spinal cord injury 4

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spinal cord injury 4
2013-03-09 19:07:40
spinal cord injury

rosen & karpatkin spring 2013
Show Answers:

  1. tetraplegia def by ASIA
    • impairment or loss of motor and/or sensory function in cervical segments of spinal cord
    • doesn't include brachial plexus lesions or peripheral nerve lesions (can't be cord root)
  2. paraplegia def by ASIA
    • impairment or loss of motor and/or sensory function in the thoracid, lumbar, or sacral segments of the spinal cord
    • doesn't include lumbosacral plexus lesions or peripheral nerve lesions
    • (it's got to be a cord injury, not an injury anywhere else)
  3. quadriparesis & paraparesis - thoughts on these words?
    usage is discouraged due to imprecise descriptions of incomplete lesions... so don't say paresis, just plegia
  4. neurological level of injury (per ASIA)
    • aka NLI
    • the most caudal segment of the spinal cord with normal sensory and motor function on both sides of the body.
    • but if segments differ L vs R, seperate levels should be stated
  5. SLI: sensory level of injury (per ASIA)
    • most caudal segment of the spinal cord w normal sensory function on both sides of the body
    • can have diff levels L vs R
  6. MLI: motor level of injury (per ASIA)
    • the most caudal segment of the spinal cord with normal motor function on bothsides of the boyd
    • lowest key muscle that has a grade of at least 3, providing the key muscle of the segment above is tested to be 5
  7. SkLI: skeletal level of injury
    • radiographic level where greatest vertebral damage is found
    • remember, level of bone is usually higher than the level of cord injury, except in cervical spine
  8. incomplete injury
    partial preservation of sensory and/or motor function below the neruological level including the lowest sacra segment
  9. sacral sensation includes...?
    • sensation at anal mucocutaneous junction
    • deep anal sensation
  10. motor function at lowest sacral segment includes...?
    voluntary contraction of the external anal sphincter upon digital stimulation
  11. complete injury
    • absence of sensory & motor function in lowest sacral segment
    • this is true regardless of the level of injury - if there's any motor or sensory down there, it's incomplete
  12. sacral sparing
    • maintaining sensation in lowest sacral segments while there's absent or diminished motor function above
    • this distinguishes complete from incomplete injuries
  13. ZPP: zone of partial preservation
    • this is used only with complete injuries (ie no sacral sparing)
    • segments caudal to neurological level are partially inervated
    • named for/defined by the most caudal segement w some (any) motor and/or sensory function
  14. Frankel Scale
    • predecessor to ASIA
    • designed to quickly give a sense of how much function a pt has
  15. grades in the Frankel Scale
    • A: complete
    • B: incomplete w preservation of some sensation below level of injury
    • C: incomplete w preserved nonfunctional motor (useless) below level of injury, while sensation may or may not be preserved
    • D: incomplete: preserved voluntary functional motor
    • E: complete recovery - copmlete return of all motor & sensory function, but may still have abnormal reflexes
  16. Letter grades on ASIA impairment scale
    • A: complete
    • B: incomplete w/ wensory but not motor below neurological level, down thru sacral segments S4-5
    • C: incomplete w motor preserved below the neurological level and more than half the key muscles below the neuro level ahave a muscle grade <3 (0-2)
    • D: incomplete w motor preserved below neuro level and at least half the key muscles below have muscle grade greater or equal to 3
    • E: normal motor and sensory function
  17. see pg 88 of the body dermatome map
    memorize general location of each zone
  18. 5 key UE muscles
    • C5 elbow flexors
    • C6 wrist extensors
    • C7 elbow extensors
    • C8 finger flexors (DIP of middle finger)
    • T1 finger abductors (use pinky)
  19. 5 key LE muscles (descriptions, not names)
    • L2 hip flexors
    • L3 knee extensors
    • L4 ankle dorsiflexors
    • L5 long toe extensors
    • S1 ankle plantar flexors
  20. deltoid is what nerve roots?
    C5-6 (and sometimes C4)
  21. abs are what n roots?
  22. Beevor's sign -- what is it? most striking where?
    • like Babinski test, but running it on the stomach -- if one side isn't enerverated the umbilicus will move toward the enervated side
    • most striking at T9-12, but you can't tell the specific level in this test
  23. hip adductors are what N root?
  24. scoring  in ASIA's mmt
    • 0-5 w/o +/-
    • max score 25/extremity, total possible 100
  25. motor level per ASIA
    • the lowest key muscle that has a grade of at least 3, providing the muscle above that level has a 5
    • ex: C6 - 5, C5 - 3, C4 - 3 ... it's a C5 motor level
    • C6 - 5, C5 - 4, C4 - 3 ... still C4
  26. how to grade a muscle if ROM is decreased
    • if you have at least 50% of range, grade it thru that range
    • if it has less than that range, mark it as NT (not testable)
    • if spasticity or clonus prevents testing... NT
  27. LEMS and implications
    • lower extremity motor score (the MMT for the lower 5 key muscles)
    • LEMS < 20 indicates limited ambulators
    • LEMS > 30 suggests increased likelihood of being a community ambulator
    • (this is an ASIA thing)
  28. asia stands for what
    american spinal injury association
  29. sensory points (ASIA) how many are there? graded how? how to stim them?
    • 28
    • 0, 1, or 2
    • first do sharp/dull discrim (as compared to the face) w two ends of a safety pin
    • then do light touch (cotton)
    • total possible score 112 (28 x two sides x two types of stim)