IV. PATHOLOGY

Gray Matter: Neuronal cell bodies and synapse

Anterior Horn: mainly responsible by motor neurons.

Posterior Horn: mainly responsible by sensory neurons.

White Matter: ascending and descending fiber pathway

Ascending: transmit sensory information to the brain.

Descending: transmit motor information to the cord.

A section of skin innervated through specific part of the spine is called a “dermatome”, and spinal injury can cause pain, numbness, and loss of sensation in the relevant areas.

A group of muscles innervated through specific part of the spine is called “myotome”, and injury to the spine can cause problems with voluntary controls.

Dermatomes

C2- External Occipital ProtuberanceC3- Supraclavicular FossaC4- top of the Acromioclavicular jt.C5- Lateral side of the antecubital fossaC6- thumbC7- Middle fingerC8- Little fingerT1- Medial side of the antecubital fossaT2- apex of the AxillaT3- 3rd intercostals spaceT4- nipple lineT5- 5th intercostals spaceT6- Level of the xiphisternumT7- 7th intercostals spaceT8- 8th intercostals spaceT9- 9th intercostals spaceT10- UmbilicusT11- 11th intercostals spaceT12- Inguinal ligament at midpointL1- half the distance between T12 and L2

L2- Mid anterior ThighL3- medial femoral condyleL4- medial malleolusL5- Dorsum of the foot at the 3rd MTP jointS1- Lateral heelS2- Popliteal fossaS3- Ischial tuberosityS4-S5- perianal area

IV - B.S. Occupational OT 5 January 15, 2015 Therapy

MYOTOMESC5- Elbow flexorsC6- wrist extensorsC7- Elbow extensorsC8- Finger flexorsT1- Finger abductorsL2- hip flexorsL3- knee extensorsL4- Ankle-dorsiflexorsL5- Long toe extensorsS1- Ankle plantarflexors

CLASSIFICATION

Complete SCI- if there is no sensation or return of motor function below the level of lesion 24 to 48 hrs after the injury in carefully assessed complete lesions, motor function is less likely to return.

Incomplete SCI- in incomplete lesions, progressive return of motor function is possible, yet it is difficult to determine exactly how much and how quickly return will occur.

CLINICAL SYNDROMES

Central cord syndrome Brown-séquard Syndrome (Lateral Damage) Anterior Spinal Cord Syndrome Cauda Equina (peripheral) Conus Medullaris Syndrome

Central cord syndrome

Occurs when there is more cellular destruction in the center of the cord than in the periphery. Paralysis and sensory loss are greater in the UEs because these nerve tracts are more centrally located than those of the LEs.

Brown-séquard Syndrome (Lateral Damage)

Brown-séquard Syndrome result when only one side of the cord is damaged. There is motor paralysis and loss of proprioception on the ipsilateral side and loss of pain, temperature and touch sensation on the contralateral side.

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IV - B.S. Occupational OT 5 January 15, 2015 Therapy

Anterior Spinal Cord Syndrome

Anterior Spinal Cord Syndrome result from injury that damage the anterior spinal artery or the anterior aspect of the cord. Paralysis and loss of pain, temperature, and touch sensation. Proprioception is preserve.

Cauda Equina (peripheral)

Cauda Equina injury involves peripheral nerves rather than directly involving the spinal cord. Patterns of sensory and motor deficits are highly variable and asymmetrical.

Conus Medullaris Syndrome

Conus Medullaris Syndrome involves injury of the sacral cord (cunos) and lumbar nerve roots. Results in an areflexic bladder, bowel, and LEs.

V. ASSESSMENT

The International Standards for Neurological Classification of SCI has been adapted worldwide as the preferred assessment instrument. (Braddom, 2011) Others include: FIM, RLA, Frankel’s Classification for Acute SCI, etc.

VI. TREATMENT

May or may not include the ff:

Pharmacologic tx Surgical tx ROM Modalities Pressure reliefs

Transfers Standing Ambulation ATDs (Assisted

Technology Devices) Home Modifications

VII. PROGNOSIS

The major factors in predicting recovery early after traumatic SCI include the initial Neurological Level of Injury (NLI), the initial motor strength, and most importantly, whether by examination the injury is classified as neurologically complete or incomplete. (DeLisa, 2011)

Karen Abinsay Jet Duria Sheena Gazzingan

IV - B.S. Occupational OT 5 January 15, 2015 Therapy

If there is no sensation or return of motor fxn BELOW the level of lesion 24-48 hrs after the injury in carefully assessed complete lesions, motor fxn is less likely to return. However, partial to full return of fxn to one spinal nerve root level below the fracture can be gained and may occur in the first 6 months. (Pedretti, 2013)

In incomplete lesions, progressive return of motor fxn is possible, yet it is difficult to determine exactly how much and how quickly return will occur.

Incomplete injuries are associated with a better chance of further recovery than are complete injuries, but even with incomplete injuries there is no guarantee that further recovery will occur. (Pedretti, 2013)

Frequently, the longer it takes for recovery to begin, the less likely it is that it will occur. (*Most of the recovery that will occur starts within the first few weeks.) (Pedretti, 2013)

Karen Abinsay Jet Duria Sheena Gazzingan