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SPINAL CORD INJURY, Descending Tracts 1. Corticospinal Tracts
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SPINAL CORD INJURY
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Mechanism of spinal cord injury can be divided into :
- Hyperflexion,
- hyperextension
- compression
- rotation
- distraction
PARAPLEGIA
- paralysis that occur in the lower half of the body
Symptoms
- loss of sensation
- impaired mobility
- weight gain
- depression
- sexual dysfunction
- difficulty with bladder and bowel function
- autonomic dysreflexia
- secondary infection
Causes
- accidents
- severe spinal cord injury
- motor neuron disease
- tumour/blood clot
- spina bifida
- multiple sclerosis
Causes of SCI - MVA , trauma, violence, osteoporosis, diving, sports
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Loss of Sensation
Anterior and lateral spinothalamic tract affected 
Descending Tracts 1. Corticospinal Tracts
- Corticonuclear Tracts
- Rubrospinal Tract
- Reticulospinal Tract
- Tectospinal Tract
- Vestibulospinal Tract
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UMN
- cell body originate in the cerebral cortex/brainstem and terminates at brainstem/spinal cord
LMN
- cell body LMN lies within ventral horn of spinal cord/brainstem motor nuclei of the cranial nerves
Tendon reflex
Reflexive contraction of the muscle is combined with reciprocal inhibition of its antagonists, seen as a brief ‘jerk’ of the limb
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Clonus and Babinski
After spinal shock :
- Knee jerk is normal on both sides.
- Ankle jerk is exaggerated on both sides.
- Babinski sign positive on both sides.
- Ankle clonus present on both sides.
(Only ankle jerk present because its innervation is below the level of lesion)Clonus (rhythmic oscillating stretch reflex) and Babinski (primitive refelx) both happen in UMN lesion
Loss of reflex Spinal shock
- loss of muscle tone and spinal reflexes below the level of a severe spinal cord lesion
- mediated by synaptic changes in spinal cord segments below the level of injury
Ascending Tracts
- Spinothalamic Tracts
- Posterior Column Tracts
- Spinocerebellar Tracts
- Spinotectal Tract
- Spinoreticular Tract
- Spino-olivary Tract
- Viscera Sensory Tract
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Management
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Orthatic Brace, Postural Management, Physiotherapy, Occupational therapy, anti-spastic medication, laminectomy, vertebral augmentation
Spinal cord level and vertebral level
The SC is shorter than vertebral column→ so the spinal segments that give rise to the spinal nerves is short and crowded (esp in lower SC)
SC Segment ≠ Vertebral Level
In this patient
the fracture is at T12 vertebra, therefore the spinal segment that is affected is L5-S1 spinal segment
Spinal cord anatomy
Voluntary Movement Control
Commands for voluntary movement originate in corticol assoc areas --> the movement planned activates basal ganglia and lateral portion of cerebellar hemisphere --> funnel information to the premotor and motor cortex via thalamus --> most motor commands from motor cortex are relayed via corticospinal and corticobulbar tracts
Sensory feedback via the medial lemniscus and spinothalamic to the spinal cord and cerebral hemisphere from the muscles
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Types of Sensation
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