ABPMR SCI Medicine cheat sheet

ASIA A (complete) requires absence of sacral sparing: no S4-S5 light touch or pinprick, no deep anal pressure, and no anal contraction.

ASIA B is sensory incomplete: sensory but not motor function is preserved below the neurological level, including sacral segments S4-S5.

ASIA C is motor incomplete: motor function is preserved below the level, and more than half of key muscles below the level have MMT grade less than 3.

ASIA D is motor incomplete: at least half of key muscles below the neurological level have MMT grade 3 or greater.

ASIA E indicates normal sensory and motor exams; it is assigned only when a prior SCI is documented.

The neurological level of injury is the most caudal segment with normal sensory and motor function on both sides.

Key upper-limb muscles: C5 biceps, C6 extensor carpi radialis, C7 triceps, C8 flexor digitorum profundus, T1 abductor digiti minimi.

Upper-extremity motor score sums five key muscles per side (0-5 each), maximum 50 per side and 100 total.

Sensory scoring uses 28 key points per side for light touch and pinprick, each scored 0-2; maximum 112 per modality.

Current AANS/CNS guidance supports MAP 85-90 mm Hg for 5-7 days after acute SCI, while avoiding prolonged severe hypertension.

High-dose methylprednisolone is not routinely recommended for acute SCI; risks include infection, hyperglycemia, and GI bleeding.

Neurogenic shock combines hypotension and bradycardia from loss of sympathetic tone after cervical or high thoracic SCI.

Neurogenic shock treatment includes volume resuscitation, norepinephrine or phenylephrine, and atropine for symptomatic bradycardia.

DVT risk is high after acute SCI; use LMWH or unfractionated heparin plus mechanical prophylaxis when not contraindicated.

Autonomic dysreflexia occurs at T6 or above; triggers include bladder distension, fecal impaction, and pressure injury.

Heterotopic ossification presents with joint swelling, warmth, limited range, and elevated alkaline phosphatase; bone scan is sensitive early.

Cervical SCI above C5 can impair diaphragm and intercostal function, causing hypoventilation, weak cough, atelectasis, and pneumonia.

Acute SCI ileus and stress ulcer risk are managed with bowel rest, decompression, and acid suppression when indicated.

C5 tetraplegia: elbow flexion but no wrist extension; power wheelchair and assistance with most ADLs are typical.

C6 tetraplegia: wrist extension enables tenodesis grasp for feeding and grooming; adapted driving and sliding-board transfers are possible.

C7 tetraplegia: triceps function enables independent transfers, pressure relief, manual wheelchair propulsion, and self-catheterization.

T1 and below: full upper-extremity function; manual wheelchair mobility and independent self-care are typical.

Body-weight-supported treadmill training and robotic gait training can be used for locomotor practice, but evidence for walking recovery is mixed.

Spasticity management options include oral baclofen, tizanidine, botulinum toxin, and intrathecal baclofen for severe generalized tone.

Functional electrical stimulation can improve cardiovascular fitness, muscle bulk, and bone density but does not restore walking.

Tendon transfers for tetraplegia can restore grasp, pinch, or elbow extension in selected patients with stable neurologic status.

Range-of-motion and positioning programs reduce contracture risk; shoulder pain and overuse are common in manual wheelchair users.

Suprasacral SCI typically causes detrusor overactivity with sphincter dyssynergia; sacral lesions cause an areflexic, underactive bladder.

Clean intermittent catheterization every 4-6 hours is preferred for many patients; target drained volumes below about 500 mL.

Bowel programs use scheduled evacuation, digital stimulation, suppositories, diet, and fluids; the regimen is matched to level and pattern.

Pressure injury stage 1 is intact skin with non-blanchable erythema; stage 2 is partial-thickness skin loss with a shallow open ulcer or blister.

Stage 3 pressure injury is full-thickness skin loss with visible fat but no exposed bone, tendon, or muscle; stage 4 exposes deep structures.

Unstageable pressure injury is covered by slough or eschar; deep tissue pressure injury shows persistent deep discoloration that does not blanch.

Wheelchair users need pressure relief every 15-30 minutes; tilt, recline, or push-up relief reduces ischial loading.

Disuse osteoporosis after SCI increases fracture risk, especially at the distal femur and proximal tibia.

Autonomic dysreflexia management starts with sitting upright, removing the trigger, and using rapid-onset antihypertensives such as nifedipine if needed.

Depression is common after SCI and is associated with pain, functional loss, and social isolation; PHQ-9 screening is practical.

Suicide risk is elevated after SCI; routine screening for hopelessness, substance misuse, and social isolation is part of care.

Caregiver burden includes physical, emotional, and financial strain; respite care, skills training, and peer support reduce burden.

Return-to-work rates after SCI are low; early vocational rehabilitation, accommodations, and assistive technology improve employment.

Sexual function after SCI may preserve desire and orgasm, but erection, lubrication, and ejaculation are often impaired; PDE5 inhibitors and vibratory stimulation are options.

Men with SCI often have anejaculation and erectile dysfunction; penile vibratory stimulation, electroejaculation, and assisted reproduction can preserve fertility.

Women with SCI usually retain fertility; pregnancy requires planning for bladder, bowel, pressure injury, and autonomic dysreflexia risks.

Aging with SCI brings earlier functional decline, cardiovascular disease, osteoporosis, and pressure injuries; periodic reassessment of equipment and function is needed.

Community reintegration depends on accessible housing, transportation, assistive technology, and peer mentoring.