📖 ContentsChapter 6 · Neuromuscular
NPTE Review · Chapter 6 · Neuromuscular

Neuromuscular: Stroke, Brain Injury and Spinal Cord Injury

Stroke, traumatic brain injury and spinal cord injury fill a large share of neurologic questions on the licensing exam, and they share one theme: the location of the lesion predicts the deficits, the prognosis and the dangers. This chapter teaches you to read a stroke syndrome from its artery, stage motor recovery, manage the agitated patient with brain injury, classify a spinal cord injury and predict function from its level, and recognize the medical emergencies, such as autonomic dysreflexia, that you must act on immediately.

By the end of this chapter you can

  • Match the deficits of MCA, ACA, PCA, vertebrobasilar and lacunar strokes to their arteries, including the aphasias, neglect and pusher syndrome.
  • Describe Brunnstrom stages and the upper and lower extremity flexion and extension synergies.
  • Apply positioning, hemiplegic shoulder care, gait training and acute care blood pressure precautions after stroke.
  • Use the Glasgow Coma Scale and Rancho Los Amigos levels to classify brain injury and plan behavior management.
  • Apply graded return to learn and return to sport after concussion and recognize red flags.
  • Classify a spinal cord injury with the key muscles, key sensory points and the ASIA Impairment Scale, and identify the incomplete cord syndromes.
  • Predict functional outcomes by level from C1 to S5, including tenodesis.
  • Recognize and manage autonomic dysreflexia, orthostatic hypotension, heterotopic ossification, pressure injury and spasticity.

Section 1Stroke syndromes by artery

A stroke (cerebrovascular accident) is the sudden onset of a focal neurologic deficit from interrupted blood flow lasting more than 24 hours or showing infarction on imaging. About 85 to 87 percent are ischemic (thrombotic, embolic often from atrial fibrillation, or small vessel lacunar disease). The rest are hemorrhagic: intracerebral hemorrhage, usually from chronic hypertension, and subarachnoid hemorrhage, usually from a ruptured aneurysm and announced by a sudden "worst headache of my life." A transient ischemic attack (TIA) is a temporary episode without infarction; it is a warning, and about one in ten patients has a stroke within the following weeks to months, so new or recurring symptoms require emergency referral. The public warning sign BE FAST covers balance loss, eye (vision) changes, face drooping, arm weakness, speech difficulty and time to call emergency services. Major modifiable risk factors are hypertension (the most important), atrial fibrillation, diabetes, smoking, hyperlipidemia, obesity and physical inactivity.

Arterial syndromes

Each artery supplies a predictable territory (Chapter 5), so each stroke produces a predictable cluster. Deficits from hemispheric strokes appear on the side of the body opposite the lesion. The hemisphere matters as much as the artery: a dominant (usually left) hemisphere lesion causes language deficits; a nondominant (usually right) lesion causes neglect and visuospatial problems.

ArteryMotor and sensoryOther key findings
Middle cerebral (most common)Contralateral hemiparesis and sensory loss, face and arm greater than legContralateral homonymous hemianopia; eyes deviate toward the lesion; dominant side: aphasia (Broca, Wernicke or global); nondominant side: neglect, anosognosia, visuospatial deficits, impulsivity
Anterior cerebralContralateral hemiparesis and sensory loss, leg greater than arm, face sparedUrinary incontinence; abulia (lack of initiative), slowed responses, perseveration; grasp reflex; apraxia; personality change
Posterior cerebralUsually little weakness; contralateral sensory loss if the thalamus is involvedContralateral homonymous hemianopia with macular sparing; visual agnosia, prosopagnosia; alexia without agraphia (dominant); memory loss; thalamic pain syndrome (severe burning pain on the contralateral body)
VertebrobasilarCrossed signs: ipsilateral cranial nerve deficit, contralateral body weakness or sensory loss; may be bilateralVertigo, nystagmus, diplopia, dysarthria, dysphagia, ataxia, drop attacks, decreased consciousness
Lateral medullary (Wallenberg; vertebral or PICA)Ipsilateral face and contralateral body loss of pain and temperature; no major weaknessIpsilateral Horner syndrome and limb ataxia, dysphagia, hoarseness, vertigo, nystagmus
Locked in syndrome (basilar, ventral pons)Quadriplegia, anarthriaConsciousness and vertical eye movements and blinking preserved; communicate by eye movement
Lacunar (small penetrating arteries)Pure motor (posterior limb internal capsule), pure sensory (thalamus), ataxic hemiparesis, dysarthria clumsy hand, sensorimotorNo cortical signs: no aphasia, neglect or field cut; generally good recovery
Anterior (frontal) Posterior (occipital) ACA: medial frontal, parietal Leg and foot, bladder, initiation MCA: lateral convexity Face and arm, language, attention Deep MCA branches Internal capsule, basal ganglia PCA: occipital, thalamus Vision, memory, thalamic sensation
Figure 6.1 Simplified arterial territories in a horizontal slice, anterior at the top. The ACA runs along the medial surface where the leg area lies; the MCA covers the lateral convexity, and its deep lenticulostriate branches supply the internal capsule (pure motor lacunar strokes); the PCA supplies the occipital lobe and thalamus.

Aphasia

Aphasia is an acquired disorder of language, distinct from dysarthria (a motor speech disorder of articulation with intact language). Classify aphasia with three questions: is speech fluent, is comprehension intact, and can the patient repeat?

TypeFluencyComprehensionRepetitionLesion and notes
Broca (expressive)Nonfluent, effortful, telegraphicRelatively intactImpairedDominant inferior frontal gyrus; patient aware and frustrated; often with right hemiparesis (arm and face)
Wernicke (receptive)Fluent but empty, paraphasias, jargonImpairedImpairedDominant posterior superior temporal gyrus; often unaware of errors; may have little weakness
GlobalNonfluentImpairedImpairedLarge dominant MCA stroke; usually dense hemiplegia
ConductionFluentIntactImpairedArcuate fasciculus
Transcortical motor or sensoryNonfluent or fluentIntact or impairedIntactWatershed areas around the language center; repetition spared
AnomicFluentIntactIntactWord finding difficulty only; common in recovery

Communication strategies: for Broca aphasia, ask yes or no questions, allow time, and offer gestures or picture boards. For Wernicke aphasia, use short, simple sentences with demonstration and gestures, and do not rely on the patient's verbal report of understanding.

Neglect and pusher syndrome

Unilateral spatial neglect is failure to attend to the side of space and body opposite the lesion, most often left neglect after a right parietal stroke. It differs from hemianopia: a patient with hemianopia alone knows the field is missing and turns the head to compensate, while a patient with neglect does not. Neglect is tested with line bisection, cancellation tasks and copying drawings, and it predicts poor function and falls. Treatment includes visual scanning training, anchoring cues on the neglected side, prism adaptation, mirror therapy and trunk rotation toward the neglected side. Early on, place the call light and key items on the intact side for safety while training attention toward the neglected side during therapy.

Pusher syndrome (contraversive pushing) is a disorder of perceived body verticality, usually from a lesion of the posterolateral thalamus. The patient perceives upright as tilted toward the less affected side, so they actively push with the less affected arm and leg toward the hemiparetic side and resist any attempt to correct the posture toward midline, which causes falls toward the weak side. It is more common with right hemisphere lesions and often coexists with neglect. Treatment uses vision, which is intact: show the patient vertical references (a door frame, the therapist's body, a mirror), have them reach toward objects on the less affected side so that weight shifts over the midline, and seat or stand them with the less affected side next to a wall so that pushing is futile. Avoid pulling the patient upright against their push; that increases resistance. The prognosis for resolution within months is good.

Board tip. Separate the look alikes. A left MCA stroke patient is often cautious, slow and aware of deficits, so give many demonstrations and avoid long verbal instructions. A right MCA stroke patient is often impulsive, overestimates ability and ignores the left side, so give verbal cues, slow the pace and supervise closely for safety. Pusher syndrome pushes toward the weak side; ordinary hemiplegic patients lean or fall toward the weak side without pushing.
Case. A 71 year old right handed woman on day three after a stroke sits with her trunk tilted to the left. When the therapist tries to bring her upright, she pushes forcefully with her right hand on the mat and extends her right leg, resisting. She does not look to the left, and when shaving her face in a picture task she draws only the right side. Her left arm and leg are weak.
Reasoning: Left weakness and left neglect indicate a right hemisphere stroke; active pushing with the nonparetic limbs toward the paretic side and resistance to correction is pusher syndrome. The best initial strategy uses visual feedback of vertical and functional reaching to the right so that she moves her weight toward midline herself. The tempting choice, manually pushing her trunk back to midline, triggers more pushing. Weight shifting toward the left is the wrong direction. Safety point: she will fall to the left; guard on the left, use a gait belt and lock the wheelchair, and place items on her right side outside therapy until neglect improves.
Key point

The artery predicts the pattern: MCA strokes hit the face and arm with aphasia (dominant) or neglect (nondominant); ACA strokes hit the leg with behavioral and bladder changes; PCA strokes cause visual field loss and thalamic pain; vertebrobasilar strokes cause crossed signs, vertigo and ataxia; lacunar strokes are pure motor or pure sensory without cortical signs. Classify aphasia by fluency, comprehension and repetition, and treat pusher syndrome with vision of vertical, not force.

Section 2Stroke recovery and rehabilitation

Most motor recovery after stroke occurs in the first three months, with the steepest gains in the first weeks, but meaningful improvement continues for many months and responds to training even years later. Recovery tends to proceed from proximal to distal and from mass patterns to isolated movement. Early return of some voluntary movement, particularly finger extension and shoulder abduction in the first days, predicts good upper extremity recovery; a flaccid arm with no movement at four weeks predicts poor recovery of hand function.

Brunnstrom stages and synergies

After an upper motor neuron lesion, voluntary movement often first returns within stereotyped mass patterns called synergies, in which the patient cannot move one joint without the others in the pattern. Brunnstrom described the sequence of recovery in stages; patients may stop at any stage.

StageToneMovement
1FlaccidityNo voluntary movement
2Spasticity beginsBasic synergy components appear, often as associated reactions
3Spasticity peaksVoluntary movement only within synergy
4Spasticity declinesSome movements out of synergy (for example, hand behind back, elbow flexed 90 degrees with forearm pronation and supination)
5Spasticity further declinesMore complex combinations out of synergy (shoulder abduction with elbow extended, shoulder flexion to 180 degrees)
6Spasticity disappearsIsolated joint movements with near normal coordination
7NormalNormal motor function (some versions combine this with stage 6)
SegmentUE flexion synergyUE extension synergyLE flexion synergyLE extension synergy
ProximalScapular retraction and elevation; shoulder abduction and external rotationScapular protraction; shoulder adduction and internal rotationHip flexion, abduction, external rotationHip extension, adduction, internal rotation
MiddleElbow flexion (strongest component)Elbow extensionKnee flexionKnee extension
DistalForearm supination; wrist and finger flexionForearm pronation (strongest with shoulder adduction); wrist extension, finger flexionAnkle dorsiflexion and inversion; toe extensionAnkle plantarflexion and inversion; toe flexion

The typical resting posture of the hemiplegic arm (shoulder adducted and internally rotated, elbow flexed, forearm pronated, wrist and fingers flexed) mixes the strongest components of both synergies; the leg is typically held in extension synergy (hip adduction, knee extension, plantarflexion and inversion), which supports standing but causes toe drag and circumduction in swing.

1234567 FlaccidSynergiesemerge Moves insynergy Some outof synergy Complexcombos Isolatedmovement Normal Spasticity peaks Bars: voluntary motor control Dashed line: spasticity
Figure 6.2 Brunnstrom stages of recovery. Voluntary control (bars) climbs in steps while spasticity (dashed line) rises to a peak at stage 3, when movement is possible only within synergy, and then declines as isolated movement returns.

Positioning and the hemiplegic shoulder

Positioning aims to prevent contracture, pressure injury and shoulder injury, and to give sensory input to the affected side. In supine, support the affected shoulder on a pillow with the scapula protracted and the arm slightly abducted and externally rotated, elbow extended, wrist neutral; keep the hip and knee in neutral with a small towel under the hip to limit external rotation. Side lying on the affected side is encouraged for sensory input and elongation of the trunk, with the shoulder protracted forward so the patient does not lie on the point of the shoulder. In sitting, support the affected arm on a lap tray or armrest trough. Turn every two hours in bed when the patient cannot reposition.

Hemiplegic shoulder pain affects many survivors and has several causes: inferior glenohumeral subluxation (in the flaccid stage the rotator cuff and deltoid no longer hold the humeral head, and gravity pulls it down; palpate a gap below the acromion), rotator cuff and biceps tendon injury, adhesive capsulitis, spasticity of the internal rotators and adductors, complex regional pain syndrome (shoulder hand syndrome with a painful, swollen, discolored hand), and impingement from raising the arm overhead without scapular upward rotation and humeral external rotation. Prevention is the best treatment:

Gait training after stroke

Common deviations reflect the stance and swing problems of the paretic leg. Treatment combines high intensity stepping practice (Chapter 5), strengthening, orthoses and, when needed, an assistive device.

DeviationUsual causesTypical management
Toe drag, foot slap or initial contact with the forefootWeak dorsiflexors; plantarflexor spasticity or contractureAFO or peroneal FES; dorsiflexor training; plantarflexor stretching
Knee hyperextension in stance (genu recurvatum)Weak quadriceps locking the knee; plantarflexor spasticity or contracture pushing the tibia back; poor proprioceptionAFO set in slight dorsiflexion; quadriceps training in small knee flexion ranges; plantarflexor tone management
Knee buckling in stanceWeak quadriceps or hip extensorsStrengthening; AFO with anterior stop or KAFO in severe cases
Circumduction or hip hiking in swingReduced hip and knee flexion and ankle dorsiflexion; extensor synergySwing phase training, dorsiflexion assist, treat the cause rather than the compensation
Trendelenburg or lateral trunk leanWeak hip abductorsHip abductor strengthening; cane in the opposite (less affected) hand
Short stance time on the paretic leg, short step with the nonparetic legWeakness, poor balance, fearWeight shift and stance training on the paretic leg; stepping practice

A hemi walker or quad cane gives more stability than a straight cane for patients with poor balance and one functional upper extremity; any cane is held in the hand opposite the weak leg.

Acute care precautions

In the acute phase, protect the brain's perfusion. For ischemic stroke treated with intravenous thrombolysis (alteplase or tenecteplase), blood pressure is kept below 180/105 mmHg for 24 hours afterward, and therapy is usually delayed or limited during that first day while bleeding risk is highest; watch for signs of hemorrhage (new headache, declining consciousness, worsening deficit) and bleeding from puncture sites. For ischemic stroke without thrombolysis, permissive hypertension up to about 220/120 mmHg is commonly allowed in the first 24 to 48 hours to maintain flow to the penumbra. In hemorrhagic stroke, blood pressure is lowered (a systolic target around 140 mmHg is common), so a rising pressure is a reason to stop. Facility protocols vary; follow the physician's specific parameters.

Mobilization should begin once the patient is medically stable, typically within the first days. A large trial found that very early, high dose mobilization within the first 24 hours produced worse outcomes than usual care, so current guidelines advise against high dose mobilization in the first day while supporting short, frequent sessions afterward. Monitor for orthostatic hypotension, cardiac arrhythmias (atrial fibrillation is common), dysphagia and aspiration (keep the head of bed elevated and follow the swallowing plan), deep vein thrombosis, and new or worsening neurologic signs, which require stopping and notifying the team immediately.

Board tip. Exam questions often test the hemiplegic shoulder: the best answer protects the joint (support the arm, avoid pulling, avoid overhead pulleys, use NMES to the supraspinatus and posterior deltoid) rather than pushing range. A cane goes in the hand opposite the weak leg, and a sling is for standing and walking in the flaccid stage, not all day.
Case. A 63 year old man is seen on day two after a left MCA ischemic stroke treated with thrombolysis 30 hours ago. He has a flaccid right arm with a one finger breadth gap below the acromion, and a right hemiparesis. His blood pressure is 176/98 at rest and rises to 188/104 when he sits on the edge of the bed. Nursing reports he coughs when drinking water.
Reasoning: He is past the first 24 hours after thrombolysis, but he still exceeds a commonly used ceiling of about 180/105 during activity; the best action is to return him to a supported position, recheck, and notify the physician for parameters rather than continue to standing. Coughing with thin liquids suggests aspiration risk: keep the head of bed elevated and confirm a swallow evaluation by speech language pathology. Protect the subluxed shoulder by supporting the arm on a pillow or lap tray and teaching staff not to pull on it. Wrong choices: aggressive overhead range of motion (impingement), or continuing the session at that pressure.
Key point

Recovery moves from flaccidity through synergies and peak spasticity to isolated movement (Brunnstrom stages). Know the components of each synergy and the typical posture they create. Protect the hemiplegic shoulder, train gait with stepping practice and orthoses that target the cause of each deviation, and respect blood pressure limits: below 180/105 after thrombolysis, permissive up to about 220/120 without it, and lower targets after hemorrhage.

Section 3Traumatic brain injury

Traumatic brain injury (TBI) results from an external force: falls (most common overall, especially in older adults and young children), motor vehicle crashes, assaults, sports and blast. Primary injury occurs at impact: contusions, often in a coup and contrecoup pattern at the frontal and temporal poles; hematomas; and diffuse axonal injury from shearing during acceleration and rotation, which causes prolonged coma with few focal signs. Secondary injury develops over hours to days from hypoxia, hypotension, cerebral edema, raised intracranial pressure, seizures and infection; much of acute medical care aims to prevent it.

An epidural hematoma (usually a torn middle meningeal artery with a temporal fracture) classically causes a brief loss of consciousness, a lucid interval, then rapid deterioration. A subdural hematoma (torn bridging veins) may be acute or chronic; chronic subdural hematoma in older adults and people on anticoagulants presents with gradual confusion, headache or new falls days to weeks after minor trauma, and is a reason to refer an older patient whose cognition declines after a fall.

Severity scales

Glasgow Coma ScaleScore: response
Eye opening (1 to 4)4 spontaneous; 3 to voice; 2 to pain; 1 none
Verbal (1 to 5)5 oriented; 4 confused; 3 inappropriate words; 2 incomprehensible sounds; 1 none
Motor (1 to 6)6 obeys commands; 5 localizes pain; 4 withdraws; 3 abnormal flexion (decorticate); 2 extension (decerebrate); 1 none

The total ranges from 3 to 15. Severity is classified as mild 13 to 15, moderate 9 to 12 and severe 3 to 8 (a score of 8 or less generally means coma and the need to protect the airway). Duration of loss of consciousness and of post traumatic amnesia (PTA, the period of confusion and inability to form new memories after injury) also grade severity; PTA longer than about a day suggests at least moderate injury and longer than a week severe injury, and PTA duration is one of the best predictors of long term outcome. Decorticate posturing (arms flexed, legs extended) reflects a lesion above the red nucleus in the midbrain; decerebrate posturing (all four limbs extended, arms pronated) reflects a brainstem lesion below the red nucleus and carries a worse prognosis.

Rancho Los Amigos levels of cognitive functioning

LevelBehaviorTherapy focus
I No responseNo response to stimuliPositioning, range of motion, skin and pulmonary care, sensory stimulation
II Generalized responseInconsistent, nonpurposeful reactions to stimuliSame, with structured stimulation of one modality at a time
III Localized responseSpecific but inconsistent responses; may follow simple commands, turn toward soundSimple commands, early sitting and functional tasks, family education
IV Confused, agitatedHeightened activity, aggression or bizarre behavior, cannot process information, short attentionSafety and calm: see behavior management below
V Confused, inappropriate, nonagitatedFollows simple commands; distractible; poor memory; may confabulateStructured, familiar tasks; repetition; external memory aids
VI Confused, appropriateGoal directed with cues; recalls tasks with repetition; improving self careFunctional retraining with decreasing cues
VII Automatic, appropriateRobot like, appropriate routine behavior; poor judgment and insight in new situationsCommunity skills, problem solving, safety awareness; supervision for new tasks
VIII Purposeful, appropriateRecalls and integrates past and recent events; needs standby assistance for adaptationReturn to work, school and driving evaluation
IX and X (revised scale)Purposeful, appropriate with standby assistance on request (IX) and modified independent (X)Long term goals and participation

Behavior management and medical precautions

The patient at Rancho level IV is confused and agitated because of the injury, not by choice. Management principles: keep the environment calm, quiet and low in stimulation (one person speaking, television off); use consistent staff and a consistent daily schedule; give short, simple instructions; offer limited choices; keep sessions short and change activities often; allow safe movement (an enclosed or floor level bed, supervised walking) rather than restraints, which increase agitation; do not argue with confabulation, but gently redirect; and stay calm and step back if the patient becomes aggressive. Overlearned, automatic tasks such as walking or folding towels are better than new learning at this stage.

In the acute phase, intracranial pressure (ICP) is normally about 5 to 15 mmHg, and sustained values above about 20 mmHg require treatment. Cerebral perfusion pressure (CPP) equals mean arterial pressure minus ICP, with a target of about 60 to 70 mmHg. Activities that raise ICP include the Valsalva maneuver, isometric exercise, coughing, neck flexion or rotation that obstructs venous drainage, hip flexion beyond 90 degrees, the head down position and noxious stimulation. Keep the head of the bed at about 30 degrees with the head in midline, and stop activity and notify the nurse if ICP rises and stays elevated. Other complications include seizures, heterotopic ossification (common in TBI as well as SCI), spasticity, dysphagia, and endocrine and sleep disturbances.

Concussion and return to play

A concussion is a mild traumatic brain injury caused by a direct or transmitted force to the head that produces a rapid onset of transient neurologic dysfunction, usually without structural injury on standard imaging. Loss of consciousness is not required. Symptoms include headache, dizziness, nausea, light and noise sensitivity, feeling slowed or "in a fog," poor concentration, irritability and sleep disturbance. Signs on the sideline include balance problems, confusion, blank stare and amnesia. Any athlete suspected of a concussion is removed from play and is not returned the same day.

Red flags requiring emergency transfer: worsening or severe headache, repeated vomiting, seizure, deteriorating consciousness, increasing confusion or agitation, weakness or numbness in the limbs, double vision, slurred speech, unequal pupils, and severe neck pain or tenderness (suspect cervical injury and immobilize). Second impact syndrome, rapid and often fatal brain swelling after a second blow before recovery from the first, is the main reason for conservative return.

Current consensus favors a short period of relative rest (about 24 to 48 hours), followed by gradual return of light activity that does not more than mildly worsen symptoms. Early subsymptom threshold aerobic exercise speeds recovery; exercise tolerance can be determined with a graded treadmill test and the training heart rate set below the level that provokes symptoms. Return to learn (school or work) proceeds first, with academic accommodations as needed. Most adults recover within about two weeks and most children within about four weeks; symptoms beyond that warrant a multidisciplinary evaluation, often including vestibular, oculomotor and cervical spine assessment.

123456 Symptomlimited activity Aerobicexercise, lightthen moderate Individualsport specificexercise Noncontacttraining drills,high intensity Full contactpracticeafter medicalclearance Return tosport At least 24 hours per step. If symptoms worsen more than mildly, drop back a step. Return to learn comes before full return to sport. Removed from play on the day of injury; no same day return.
Figure 6.3 Graded return to sport after concussion. Each step lasts at least 24 hours; the athlete progresses only while symptoms stay at most mildly increased, and needs medical clearance before contact.
Board tip. Know the GCS cutoffs (13 to 15 mild, 9 to 12 moderate, 8 or less severe), that motor score 3 is decorticate and 2 is decerebrate, and that the Rancho IV patient needs a calm, low stimulation environment, consistent staff, short tasks and no restraints if avoidable. For concussion, the trap answer is a same day return or complete rest in a dark room for weeks; the correct pattern is brief relative rest, then graded activity.
Case. A 24 year old man three weeks after a severe TBI is on an inpatient rehabilitation unit. He pulls at his feeding tube, shouts, cannot attend to a task for more than a minute and tries to climb out of bed. He cannot recall the therapist from the previous session.
Reasoning: Agitation, confusion and inability to process information place him at Rancho level IV. The best plan: treat him in a quiet room or his own room, with one consistent therapist, short sessions of familiar gross motor activity such as walking with close guarding, simple one step commands, and redirection when he becomes agitated. An enclosed bed or floor bed is preferable to restraints. Wrong choices: teaching new compensatory strategies (he cannot retain them yet), a busy gym session, or confronting him about his behavior. Safety point: guard closely for falls and protect lines and tubes, and step back and call for help if he becomes aggressive.
Key point

TBI severity is graded by GCS (mild 13 to 15, moderate 9 to 12, severe 3 to 8), loss of consciousness and post traumatic amnesia. The Rancho levels guide therapy, and level IV demands a calm, consistent, low stimulation approach. Acutely, avoid activities that raise intracranial pressure and keep CPP near 60 to 70 mmHg. After concussion, remove the athlete from play, screen for red flags, use brief relative rest then subsymptom aerobic exercise, and progress through the graded steps with medical clearance before contact.

Section 4Spinal cord injury

Traumatic spinal cord injury (SCI) most often follows motor vehicle crashes and falls (falls dominate in older adults), followed by violence and sports such as diving. Injuries cluster at the mobile cervical spine (especially C5 and C6) and the thoracolumbar junction. Tetraplegia means impairment of the cervical segments, affecting the arms, trunk, legs and pelvic organs; paraplegia means impairment of thoracic, lumbar or sacral segments, sparing the arms. Immediately after injury, spinal shock causes flaccid paralysis, areflexia and loss of autonomic function below the lesion; it usually resolves over days to weeks, signaled by the return of reflexes such as the bulbocavernosus reflex, after which spasticity and hyperreflexia appear below an upper motor neuron level.

Classifying the injury

The International Standards for Neurological Classification of SCI (the ASIA examination) test 10 key muscles on each side (graded 0 to 5) and 28 key sensory points on each side for light touch and pin prick (0 absent, 1 altered, 2 normal), plus an anorectal examination. Useful sensory landmarks: C4 over the acromioclavicular joint, C5 lateral antecubital fossa, C6 thumb, C7 middle finger, C8 little finger, T1 medial antecubital fossa, T4 nipple line, T10 umbilicus, L1 inguinal area, L3 medial femoral condyle, L4 medial malleolus, L5 dorsum of the foot at the third metatarsophalangeal joint, S1 lateral heel, and S4 to S5 perianal area.

The motor level is the lowest key muscle with a grade of at least 3, provided all key muscles above it are 5. The sensory level is the lowest dermatome with normal light touch and pin prick. The neurological level of injury is the most caudal segment with normal sensory and antigravity motor function on both sides. An injury is complete when there is no sacral sparing: no sensation at S4 to S5, no deep anal pressure and no voluntary anal contraction. In a complete injury, partially preserved segments below the level form the zone of partial preservation.

LevelKey muscle groupWhat it adds C3 to C5Diaphragm (phrenic nerve)Breathing off a ventilator (C4 and below) C5Elbow flexorsFeeding with setup and adaptive devices C6Wrist extensorsTenodesis grasp; sliding board transfers C7Elbow extensorsDepression transfers; manual chair C8Finger flexors (middle finger)Grasp; full hand function begins T1Small finger abductorsFine hand use; independent ADLs L2Hip flexorsHousehold walking with KAFOs (T10 to L2) L3Knee extensorsCommunity walking with AFOs L4Ankle dorsiflexorsToe clearance in swing L5Long toe extensorsImproved swing and foot control S1Ankle plantarflexorsPush off in terminal stance Red line: arm key muscles above, leg key muscles below (T2 to L1 are judged by sensation).
Figure 6.4 Key muscles of the ASIA examination and the main functional gain each level adds. A muscle counts toward the motor level at grade 3 or better when the level above is grade 5.
ASIA Impairment ScaleDefinition
A CompleteNo sensory or motor function preserved in the sacral segments S4 to S5
B Sensory incompleteSensory but no motor function preserved below the neurological level, including S4 to S5, and no motor function more than three levels below the motor level on either side
C Motor incompleteMotor function preserved below the neurological level, and more than half of key muscles below the neurological level have a grade less than 3
D Motor incompleteMotor function preserved below the neurological level, and at least half of key muscles below the neurological level have a grade of 3 or more
E NormalSensation and motor function normal in all segments in a person who had prior deficits

Incomplete cord syndromes

SyndromeTypical causeFindingsPrognosis
Central cord (most common)Cervical hyperextension in an older adult with spondylosisUpper extremities weaker than lower (cervical fibers lie more centrally in the lateral corticospinal tract); variable sensory loss; sacral sparingGood for walking and bladder; hand function recovers least
Brown-SequardHemisection, often a stab or gunshot woundIpsilateral motor loss and loss of vibration and proprioception; contralateral loss of pain and temperature a level or two belowBest of the syndromes; most walk
Anterior cordFlexion injury, disc or bone retropulsion, or anterior spinal artery occlusion (for example after aortic surgery)Bilateral loss of motor function and of pain and temperature; proprioception, vibration and deep touch preservedPoorest for motor recovery
Posterior cordRare; posterior compression, vitamin B12 deficiency (subacute combined degeneration), tabes dorsalisLoss of proprioception and vibration; motor, pain and temperature preserved; wide based, watched, high stepping gaitWalking possible using vision to compensate
Conus medullarisInjury at about T12 to L1Sacral cord damage: areflexic bladder and bowel, saddle anesthesia; mixed UMN and LMN leg signsVariable
Cauda equinaInjury below L1 (nerve roots), large central disc herniationLMN pattern: flaccid, areflexic, often asymmetric leg weakness; saddle anesthesia; bowel and bladder dysfunctionRoots can regenerate; urgent surgical decompression for acute compression
Posterior (dorsal) is at the top of each section; red marks the damaged region Central cordBrown-SequardAnterior cordPosterior cord Arms weakerthan legsSacral sparing Same side: motor,position, vibrationOpposite side:pain, temperature Lost: motor, pain,temperatureKept: position,vibration Lost: position,vibrationKept: motor, pain,temperature Good for walkingBest prognosisPoorest prognosisRare
Figure 6.5 The incomplete spinal cord syndromes. The region damaged determines which tracts are lost: the center of the cord in central cord syndrome, one half in Brown-Sequard syndrome, the anterior two thirds in anterior cord syndrome and the dorsal columns in posterior cord syndrome.

Functional expectations by level

Expected outcomes for a complete injury at each level, assuming no complications, guide goals, equipment and discharge planning. Incomplete injuries often exceed them.

LevelKey new functionExpected outcome
C1 to C3Neck movementVentilator dependent (or diaphragm pacing); power wheelchair with head, chin or sip and puff control; directs all care; total assist for ADLs
C4Diaphragm, upper trapeziusMay breathe independently; power wheelchair with head or chin control; power recline or tilt for pressure relief; directs care
C5Elbow flexion, shoulder movementPower chair with hand control; manual chair with rim modifications for short level distances; feeds with setup and adaptive devices; dependent transfers; drives a specially adapted van
C6Wrist extension (tenodesis)Manual wheelchair on level surfaces; may achieve independent sliding board transfers; independent feeding and upper body dressing with equipment; drives with hand controls
C7 to C8Elbow extension, finger flexionIndependent transfers to level surfaces (depression transfers); manual chair; independent in most ADLs; drives with hand controls
T1 to T9Full upper extremities; increasing trunk controlIndependent in all ADLs and wheelchair skills including wheelies and curbs; standing with a frame or KAFOs for exercise only
T10 to L2Abdominal and more trunk controlHousehold ambulation possible with KAFOs and walker or crutches (high energy cost); wheelchair for community
L3 to S5Knee extension and belowCommunity ambulation with AFOs and crutches or canes; wheelchair for long distances in some

Tenodesis is the passive finger flexion that occurs when the wrist is actively extended (and finger opening when the wrist flexes), because the long finger flexors are slightly shortened over the wrist. It provides a functional grasp for C6 and C7 injuries. To preserve it, never stretch the finger flexors with the wrist extended: range the fingers with the wrist flexed and the wrist with the fingers flexed. For long sitting, which is needed for dressing and bed mobility, hamstring length of about 100 to 110 degrees of straight leg raise is required, but avoid overstretching the low back extensors, which provide passive trunk stability.

Board tip. Expect level by function questions. C5 is the first level with elbow flexion and is not independent in transfers; C6 is the classic tenodesis level and the first that can be independent in many tasks with equipment; C7 is the key level for independent transfers and living alone with minimal assistance. The anterior cord syndrome has the worst motor prognosis and Brown-Sequard the best.
Case. A 23 year old man has a C6 ASIA A injury after a diving accident. On examination, wrist extensors are 4/5 bilaterally and triceps are 1/5. His family asks whether he will be able to transfer himself and feed himself. A student begins stretching his fingers into full extension with the wrist extended to "prevent contracture."
Reasoning: At C6 complete, expected outcomes include independent feeding with a universal cuff or tenodesis splint, manual wheelchair propulsion on level surfaces with projection rims, and possibly independent sliding board transfers with practice; he will need some assistance for lower body care. The student's stretch is wrong because it overlengthens the finger flexors and destroys tenodesis; stretch the fingers with the wrist flexed instead. Do not promise ambulation. Safety point: at C6 he is at risk of autonomic dysreflexia and orthostatic hypotension, so monitor blood pressure and symptoms with every position change.
Key point

Classify SCI with the key muscles, the sensory points and sacral sparing: AIS A complete, B sensory incomplete, C and D motor incomplete split by whether half the key muscles below the level reach grade 3. Central cord affects arms more than legs, Brown-Sequard splits motor and pain loss by side, anterior cord spares the dorsal columns and has the worst prognosis. Predict function by level (C6 tenodesis, C7 independent transfers, T10 to L2 household walking with KAFOs) and protect tenodesis.

Section 5Medical complications of SCI and neurologic injury

Many complications after spinal cord and brain injury are preventable, and some are emergencies that a therapist may be the first to see. The exam rewards fast recognition and the correct first action.

Autonomic dysreflexia

Autonomic dysreflexia (AD) is a potentially life threatening rise in blood pressure in people with injuries at T6 and above. A noxious stimulus below the lesion triggers a massive sympathetic reflex through the intact cord below the injury, causing vasoconstriction in the large splanchnic vascular bed. Baroreceptors detect the hypertension and the brain responds with vagal slowing of the heart and attempts at vasodilation, but the descending inhibitory signals cannot pass the injury, so the pressure keeps rising. Above the lesion, the body shows the brain's response; below it, the body shows the sympathetic storm.

Injury at T6 or above Above the lesionBradycardia, headache,flushing, sweating Brain respondsBaroreceptors sensehigh blood pressure Noxious stimulusFull bladder, bowel,pressure, tight strap Sympathetic surgeVasoconstriction, pale,cool skin below lesion Severe hypertension SBP 20 to 40 mmHg above baseline signal downis blocked Act now 1. Sit upright,lower the legs 2. Loosen clothing,binders, straps 3. Check catheterand bladder 4. Check bowel,skin, other triggers 5. BP every2 to 5 minutes 6. Call for medicalhelp
Figure 6.6 Autonomic dysreflexia. A stimulus below the lesion drives unopposed sympathetic vasoconstriction; the brain's attempt to correct it cannot pass the injury, so signs differ above and below the lesion. Removing the trigger is the definitive treatment.

Orthostatic hypotension

Orthostatic hypotension is a fall in systolic pressure of at least 20 mmHg or in diastolic pressure of at least 10 mmHg within three minutes of moving upright. It is common after SCI above T6 (loss of sympathetic vasoconstriction and of the muscle pump), and after prolonged bed rest, stroke and TBI. Symptoms include lightheadedness, blurred vision, nausea, yawning and loss of consciousness. Prevent it with gradual elevation (head of bed, then reclining wheelchair, then tilt table), compression stockings, an abdominal binder, adequate hydration, and medications such as midodrine prescribed by the physician. If symptoms occur, recline the patient or tilt the wheelchair back and elevate the legs. Note the contrast with AD: in hypotension, lie back and raise the legs; in AD, sit up and lower them.

Heterotopic ossification

Heterotopic ossification (HO) is the formation of bone in soft tissue around joints, typically 1 to 6 months after SCI or TBI. It occurs below the level of SCI, most often at the hip, then the knee; after TBI it also affects the shoulder and elbow. Early signs are warmth, swelling, erythema and decreasing range of motion, sometimes with fever; serum alkaline phosphatase rises and a bone scan detects it early. Because it mimics deep vein thrombosis and cellulitis, a swollen warm leg needs medical evaluation, including Doppler ultrasound, before therapy continues. Management includes medications (bisphosphonates such as etidronate, or NSAIDs) and gentle range of motion within the pain free range to maintain function; avoid forceful stretching, which may worsen the process. Surgical excision is considered after the bone matures.

Pressure injury

Loss of sensation, immobility, moisture, poor nutrition and spasticity make pressure injuries a lifelong risk after SCI. The usual sites are the ischial tuberosities (sitting), sacrum and coccyx (supine and semireclined), heels, trochanters and the occiput. Prevention: turn at least every 2 hours in bed; perform wheelchair pressure relief every 15 to 30 minutes for about 1 to 2 minutes (push ups, side leans or forward leans, or power tilt of at least about 30 to 45 degrees); use pressure redistributing cushions and mattresses; inspect the skin twice daily with a mirror; manage moisture; and optimize protein and calorie intake. Push ups are less effective than forward and side leans and stress the shoulders.

StageDescription
Stage 1Intact skin with nonblanchable erythema (may look different in darkly pigmented skin)
Stage 2Partial thickness loss with exposed dermis; pink, moist wound bed or intact or ruptured serum filled blister; no fat, slough or eschar
Stage 3Full thickness skin loss; fat visible; slough or eschar may be present; may have undermining and tunneling; no exposed fascia, muscle, tendon or bone
Stage 4Full thickness skin and tissue loss with exposed or palpable fascia, muscle, tendon, ligament, cartilage or bone
UnstageableFull thickness loss whose depth is obscured by slough or eschar
Deep tissue pressure injuryIntact or nonintact skin with persistent nonblanchable deep red, maroon or purple discoloration, or a blood filled blister

Spasticity management

Spasticity after SCI, stroke, TBI and MS is not always harmful: extensor tone can assist standing and transfers, and muscle activity helps maintain bulk and venous return. Treat it when it interferes with function, hygiene, positioning, sleep or skin, or causes pain or contracture. A sudden increase in spasticity is a warning sign of a new noxious stimulus, such as a urinary tract infection, pressure injury, ingrown toenail or fracture, and should prompt a search for the cause.

ApproachExamplesNotes for therapists
PhysicalDaily prolonged stretching, positioning, weight bearing (standing frame), serial casting, splinting, cold, NMES of antagonistsFoundation of every program; serial casting for dynamic contracture
Oral medicationsBaclofen (GABA-B agonist), tizanidine (alpha-2 agonist), dantrolene (acts on muscle), diazepamDrowsiness and weakness common; dantrolene can be hepatotoxic; abrupt baclofen withdrawal can cause seizures and hallucinations
Focal injectionBotulinum toxin (blocks acetylcholine release at the neuromuscular junction), phenol or alcohol nerve blocksPeak effect in about 2 to 6 weeks, lasting about 3 months; combine with stretching, casting and strengthening of antagonists
IntrathecalIntrathecal baclofen pumpFor severe generalized spasticity; pump failure causes withdrawal: rebound spasticity, itching, fever, altered mental status, which is an emergency
SurgicalTendon lengthening, selective dorsal rhizotomyFor fixed deformity or selected children with cerebral palsy

Other complications

Board tip. The first actions differ by emergency. Autonomic dysreflexia: sit up, lower the legs, loosen clothing, check the bladder. Orthostatic hypotension: recline, elevate the legs. Suspected DVT: stop, do not massage or exercise the limb, notify the physician. Intrathecal baclofen withdrawal (fever, itching, rebound spasticity, confusion): emergency medical care.
Case. A 30 year old woman with a T4 ASIA A injury is doing mat exercises in outpatient therapy. She suddenly reports a pounding headache and blurry vision. Her face is flushed and sweaty, her heart rate is 54, and her blood pressure is 168/96; her usual pressure is 98/62.
Reasoning: A T4 injury is above T6, and severe headache, flushing above the lesion, relative bradycardia and a systolic pressure about 70 mmHg above baseline define autonomic dysreflexia. Sit her up immediately with legs lowered, loosen her clothing and leg bag straps, check her catheter for kinks and her bladder for distension, look for other triggers, recheck blood pressure every 2 to 5 minutes and call for medical help. The trap answers are laying her supine to "treat the headache," which raises pressure further, and assuming 168/96 is only mildly high: relative to her baseline it is dangerous. Safety point: AD can cause stroke, seizures and death, so it is managed as an emergency, and she should carry information about it.
Key point

Autonomic dysreflexia (T6 and above) is a hypertensive emergency: sit up, lower the legs, remove the trigger and monitor. Orthostatic hypotension is treated the opposite way, with recline and leg elevation, and prevented with gradual tilting, compression and binders. Watch for heterotopic ossification (warm, swollen joint, falling range, usually the hip), pressure injury (relief every 15 to 30 minutes, staging by depth), DVT and respiratory decline, and manage spasticity only when it interferes with function, always searching for a new noxious trigger first.

The chapter in one breath

  • MCA stroke: face and arm greater than leg, with aphasia (dominant) or neglect (nondominant); ACA: leg greater than arm with bladder and behavior changes; PCA: hemianopia with macular sparing and thalamic pain.
  • Vertebrobasilar strokes give crossed signs, vertigo, dysphagia and ataxia; lacunar strokes are pure motor or pure sensory without cortical signs.
  • Classify aphasia by fluency, comprehension and repetition; treat pusher syndrome with visual feedback of vertical, not force.
  • Brunnstrom stages move from flaccidity through synergy and peak spasticity (stage 3) to isolated movement; elbow flexion and shoulder adduction with internal rotation are the strongest UE synergy components.
  • Protect the hemiplegic shoulder, avoid overhead pulleys, and respect blood pressure limits: below 180/105 after thrombolysis, permissive up to about 220/120 without it.
  • GCS: 13 to 15 mild, 9 to 12 moderate, 3 to 8 severe; Rancho IV (confused, agitated) needs a calm, consistent, low stimulation approach.
  • Concussion: no same day return, screen red flags, brief relative rest, subsymptom aerobic exercise and a graded six step return with clearance before contact.
  • ASIA: A complete, B sensory incomplete, C and D motor incomplete split by half the key muscles below the level at grade 3; sacral sparing defines incompleteness.
  • Central cord: arms weaker than legs; Brown-Sequard: best prognosis; anterior cord: worst motor prognosis with preserved proprioception.
  • C6 gives tenodesis, C7 independent transfers, T10 to L2 household walking with KAFOs, L3 and below community walking with AFOs.
  • Autonomic dysreflexia (T6 and above): sit up, lower the legs, find the trigger, monitor blood pressure every 2 to 5 minutes.
  • Watch for heterotopic ossification, pressure injury, DVT and respiratory compromise; a sudden rise in spasticity signals a new noxious stimulus.

Words worth knowing

TermWhat it means
AbuliaLack of initiative, will or spontaneity, typical of medial frontal (ACA) lesions.
AnosognosiaUnawareness of one's own deficits, typical of nondominant parietal stroke; a major safety risk.
Autonomic dysreflexiaA sudden, dangerous rise in blood pressure triggered by a noxious stimulus below an SCI at T6 or above.
Brown-Sequard syndromeCord hemisection with ipsilateral motor and position sense loss and contralateral pain and temperature loss.
Central cord syndromeIncomplete SCI, usually from hyperextension, with arms weaker than legs and sacral sparing.
Cerebral perfusion pressureMean arterial pressure minus intracranial pressure; kept around 60 to 70 mmHg after brain injury.
Contrecoup injuryBrain contusion on the side opposite the point of impact as the brain rebounds inside the skull.
Decerebrate posturingExtension of all four limbs from a brainstem lesion below the red nucleus; worse prognosis than decorticate.
Decorticate posturingUpper extremity flexion with lower extremity extension from a lesion above the red nucleus.
Diffuse axonal injuryWidespread shearing of axons from rotational acceleration, causing prolonged coma.
DysarthriaA motor speech disorder of articulation with normal language, unlike aphasia.
HemianopiaLoss of half of the visual field in each eye; homonymous means the same side in both eyes.
Heterotopic ossificationFormation of bone in soft tissues around a joint after neurologic injury, most often at the hip.
Lacunar strokeA small deep infarct from occlusion of a penetrating artery, producing pure motor or pure sensory syndromes.
Neurological level of injuryThe most caudal spinal segment with normal sensory and antigravity motor function on both sides.
Post traumatic amnesiaThe period after brain injury during which new memories are not formed; its length predicts outcome.
Pusher syndromeA disorder of perceived verticality in which the patient pushes toward the hemiparetic side and resists correction.
Sacral sparingPreserved sensation or motor function at S4 to S5, which makes an SCI incomplete.
Second impact syndromeRapid, often fatal brain swelling after a second head injury before recovery from a first concussion.
Spinal shockTemporary flaccid paralysis, areflexia and autonomic loss below a new SCI.
SynergyA stereotyped mass movement pattern in which one joint cannot move without the others in the pattern.
TenodesisPassive finger flexion produced by active wrist extension, used as a functional grasp after C6 to C7 SCI.
Thalamic pain syndromeSevere, burning contralateral pain after a thalamic stroke, usually in the PCA territory.
Zone of partial preservationSegments below the neurological level with some preserved function in a complete SCI.

Check yourself

A patient has right hemiparesis worse in the arm and face, right homonymous hemianopia and nonfluent speech with good comprehension. Which artery and which hemisphere?
Answer. The left middle cerebral artery. Face and arm greater than leg weakness indicates the MCA, and nonfluent speech with relatively intact comprehension is Broca aphasia from the dominant inferior frontal gyrus.
A patient with a stroke has dizziness, dysphagia, hoarseness, left facial numbness, left Horner syndrome, left limb ataxia and loss of pain and temperature on the right body. What is the syndrome?
Answer. Left lateral medullary (Wallenberg) syndrome from the left vertebral or posterior inferior cerebellar artery. Ipsilateral face and contralateral body loss is a crossed pattern, and there is no major weakness because the pyramids are spared.
A patient after stroke speaks fluently but with nonsense words, cannot follow commands and cannot repeat a phrase. Which communication strategy is best?
Answer. This is Wernicke aphasia. Use short, simple phrases with demonstration, gestures and visual cues, and do not rely on the patient's verbal confirmation of understanding.
When a patient with hemiplegia raises the arm, the shoulder abducts and externally rotates, the elbow flexes and the forearm supinates. What Brunnstrom stage is suggested if the patient can move only this way?
Answer. Stage 3: voluntary movement is possible only within the flexion synergy, and spasticity is at its peak. Stage 4 would show some movements out of synergy.
A patient on day one after thrombolysis for ischemic stroke has a blood pressure of 192/108 when seated. What should the therapist do?
Answer. Stop the activity, return the patient to a supported position, recheck and notify the medical team. Within 24 hours after thrombolysis, pressure is kept below 180/105 mmHg because of bleeding risk.
A patient opens his eyes to pain, makes incomprehensible sounds and withdraws from a painful stimulus. What is the GCS score and severity?
Answer. Eye 2, verbal 2, motor 4, for a total of 8: severe brain injury (8 or less).
A high school soccer player was hit in the head 3 days ago. She now has no symptoms at rest but gets a headache with light jogging. What is the most appropriate plan?
Answer. Continue graded activity at a level that does not more than mildly worsen symptoms (subsymptom threshold aerobic exercise), prioritize return to learn, and progress through the stepwise return to sport, at least 24 hours per step, with medical clearance before full contact. She is not ready for practice or play.
A patient after SCI has elbow flexors 5/5, wrist extensors 5/5, elbow extensors 4/5, finger flexors 2/5 bilaterally, normal sensation through C7 and none below, and no sacral sparing. What is the classification?
Answer. C7 ASIA A. The motor level is C7 (grade 3 or more with the levels above at 5), the sensory level is C7, and the absence of sacral sparing makes it complete.
A 70 year old man falls forward and hits his chin. He has marked weakness of both hands and arms, milder leg weakness and preserved perianal sensation. What is the likely syndrome and prognosis?
Answer. Central cord syndrome from a hyperextension injury on a spondylotic cervical spine. Prognosis for walking and bladder control is good; fine hand function recovers least.
Ten weeks after a T10 SCI, a patient's hip is warm and swollen and hip flexion range has dropped from 110 to 80 degrees. What should the therapist suspect and do?
Answer. Heterotopic ossification (or DVT, which must be ruled out). Notify the physician for evaluation (Doppler, alkaline phosphatase, bone scan) and, once DVT is excluded, continue gentle range of motion within the pain free range without forceful stretching.