SCI 9/16/2012 7:42:00 PM

ASIA
 0 - absent
 1 – impaired
 2 – intact
Brown sequard
 Ipsilateral
o Loss sensation
o Dec reflex
o Babinski
 Contralateral
o Loss pain
o Loss sensation
Ant cord syndrome
 Flexion injury
 Loss motor (CS)
 Loss pain, temp (ST)
 Spared
o Proprio
o Kinesthesia
o Vibratory
Central cord syndrome
 Hyperex
 Congenital narrowing
 UE>LE
 Preserve
o Sacral tracts
o Normal sexual
o Bladder
 Ambulate
Posterior cord
 Rare
 Preserve
o Pain
o Motor
o Light touch
 X
 o Proprioception
o 2 pt
o graphesthesia
o stereognosis
 wide based steppage
Sacral sparing
Cauda equina syndrome
 frequently incomplete
 full reinnervation not common

Frankels

SCI Assessment
 Ashworth
o 0 – no increase
o 1 – slight increase (end)
o 1+ - slight increase (less than half)
o 2 – more marked
o 3 – considerable increase in mm tone
o 4 – rigid

 Neurological level of injury

o Most caudal w/ normal sensory & motor on both sides
 Skeletal level
o Radiographic
o Greatest damage
 Sensory portion
o Pinprick – disposable safety pin
o Touch sensation – wisp of cotton
 Levels
o C2 – occipital protuberance
o C3 – supraclavicular
o T12 – midpoint of inguinal lig
o S2 – popliteal fossa
o S3 – ischial
o S4-S5 – anal
  Testing
o Start grade 3
o Then 4 and 5
o If cant perform against resistance, 2 then 1
 ISNCSI def’n
o Grade 5 – 2 intact nerve segments
o Grade 3 or 4 – 1 intact nerve segments
o Grade 2 or less – no intact
 Grading
o 4 – some resistance
o 5 – normal resistance
Clinical Manifestations
 Spinal shock
o Period of areflexia
o Flaccidity
o Loss of sensation
o Loss of motor fxn
o (+) bulbocavernosus – indicator of recovery
 Motor & Sensory impairments
o Complete/partial loss below level of lesion
 Autonomic dysreflexia
o Massive imbalance of reflex sympathetic discharge
o Above T6
o 3 years – episodes dubside
o seen in complete/incomplete lesions
o Hyperreflexia
 Stimuli:
 Bladder distention – most common
 Rectal distention
 Pressure sores
 Bladder infxns
 Urinary stones
 Noxious cutaneous stimuli
 Kidney malfxn
 Urethral / bladder irritation
 Env temp changes
  Symptoms
 Htn
 Bradycardia (severe pounding)
 HA
 Profuse sweating
  spasticity
 restlessness
 Postural hypotension
o Frequent in
 Cervical
 Upper thoracic
o Assoc
 Edema legs, ankle
 Symmetrical
 pitting
 Impaired temp control
 Resp impairment
o Lesions: C1-C3, phrenic nerve innervations
o Lumbar lesions
 Full innervation
o Altered breathing pattern
o Px
 Flattened chest wall
 Dec expansion
 Spasticity
o Char
 Hypertonicity
 Hyperactive stretch reflex
 Clonus
o Occurs after spinal shock subsides
o Inc – 6 mos
o Plateau – 1 yr
 Inc by
 Stress
 Ulcers
 Tight clothing
  UTI
 Env temp
 UTI
o Most freq medical complication
o Above conus medullaris – active bladder
 Bowel dysfxn
o Above conus medullairs – spastic/reflex bowel
o In conus, cauda (LMN) - flaccid
 Bladder
 Sexual
o male
 A. erectile capacity
 Greaten capacity: UMN
 Greater: incomplete lesions
 2 types erection
 reflexogenic – external stimulus genitals
 psychogenic - fantasize
 B. ejaculation & orgasm
o Female
UMN – reflex arc intact
 Reflexogenic – present
 Psychogenic – absent
 LMN
 Reverse
 A. menstruation
 1-3 mos interrupted
Indirect impairments & complications
 Resp complications
o most common cause of death
 Decubitus ulcers
o Serious med complication
 Major cause of delayed rehab, death
o Change pos’n every 2 hours
o 2 influential factors
 inability to make positional changes
 impaired sensory fxn
 o other factos
 loss vasomotor control
 spasticity
 skin maceration
 trauma
 DVT
o Thrombusinflammation
 Local swelling
 Erythema
 Heat
 Contractures
 Heterotopic Ossification
o Osteogenesis of soft tissue
o Hips knees – most common
 Pain
o Traumatic pain
 From fx, ligamentous, soft tissue damage
o Nerve root pain
 Acute compression/tearing of nerve roots
o Spinal cord dysesthesias
 Diffuse
 Don’t follow dermatome
o Musculoskeletal pain
 ABOVE level of lesion
o Osteoporosis & renal calculi
 Net loss of bone mass bec rate of resorption greater
 HYPERCALCIURIA – calcium in urine

Med Mx
 Potential clinical tx
o Methylprednisolone
o GM-1 ganglioside
o Gacyclidine
o Tirilazad
o Naloxone
 MPDD – standard of care
 o Methylprednisolone sodiumsuccinale
PT mx
 Acute phase
o Respiratory mgt – emphasis (C1-C3 – difficult resp)
 Deep breathing
 GP breathing
 Airshift maneuver
 Strengthening
 Assisted cougin
 Abdominal support
 Stretching
o ROM & positioning
 Prone & supine
o Selective strengthening
 Bilat UE – emphasize
 Straight planes
 PNF
 PRE
o Orientation to vertical posn
* know levels
 functional abilities
 orthotic devices

Orthotic devices
 Paraplegia – scott-craig orthosis
 T9-t12 – kafo
 L3 below - afo
9/16/2012 7:42:00 PM
9/16/2012 7:42:00 PM