SCI knowledge Check

Your C7 spinal cord injured patient has a minimum elbow extension grade of:

• 5/5

• 3/5

• 2/5

• -2/5

Answer explanation

• Correct (3/5): A C7 SCI typically preserves partial innervation to the triceps brachii (C6-C8), responsible for elbow extension. A minimum grade of 3/5 (able to perform full range of motion against gravity but not against resistance) is expected due to partial denervation or weakness at the C7 level, especially in incomplete injuries or early recovery (O’Sullivan & Schmitz’s Physical Rehabilitation). This aligns with your correction, as 3/5 reflects the minimum functional strength for elbow extension in C7 SCI.

• 5/5: Incorrect, indicates normal strength, which is less likely in C7 SCI due to potential partial denervation or early recovery limitations, though possible in some incomplete injuries with full recovery.

• 2/5: Incorrect, indicates movement only with gravity eliminated, which is too severe for C7 SCI, where triceps function is typically preserved at least against gravity.

• -2/5: Incorrect, not a valid manual muscle testing (MMT) grade; MMT uses a 0-5 scale.

Incomplete spinal cord injuries have:

• ASIA scale A

• no motor or sensation below injury level

• inability to ambulate

• sacral sparing

Answer explanation

• Correct (Sacral sparing): Incomplete SCI is defined by partial preservation of sensory or motor function below the neurological level of injury, often including sacral sparing (sensation or motor function in S4-S5 dermatomes/myotomes, e.g., anal sensation or voluntary anal contraction), distinguishing it from complete SCI (O’Sullivan & Schmitz’s).

• ASIA scale A: Incorrect, indicates complete SCI with no sensory or motor function below the injury level, per the American Spinal Injury Association (ASIA) scale.

• No motor or sensation below injury level: Incorrect, describes complete SCI, not incomplete.

• Inability to ambulate: Incorrect, not a defining feature; some patients with incomplete SCI may ambulate depending on the extent of preserved function.

This happens immediatley after a spinal cord injury resulting in flaccidity, areflexia, and loss of bowel/bladder function.

• Spinal Shock

• Sacral Sparing

• autonomic dysreflexia

• regain function of the S4/S5 dermatome

Answer explanation

• Correct (Spinal shock): Spinal shock occurs immediately after SCI, causing temporary flaccidity, areflexia, and loss of bowel/bladder function due to disrupted neural signaling below the injury level. It typically resolves over days to weeks (O’Sullivan & Schmitz’s).

• Sacral sparing: Incorrect, indicates incomplete SCI with preserved S4-S5 function, not an immediate post-injury phenomenon.

• Autonomic dysreflexia: Incorrect, a later complication in SCI (typically T6 or above) triggered by noxious stimuli, not immediate.

• Regain function of S4/S5 dermatome: Incorrect, implies recovery, not an immediate effect of SCI.

A spinal cord injury at L2 would possibly present as:

• 3/5 hip flexion, 2/5 or worse for knee flexion, extension

• 3/5 hip extension, 2/5 or worse for knee flexion, extension

• 3/5 hip abduction, 2/5 or worse for knee flexion, extension

• 3/5 hip flexion, 5/5 or for knee flexion, extension

Answer explanation

• Correct (3/5 hip flexion, 2/5 or worse for knee flexion, extension): An L2 SCI affects the L2 myotome (hip flexion, iliopsoas, innervated by L1-L3), potentially preserving partial strength (e.g., 3/5, movement against gravity). Muscles innervated below L2, such as those for knee flexion (hamstrings, L4-L5/S1) and extension (quadriceps, L3-L4), are more severely impaired (2/5 or worse, movement with gravity eliminated or less) due to disrupted innervation (O’Sullivan & Schmitz’s).

• 3/5 hip extension, 2/5 or worse for knee flexion, extension: Incorrect, hip extension (gluteus maximus, L5-S2) is typically more affected than hip flexion in L2 SCI.

• 3/5 hip abduction, 2/5 or worse for knee flexion, extension: Incorrect, hip abduction (gluteus medius, L4-S1) is also more affected than hip flexion in L2 SCI.

• 3/5 hip flexion, 5/5 for knee flexion, extension: Incorrect, knee flexion/extension (L3-L5) would not have normal strength (5/5) due to L2-level disruption.

Your patient with a spinal cord injury at T10 may need which of the following:

• transfer board and dependent assist

• breathing stimulator

• TLSO

• power-assisted chair

Answer explanation

• Correct (Power-assisted chair): A T10 SCI results in paraplegia with preserved upper body function but impaired lower extremity function (L1 and below). A power-assisted wheelchair is often needed for mobility, especially for community ambulation or energy conservation, depending on the patient’s functional goals (O’Sullivan & Schmitz’s).

• Transfer board and dependent assist: Incorrect, patients with T10 SCI typically have sufficient upper body strength (intact C5-T1) for independent or assisted transfers using a sliding board, not requiring dependent assistance.

• Breathing stimulator: Incorrect, typically required for high cervical injuries (e.g., C1-C4) affecting diaphragmatic function (C3-C5), not T10.

• TLSO (thoracolumbosacral orthosis): Incorrect, used for acute spinal stabilization (e.g., fractures), not typically for chronic T10 SCI management.

This type of SCI results in loss of sensation on the opposite side of the body

• Complete spinal cord injury
• Horner's syndrome
• Anterior cord syndrome
• Brown-Séquard syndrome

Answer explanation

• Correct (Brown-Séquard syndrome): Brown-Séquard syndrome, caused by hemisection of the spinal cord, results in contralateral (opposite side) loss of pain and temperature sensation due to damage to the spinothalamic tract, with ipsilateral loss of motor function and proprioception (O’Sullivan & Schmitz’s).

• Complete spinal cord injury: Incorrect, causes bilateral loss of sensation and motor function below the injury level.

• Horner’s syndrome: Incorrect, involves ptosis, miosis, and anhidrosis due to sympathetic chain disruption, not contralateral sensory loss.

• Anterior cord syndrome: Incorrect, causes bilateral loss of motor function and pain/temperature sensation below the injury, not contralateral-specific sensory loss.

This spinal cord injury may have higher MMT in the lower extremity compared to the upper extremity

• Brown-Sequard

• Anterior Cord

• Central Cord

• Posterior Cord

Answer explanation

• Correct (Central cord): Central cord syndrome, often from cervical hyperextension injuries, affects the central corticospinal tracts, causing greater motor impairment in the upper extremities than the lower extremities due to the somatotopic organization (upper extremity fibers more medial, thus more affected) (O’Sullivan & Schmitz’s).

• Brown-Séquard: Incorrect, causes ipsilateral motor loss, not specific to upper vs. lower extremity differences.

• Anterior cord: Incorrect, affects motor function bilaterally below the injury, not upper vs. lower.

• Posterior cord: Incorrect, primarily affects proprioception and vibration sense, with minimal motor impact.

This spinal cord injury may have an increased loss of balance, pressure, and stretch sensations.

• central cord

• anterior cord

• posterior cord

• Brown-Sequard

Answer explanation

• Correct (Posterior cord): Posterior cord syndrome affects the dorsal columns, leading to loss of proprioception, vibration, pressure, and stretch sensations, which significantly impair balance (O’Sullivan & Schmitz’s).

• Central cord: Incorrect, primarily causes motor deficits, especially in upper extremities, with less impact on proprioception.

• Anterior cord: Incorrect, affects motor function and pain/temperature sensation, sparing dorsal column sensations.

• Brown-Séquard: Incorrect, causes ipsilateral proprioception loss and contralateral pain/temperature loss, but not as specific to balance-related sensations as posterior cord.

Areflexive bowel and bladder:

• Areflexive bowel and bladder is a condition with increased reflex control.
• Areflexive bowel and bladder is characterized by excessive muscle contractions.
• Areflexive bowel and bladder refers to normal reflex function.
• Areflexive bowel and bladder is a condition characterized by loss of reflex control.

Answer explanation

• Correct (Loss of reflex control): Areflexive (flaccid) bowel and bladder result from lower motor neuron injuries (e.g., cauda equina or sacral SCI, S2-S4), causing loss of reflex control, leading to incontinence and flaccidity (O’Sullivan & Schmitz’s).

• Increased reflex control: Incorrect, describes spastic bowel/bladder from upper motor neuron injuries (e.g., above S2).

• Excessive muscle contractions: Incorrect, also describes spastic conditions, not areflexive.

• Normal reflex function: Incorrect, areflexive indicates abnormal loss of reflexes.

This condition is a medical emergency:

• autonomic dysreflexia

• areflexive bowel

• spastic bowel

• orthostatic hypotension

Answer explanation

• Correct (Autonomic dysreflexia): Autonomic dysreflexia is a medical emergency in SCI patients (typically T6 or above), characterized by severe hypertension, headache, and sweating due to unopposed sympathetic response to a noxious stimulus (e.g., blocked catheter, tight clothing). Immediate intervention is required to prevent stroke or organ damage (O’Sullivan & Schmitz’s).

• Areflexive bowel: Incorrect, a chronic condition manageable with bowel programs, not an emergency.

• Spastic bowel: Incorrect, a chronic condition, not immediately life-threatening.

• Orthostatic hypotension: Incorrect, manageable with positioning or compression, not typically an emergency.