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