SCI 2 (NEURO BASIC (determine of nerological level (neurological…
determine of nerological level
sensory level- most caudal segment with normal sensory function. determined with dermatomes level
the neurological level- most caudal level of the spinal cord with normal motor and sensory function on both the left and right sides of the body
first check sensation(dermatomes level) 2. motor level both left&right, MMT must 3 or more than 3
Motor level- most caudal segment of the spinal cord with normal motor function bilaterally
남아있는 function을 알기 위해 중요함
keymuscle아닌건 dermatome level과 연결해서 생각
ADL activity is everything
focus on what is remaining!
basis vertebra intact
most caudal level
of the spinal cord with
normal "motor" and "sensory"
both the "left" and "right" sides
of the body;몸의 왼쪽과 오른쪽 모두에서 정상적인 운동과 감각 기능을 가진 척수의 거의 꼬리 수준.
most caudal segment of the spinal cord with normal motor function bilaterally
;양측 정상 운동 기능을 가진 척수의 가장 꼬리 부분
most caudal segment with normal sensory function. determined with dermatomes level
정상적인 감각 기능을 가진 대부분의 꼬리 부분은 dermatomes 수준으로 결정됩니다
only 1 level
먼저 sensory level을 체크!(pinprint) C5가 손상이라고 할때 2. MOTOR level을 확인하라
"always more than are equal to 3 or 3+"
1.First check sensation(dermatomes level)
motor level both left & right, MMT must 3 or more than 3
C8이 neurological level임
손상밑은 아무것도 기능 안함
sensory는 둘다 C6
Q.Lt. C6 3+/5 C7
,Rt C6 3/5 일때 neurological level은
neurological level is C6 (C7 2/5이기 때문에?)
Q. Lt. C6 3+/5, C7 3/5, Rt. C6 3+/5의 neurological level은
Rt. C6 motor, Lt. C7 motor임
above C5는 정상
sensation lt. C5, Rt. C6, motor Lt. C5, Rt. C5일때 motor is C5
(3 or more than 3)
soensory left C5, Rt.C5, motor Lt. C6(3/5) Rt. C7(3+/5) , patient has dicpts MMT 5/5, C4, C5,C6, C7에서 C5가 neurological level이다, -motor level 은 bilaterally
nuerulogical level of injury?
3/5 or 3+/5
A = Complete. No sensory or motor function is preserved in the sacral segments S4-S5.
B = Sensory Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5, AND no motor function is preserved more than three levels below the motor level on either side of the body.
C = Motor Incomplete. Motor function is preserved below the neurological level, and more than half of key muscle functions below the single neurological level of injury have a muscle grade less than 3 (Grades 0-2).
D = Motor Incomplete. Motor function is preserved below the neurological level, and at least half (half or more) of key muscle functions below the NLI have a muscle grade ≥ 3.
E = Normal. If sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the patient had prior deficits, then the AIS grade is E. Someone without a SCI does not receive an AIS grade.
from frontal lobe
CN 5, 6,7,8
psedu bulbar palsy
affected speech, swollowing
CVA, ALS, TBI, MS, CP, tumors
nerve injury, polio, GBS, ASL
can be test in supine position
L2; hip flexors(iliopsoas), L3; knee extensors(quadricpes), L4;ankle dorsiflexors(tibialis anterior), L5; long toe extensors(extensor hallucis longus), S1; ankle plantar flexors(gastrocnemius, soleus)
C5;elvow flexors(biceps, brachialis) C6; wrist extensors(extensor carpi radialis longus/brevis) C7; elbow extensors(triceps) C8; long finger flexors(flexor digitorum profundus), T1; small finger abductors(abductor digiti minimi)
5)central cord syndrome
cervical hyperextension injury
causes UMN in LE and LMN in UE
lesion affect mostly the gray matter and tracts located cently
dorsal column not affected
UE pain -temp loss>LE
why UE is more affcted than LE
그것은 긴 이야기가 되지
cortical spinal tract and ant lateral tract in UE are located centrally than LE, so "UE affected>LE"
fasiculus cuneatus 와 fasciculas gracillis
3)posterior cord syndrome
2)anterior cord syndrome
frequently related to flexion injury
in cervical region with resultant damage to the 2/3 anterior portion of the cord and/or its vascular supply from the anterior spinal artery secondary to flexion injuries
there is typically compression of the anterior cord from fracture, dislocation, or cervical disk protrusion
this syndrome is characterized by loss of motor function(corticospinal tract damage) and loss of the sense of pain and temperature(spinothalamic tract damage) below the level of the lesion
proprioception, light touch, and vibratory sense are generally preserved
4)cauda equina injury
anteriorlateral spinothalamic tract
pain , temperature, crudely localized touch, tickle, itch, sexual sensation
pain, temp, itching, ticking
corss at SC level
to raticular system in vrain stem>cayse arousal on injury
end at superior colliculus. the superior colliculi have the reflex function of turning the upper body, head, and eyes in the direction of a painful stimulus
dorsal and ventral spinocerebellar
unconcious proprioception for movement and co-ordination
Dorsal column system
Dorsal column medial lemniscal(DCML)
pressure, vibration, position sense, awareness of joint at rest, discriminative touch
입체 지각: 물체를 만지거나 들어올려 그 모양·중량을 측정하는 능력.
two point discrimination
손바닥에 무슨글씨 썼는지 알아채는것
위치인식을 알기 위한 검사
눈감고 몇번째 손가락 잡았는지 아는것
recognition of texture
double simultaneous stimulus
두곳을 순서대로 만졌을때 아는것??
fibers don't cross at spinal level
CROSS IN MEDULAR
fast conducting, myeilinated