged, there will be no return of function

• L1 vertebrae or below
• occurs at cauda equina, not the spinal cord

• injures peripheral nn
• flaccid paralysis w/ no spasticity
• do have severe amounts of pain, parasthesia, burning, and tingling occurs

• excellent!
• peripheral injuries regenerate
• pain can be a limiting factor to return of strength and funciton
• will not regain calf and foot intrinsic strength and may require orthotics

complete - no sensory or motor function is preserved in the sacral segments S4-5

incomplete - sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-5

incomplete - motor function is preserved below the neurological level and more than 1/2 of the key muscles below the neurological level have a muscle grade less than 3

Incomplete - motor function is preserved below the neurological level, and at least half of key mm below the neurological level have a muscle grade of 3 or more

normal