Central/Anterior Cord Syndromes
What should be utilized during all PT activities with ACS?
compensatory techniques, use of momentum, and the head-hips relationship
Who all is involved in the medical management of a patient with CCS?
physiatry, PT, OT, vocational counseling, social services
What is the prognosis of ACS?
poor prognosis; associated w/ high mortality and poor functional outcomes prognosis is not always poor: - some level of recovery after 1-2 years of initial injury - prognosis is best when it is noted w/in the first 24 hours after injury
What are other etiologies of ACS?
traumatic incident: compresses/damages ant spinal artery d/t fx or dislocation nontraumatic incidents: atherosclerosis, external compression (disk protrusion/mass), aortic pathology can cause decreased perfusion/vascular insufficiencies
What population tends to recovery well from a CCS?
younger population
What is involved in the patient's HEP with CCS?
continuation of ex; endurance; functional mobility training; outpatient may be warranted
Why is the ACS considered an incomplete SCI or syndrome?
it does not damage the dorsal columns
Why are the sacral segments usually unaffected with CCS?
lumbar, thoracic, cervical components proceed medially in order towards the SC; sacral segments are located laterally w/in the SC, so they are usually unaffected
What is involved during acute PT with ACS?
- ROM - respiratory management - pressure relief - skin care education/management - functional mobility
What are other etiologies of CCS?
- anterior compression of cord d/t osteophyte formation - cervical spondylosis - narrowing/congenital defect of spinal canal - tumor - RA - syringomyelia - > 50 y/o - men > women
What is the likely outcome of PT with ACS?
- extensive PT required - assists patient to compensate for the injury - only minor improvements in motor function anticipated - unusual for significant neurological recovery following SC infarct
What are the S/S of CCS?
- greater UE motor loss vs LE; most severe distally in the UE - limited sensory loss below lesion; can be variable - B&B function resolves in most pts after 6 months
What medications will a patient with CCS typically be on?
- methylprednisolone: given w/in 8 hrs of injury to assist w/ neurologic recovery - BP medications (combar autonomic dysreflexia) - antispasticity meds - anticonvulsants - antidepressants
What should be included in the patient's PT POC with CCS?
- patient/caregiver education - ROM - strengthening - endurance activities - balance retraining - proximal stabilization ex - functional mobility (based on pt's status) - adaptive devices (assist w/ overall mobility)
What is involved during the rehabilitation phase of PT with ACS?
- strengthening - transfer training - adaptive device training - ambulation and/or w/c management - most will need to be trained to utilize a w/c
What are the S/S of ACS?
BILATERALLY: - complete motor loss - loss of pain/temperature sensation autonomic dysfunction: - loss of B&B function - loss of sexual function likely may affect respiratory function
How is CCS diagnosed?
MRI: assess SC impingement from bone/disk CT scan: assess spinal canal compromise & deg of impingement x-ray: assess potential dx, dislocations, degree of spondylotic deterioration PMH & MOI
How is ACS diagnosed?
MRI: determines location/extent of injury x-rays: determines fx/dislocation CT scan: more sensitive in detecting injuries to the spine/spinal canal neuro exam: special attention given to sensory/motor testing ASIA impairment scale: determines extent of injury
What is the likely outcome of a course of PT with CCS?
assists patients to attain max functional outcome based on level/extent of injury; overall outcome based on age, motivation, compliance, extent of injury
When are rehabilitation services initiated with CCS?
once the patient is medically stable
What is the MOI ACS?
cervical flexion: compresses/damages anterior structures, specifically the (ant spinal artery) or through infarction of the anterior spinal artery
What is the most common incomplete SCI?
central cord syndrome
What is the most common MOI for CCS?
cervical hyperextension (ligamentum flavum hyperextension)
What spinal tracts are damaged with ACS?
damages the anterior/posterior corticospinal tracts (motor function) and spinothalamic tracts (sensation of pain/temperature)
What are the favorable long-term prognostic factrors for a good outcome with CCS?
early hand function; strength improvement in all 4 extremities during inpatient stay; little to no LE involvement
What will the HEP of ACS look like?
exercise (ROM/strengthening) functional mobility skin care management community skill training outpatient PT participation
What is involved during initial treatment of ACS?
immobilization: halo or Minerva orthosis stabilization high doses of methylprednisolone to limit swelling/damage/improve neurological functions
What is a central cord syndrome (CCS)?
incomplete lesion; d/t compression/damage to central portion of the SC; most commonly results from a fall but can occur from other forms of trauma (MVA)
What is an anterior cord syndrome?
incomplete lesions; d/t compression/damage (fx or dislocation) of the anterior 2/3 of the SC or anterior spinal artery
If the patient with CCS ambulates, what type of AD is typically used?
initially, a platform attachment walker b/c hand function is usually poor for grasp
What remains intact with ACS?
sensations controlled through the dorsal columns (proprioception, vibration
How are the central tracts damaged with CCS?
spinal cord sustains bleeding into the central gray matter that causes damage to the central located cervical tracts
Which tracts are damaged with CCS?
spinothalamic, corticospinal, and dorsal columns
Where does the anterior spinal artery supply blood, and what happens when it is damaged?
supplies anterior 2/3 of the spinal canal; damage results in decreased perfusion to the spinal tracts that it supplies (corticospinal and spinothalamic tracts)