Disorders of Neuromuscular Function

Sub-acute SCI trauma

1-14 days -Neuroimmune response -BSCB breakdown/inflammation, vicious cycle -Upregulation of axonal growth inhibitors/initiation of scar -neuropathic pain

Neurological level of injury

lowest part of spinal cord that functions normally after injury

What is the most recent leading cause of SCI

vehicle crashes

What do injuries above C3 cause?

virtually complete paralysis of both the muscles of inhalation and exhalation and dependence on mechanical ventilation

What would you see in a patient with Autonomic Dysreflexia?

High blood pressure and Bradycardia that can lead to stroke, seizure, or even death Increase in blood pressure - activation of SNS Low heart rate- baroreceptors in vessels send signals to the brain with sends messages via parasympathetic vagus nerve to the heart

Paraplegia

Impairment or loss of motor or sensory function (or both) after damage to nerual structures in the thoracic, lumbar, or sacra segments of the spinal cord. Affects all or part of the trunk, legs, and pelvic organs. (LOWER HALF) Th2-Th6 & Th7-Th12

Tetraplegia (quadriplegia)

Impairment or loss of motor or sensory function (or both) after damage to neural structures in the cervical segments of the spinal cord Affects functioning in the arms, trunk, legs, and pelvic organs C1-C4 & C5-Th1

A spinal cord injury resulting in some motor or sensory function below the level of the injury is classified as which type of injury?

Incomplete spinal cord injury

Hyperacure SCI trauma

Instant Axons are severed and bv rupture from mechanical forces

Lumber nervers

L3- leg muscles

Frequent respiratory assessment is important in acute spinal cord injury because:

Loss of defensive respiratory muscles places them at high risk for respiratory failure

Signs and symptoms of SCI

Loss of movement, sensation, bladder or bowl control, Spasms, changes in sexual function, fertility, pain/pressure in head, neck, or back ,difficulty breathing, numbness, tingling in hands, fingers, feet, toes (neuropathy), twisted neck or back, weakness, or paralysis in part of body

Chronic SCI trauma

Months -decreased nuerotrophic support -scar firmly established around lesion site -demyelination -axonal growth failure

A patient with a complete T12 classification will have?

No inspiratory or expiratory impairment

Sacral Injuries- Neurogenic bladder

Possibility of detrusor areflexia resultin gin urinary retention Possible incontincence owing to loss of urethral resistance Bladder reflex is absent: retain urine

Suprasacral Injuries- Neurogenic Bladder

Possible loss of synergia between detrusor and sphincter Supression of the brains ability to control the bladder reflex resulting in urinary incontinence, residual urine volume

You can only treat secondary injury True or False?

True because primary injury already occured

Complete SCI

All sensory and motor function are lost below the spinal cord injury Paraplegia- from elbows down Tetraplegia/Quadriplegia- from neck down

What is the Highest priority to Quadriplegics?

Arm/hand function

A patient with a spinal cord injury at the T1 level complains of a severe headache and an "anxious feeling." Which is the most appropriate initial reaction by the nurse?

Assess for a full bladder

This is a very serious condition often experienced by individuals with SCI usually at or above the level of T6

Autonomic Dysreflexia

What is the most serious conseuquence of Neurogenic Bladder?

Autonomic Dysreflexia

What is the functionally relevant muscle at C4?

Biceps

Main causes of Autonomic Dysreflexia: 3 Big B's

Bladder (most common) make sure is it empy properly; look for signs of infection Bowel: check for impacted stools, palpate the abdomen for distention, assess bowel movement Break down of skin: Assess skin regularly, protect from injury, remove binding devices

Cervical Nerves (C1-C8)

C1-head and neck C2 & C3- diaphragm C4- Deltoids, biceps C5- Wrist extenders C6 & C7- Triceps C8- hand

Hyperreflexic bowel (upper motor neuron bowel syndrome)

Caused by a lesion above T10, involuntary contractions of muscles of the rectum and anus remail intact. There is an inability to voluntary relax anal spincters and defecate leading to constipation

Areflexic bowel ( lower motor neuron bowel syndrome)

Caused by a lesion below T10, loss of peristalsis adn slow stool propulsion. No spinal cord mediated reflex occurs leading to constipation with leaking of stool

Clinical signs of Respiratory problems

Change is respiratory rate Shortness of breath Increased HR Increased anxiety Increased volume or thickness of secretions Decreased oxygen saturation Elevated temperature

Neurogenic Bladder

Complete or partial loss of bladder control, resulting in incontinence, renal impairment, UTI, stone, and poor quality of life.

Rotation SCI

Displacement of vertebrae

Extension/hyperextension SCI

Ruptured anterior ligament and compressed ligament

Sacral nerves

S3- Bowel, bladder S4-Sexual function

What causes retention of secretions during infections in SCI?

SCI affects innervation of abdominal muscles and compromises the ability to generate coughs

Acute SCI trauma

Seconds-minutes -uncontrolled influx of blood & blood proteins -Hypoxia/ischemia -release of excitatory neurotransmitters

Highest Priority to Paraplegics

Sexual function

Respiratory dysfunction and related diseases such as pneumonia , are common causes of death in

Spinal Cord Injury

Thoracic Nerves

T7-chest muscle T8-Abdominal muscles

True or False? Patients with SCI report bowel dysfunction as more problematic than any of bladder dysfunction, sexual dysfunction, pain, fatigue, or perception of body image

TRUE

Vertebrae can be fractured by tramau but unless spinal cord is injured there will be no motor/sensory deficits. True or False?

TRUE

Myotome

The muscles served by a spinal nerve root

Incomplete SCI

There is some residual motor and/or sensory function below the level of injury; prognosis for returning of function is better because of preservation of axonal function Paraplegia- from thoracic down Tetraplegia/Quadriplegia- from neck down

A SCI above this area can result in neurogenic shock, where the pt may exhibit extremely unstable hypotention and bradycardia.

above T6

What is a SCI

complete or partial damge to the neural elements of the spinal cord that causes permaent changes in sensation and loss of voluntary control below the site of injury

Neurogenic bowel

complete or partial loss of bowel control, symptoms comprise constipation and fecal incontinence

Compression SCI

compression of spinal cord and fractured vertebrae

Flexion SCI

forward dislocation, damage to spinal cord, ruptured posterior ligaments