IV.

PATHOLOGY
Gray Matter: Neuronal cell bodies and synapse
Anterior Horn: mainly responsible by motor neurons.
Posterior Horn: mainly responsible by sensory neurons.
White Matter: ascending and descending fiber pathway
Ascending: transmit sensory information to the brain.
Descending: transmit motor information to the cord.
A section of skin innervated through specific part of the spine is called a dermatome,
and spinal injury can cause pain, numbness, and loss of sensation in the relevant areas.
A group of muscles innervated through specific part of the spine is called myotome,
and injury to the spine can cause problems with voluntary controls.
Dermatomes
C2- External Occipital Protuberance
C3- Supraclavicular Fossa
C4- top of the Acromioclavicular jt.
C5- Lateral side of the antecubital fossa
C6- thumb
C7- Middle finger
C8- Little finger
T1- Medial side of the antecubital fossa
T2- apex of the Axilla
T3- 3rd intercostals space
T4- nipple line
T5- 5th intercostals space
T6- Level of the xiphisternum
T7- 7th intercostals space
T8- 8th intercostals space

T9- 9th intercostals space

T10- Umbilicus
T11- 11th intercostals space
T12- Inguinal ligament at midpoint
L1- half the distance between T12 and
L2
L2- Mid anterior Thigh
L3- medial femoral condyle
L4- medial malleolus
L5- Dorsum of the foot at the 3rd MTP
joint
S1- Lateral heel
S2- Popliteal fossa
S3- Ischial tuberosity
S4-S5- perianal area

IV - B.S. Occupational
Therapy

OT 5

January 15, 2015

MYOTOMES
C5- Elbow flexors
C6- wrist extensors
C7- Elbow extensors
C8- Finger flexors
T1- Finger abductors
L2- hip flexors
L3- knee extensors
L4- Ankle-dorsiflexors
L5- Long toe extensors
S1- Ankle plantarflexors
CLASSIFICATION
Complete SCI- if there is no sensation or return of motor function below the level of
lesion 24 to 48 hrs after the injury in carefully assessed complete lesions, motor function
is less likely to return.
Incomplete SCI- in incomplete lesions, progressive return of motor function is possible,
yet it is difficult to determine exactly how much and how quickly return will occur.
CLINICAL SYNDROMES

Central cord syndrome

Brown-squard Syndrome (Lateral Damage)
Anterior Spinal Cord Syndrome
Cauda Equina (peripheral)
Conus Medullaris Syndrome

Central cord syndrome

Occurs when there is more cellular destruction in the center of the cord than in
the periphery. Paralysis and sensory loss are greater in the UEs because these nerve
tracts are more centrally located than those of the LEs.
Brown-squard Syndrome (Lateral Damage)
Brown-squard Syndrome result when only one side of the cord is damaged.
There is motor paralysis and loss of proprioception on the ipsilateral side and loss of
pain, temperature and touch sensation on the contralateral side.

Karen Abinsay

Jet Duria

Sheena Gazzingan

IV - B.S. Occupational
Therapy

OT 5

January 15, 2015

Anterior Spinal Cord Syndrome

Anterior Spinal Cord Syndrome result from injury that damage the anterior spinal
artery or the anterior aspect of the cord. Paralysis and loss of pain, temperature, and
touch sensation. Proprioception is preserve.
Cauda Equina (peripheral)
Cauda Equina injury involves peripheral nerves rather than directly involving the
spinal cord. Patterns of sensory and motor deficits are highly variable and asymmetrical.
Conus Medullaris Syndrome
Conus Medullaris Syndrome involves injury of the sacral cord (cunos) and lumbar
nerve roots. Results in an areflexic bladder, bowel, and LEs.

V.

ASSESSMENT

The International Standards for Neurological Classification of SCI has been

adapted worldwide as the preferred assessment instrument. (Braddom, 2011)
Others include: FIM, RLA, Frankels Classification for Acute SCI, etc.

VI.

TREATMENT
May or may not include the ff:

Pharmacologic tx
Surgical tx
ROM
Modalities
Pressure reliefs
Transfers

Karen Abinsay

Jet Duria

Standing
Ambulation
ATDs (Assisted
Technology Devices)
Home Modifications

Sheena Gazzingan


VII.

PROGNOSIS

The major factors in predicting recovery early after traumatic SCI include
the initial Neurological Level of Injury (NLI), the initial motor strength, and most
importantly, whether by examination the injury is classified as neurologically
complete or incomplete. (DeLisa, 2011)

If there is no sensation or return of motor fxn BELOW the level of lesion

24-48 hrs after the injury in carefully assessed complete lesions, motor fxn
is less likely to return. However, partial to full return of fxn to one spinal
nerve root level below the fracture can be gained and may occur in the
first 6 months. (Pedretti, 2013)
In incomplete lesions, progressive return of motor fxn is possible, yet it is
difficult to determine exactly how much and how quickly return will occur.
Incomplete injuries are associated with a better chance of further recovery
than are complete injuries, but even with incomplete injuries there is no
guarantee that further recovery will occur. (Pedretti, 2013)
Frequently, the longer it takes for recovery to begin, the less likely it is that
it will occur. (*Most of the recovery that will occur starts within the first few
weeks.) (Pedretti, 2013)