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1: Examination Flashcards

1
Q

What is the average age of injury?

A

43

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2
Q

What gender is more likely to get a SCI?

A

78% male

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3
Q

What are the leading causes of SCI?

A
  1. Vehicular
  2. Falls
  3. Violence
  4. Sports
  5. Medical
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4
Q

What is the ethnic breakdown of SCI?

A
  1. Non-hispanic white
  2. Non-hispanic black
  3. Hispanic
  4. Native american
  5. Asian
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5
Q

What are the most common types of SCI?

A
  1. Incomplete tetraplegia
  2. Incomplete paraplegia
  3. Complete paraplegia
  4. Complete tetraplegia
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6
Q

What is the prognosis for SCI?

A

Decreased life expectancy, mortality rate highest in the first year

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7
Q

Why does SCI have a high financial impact?

A

18% return to work within one year. Costs about $92,000 per year per person

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8
Q

What challenges are there to pediatric SCI?

A

Metal maturation, cognitive skills, body proportions and growth

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9
Q

What 4 developmental conditions increase the risk of SCI?

A
  1. AA joint instability
  2. Juvenile RA
  3. Odontoideum, failure of odontoid to fuse
  4. Dysplasia of base of skull and upper cervical vertebra
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10
Q

Why does the cervical spine have greater mobility in children younger than 10?

A
  1. Ligamentous laxity
  2. Shallow angulation of facets
  3. Incomplete ossification of vertebrae
  4. Underdevelopment of neck muscles and size of head
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11
Q

What are some nontraumatic causes of SCI in children?

A

Tumor, transverse myelitis, epidural abscess, AV malformation, MS and inflammatory myelopathies, compressive myelopathies, spinal cord infarction due to thromboembolic disorders

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12
Q

What are the two types of myelomeningocele?

A

Occulta and aperta

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13
Q

What are some conditions that are associated with myelomeningocele?

A

Orthopedic, neuro, urological, upper limb discoordination, latex allergies, visual deficits, intellectual deficits, nutrition, psychosocial

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14
Q

What is labeled 1?

A

Lateral corticospinal tract

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15
Q

What is labeled 2?

A

Rubrospinal tract

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16
Q

What is labeled 3?

A

Lateral reticulospinal tract

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17
Q

What is labeled 4?

A

Medial reticulospinal tract

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18
Q

What is labeled 5?

A

Medial and lateral vestibulospinal tract

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19
Q

What is labeled 6?

A

Anterior corticospinal tract

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20
Q

What is labeled 7?

A

Anterolateral system

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21
Q

What is labeled 8?

A

Ventral spinocerebellar tract

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22
Q

What is labeled 9?

A

Dorsal spinocerebellar tract

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23
Q

What is labeled 10?

A

Dorsal column

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24
Q

What is the function of the DCML?

A

Discriminative and deep touch, vibration, proprioception, kinesthesia

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25
What is the function of the lateral cortiocspinal tract?
Voluntary movement
26
What is the function of the rubrospinal tract?
Tone, flexion of limbs, movement modulation
27
What is the function of the lateral/medial reticulospinal tract?
Automatic posture, gait related movement
28
What is the function of the medial/lateral vestibulospinal tract?
Position of head and neck, balance
29
What is the function of the anterior corticospinal tract?
Voluntary movement of axial muscles
30
What is the function of the anterolateral spinothalamic?
Pain, temp, crude touch
31
What is the function of the spinocerebellar tract?
Unconscious proprioception
32
What are 5 non-traumatic causes of SCI?
1. Vascular dysfunction 2. Spinal stenosis and degeneration 3. Spinal neoplasms 4. Infection 5. Myelomeningocele
33
What is tetraplegia?
Involvement of all four extremities
34
What level injuries result in tetraplegia?
C1-C8
35
What is paraplegia?
Involvement of legs and part of trunk
36
What level injuries result in paraplegia?
T1-S5
37
What are the three incomplete clinical syndromes?
1. Anterior cord syndrome 2. Central cord syndrome 3. Brown-Sequard syndrome
38
What is the ASIA?
Scale developed to determine level and severity of a spinal cord injury - standardized motor and sensory examination
39
When is ASIA performed?
After spinal shock resolves
40
Why should you perform the exam?
1. Determine where spinal cord was injured 2. May be different than what was viewed on MRI or CT 3. Main test to determine level of injury, severity, and may provide insight into recovery expectation
41
What are the 5 steps to performing the ASIA?
1. Determine sensory levels for R and L extremities 2. Determine motor levels for R and L extremities 3. Determine neurological level of injury 4. Determine whether injury is complete or incomplete 5. Determine AIS grade
42
Describe the light touch assessment
28 key sensory points, compare to face
43
What is a 2 on the light touch exam?
Intact
44
What is a 1 on the light touch exam?
hyper or hypo compared to face
45
What is a 0 on the light touch exam?
Absent
46
Describe how to perform sharp/dull
3 times at each spot
47
What is a 2 on the sharp/dull exam?
Intact - accurately identifies sharp vs dull
48
What is a 1 on the sharp/dull exam?
Diminished - accurately identifies but is hyper or hypo compared to face
49
What is a 0 on the sharp/dull exam?
Absent - cannot identify, or < 80% of the time
50
Describe how to perform a motor assessment for ASIA
10 key muscles, classify MMT grade 0-5, do all muscles in upper and lower extremities
51
What is the pt position for the ASIA assessment?
Supine
52
How do you determine the motor level of a pt?
The lowest level is a 3/5, and then level directly above needs to be 5/5
53
If there is not a clinically testable myotome, how do you determine the motor level?
Use the sensory level
54
How do you assess anal sensory and motor function?
Voluntary anal contraction, deep anal pressure, dermatome assessment
55
What are the three qualifications for determining the neurological level of injury?
Most caudal segment with 1. Intact sensation 2. Muscle function of at least 3/5 3. Rostral segments must also have intact sensation and at least 4/5 muscle function
56
What are the four requirements to be classified as a complete SCI?
1. No sacral sparing 2. No voluntary anal contraction 3. All S4-S5 are 0 4. No deep anal pressure
57
What is considered to be an incomplete SCI?
Sacral sparing
58
What is the zone of partial preservation?
Areas of intact motor and/or sensory function below the ipsilateral motor or sensory level in a patient who does NOT have sacral sparing
59
What SCI population can have a zone of partial preservation?
Complete injuries
60
What is AIS A?
Complete SCI, record the zone of partial preservation
61
What is AIS B?
Motor complete (sacral sparing) - no voluntary anal contraction OR no motor function more than three levels below motor level on a given side
62
What is AIS C?
Less than half of the key muscles below neurological level are 3/5 or better
63
What is AIS D?
At least half of the key muscles below neurological level are 3/5 or better
64
What is AIS E?
Sensation and motor function are normal in all segments - only applies for follow up
65
How is the ZPP determined?
Represents the most caudal dermatome and/or myotome on each side with partially preserves function
66
Is there one or two ZPPs?
Each side is determined independently

SCI (6 decks)

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