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SCI > 2: Clinical Presentations > Flashcards

2: Clinical Presentations Flashcards

1
Q

What are the three considerations for motor and sensory function?

A
  1. Level of injury
  2. Complete or incomplete
  3. Clinical syndrome
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2
Q

Is spastic hypertonia related to UMN or LMN damage?

A

UMN

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3
Q

When will you see spastic hypertonia?

A

After spinal shock resolves

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4
Q

Where will you see spastic hypertonia?

A

Below the level of the injury

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5
Q

What symptoms are related to spastic hypertonia?

A
  1. Spasticity
  2. Hyperreflexia
  3. Clonus
  4. Hypertonia
  5. Muscle spasm
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6
Q

How is spasticity managed?

A

Stretch, exercise, electrotherapy, heat, massage, vibration therapy, medication

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7
Q

What are the six characteristics of autonomic dysfunction?

A
  1. Spinal shock
  2. Neurogenic shock
  3. Bradyarrhythmia
  4. Hypotension
  5. Orthostatic hypotension
  6. Impaired cardiovascular reflexes
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8
Q

What is the definition of spinal shock?

A

Body’s reaction to abrupt withdrawal of connection between higher centers and spinal cord

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9
Q

What are the symptoms of spinal shock?

A
  1. Absent reflexes
  2. Flaccid tone
  3. Absent sensation below injury
  4. No sweating or piloerrection
  5. Hypothermia
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10
Q

What is the duration of spinal shock?

A

Typically 24 hours – can last weeks

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11
Q

When will reflexes return following spinal shock?

A

Gradual return in 1-3 days

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12
Q

If there is a positive bulbocavernosus reflex, what is the prognosis?

A

Good

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13
Q

Injuries above what level are at risk of neurogenic shock?

A

T6

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14
Q

Why does neurogenic shock occur?

A

Sympathetic output to the heart is lacking, which results in parasympathetic input being unopposed

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15
Q

What is BP with neurogenic shock?

A

Systolic < 90 mmHg

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16
Q

What is HR with neurogenic shock?

A

< 50 bpm

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17
Q

What is the result of neurogenic shock?

A

Bradyarrhythmia, AV conduction block, hypotension

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18
Q

What is orthostatic hypotension?

A

Decrease in BP when assuming upright posture from supine

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19
Q

What change in systolic and diastolic BP are indicative of orthostatic hypotension?

A

Systolic drop > 20 mmHg
Diastolic drop > 10 mmHg

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20
Q

What are the two causes of orthostatic hypotension?

A
  1. Disrupted balance between sympathetic and parasympathetic input
  2. Lack of or decrease in active muscle contraction and prolonged time in bed
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21
Q

What % of people with SCI experience orthostatic hypotension?

A

75% in the acute stages

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22
Q

What are the symptoms of orthostatic hypotension?

A

Blurred vision, dizziness, ringing in ears, light headedness, nausea, dyspnea, fainting

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23
Q

What are treatment considerations for orthostatic hypotension?

A

Adapt gradually to vertical, compressive stockings, ACE wraps, abdominal binder, medication

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24
Q

What is autonomic dysreflexia?

A

Acute onset of autonomic activity due to noxious stimuli below the level of injury

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25
Q

What LOI can experience autonomic dysreflexia?

A

Above T6, more likely if it is a complete injury

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26
Q

What is the response of HR and BP with autonomic dysreflexia?

A

Rise in systolic BP by 20-30 mmHg and decreased HR

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27
Q

What are symptoms of autonomic dysreflexia?

A

Pounding headache, flushing, sweating above LOI, vasoconstriction below LOI, anxiety, restlessness, blurred vision, spots in visual field, muscle spasm

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28
Q

What is the cause of autonomic dysreflexia?

A

Noxious stimuli

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29
Q

What is the treatment for autonomic dysreflexia?

A

Elevate head, identify and remove the noxious stimuli, prophylactic medication

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30
Q

What are symptoms of autonomic dysreflexia in children?

A

Sleepy, irritable, crying, different BP ranges

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31
Q

What are three other likely cardiovascular impairments with SCI?

A
  1. Reduced exercise tolerance
  2. Lower stroke volume
  3. Reduced cardiac output
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32
Q

With cervical SCI, what is the average systolic BP when in supine?

A

110 mmHg

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33
Q

With cervical SCI, what is the average systolic BP when seated?

A

100 mmHg

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34
Q

What cardiovascular impairments should you be mindful of with cervical SCI?

A
  • Lower BP values
  • Lower peak HR
  • Post exercise hypotension
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35
Q

What symptoms will you see with DVT?

A
  • Vasodilation
  • Absent or reduced LE muscle function
  • Immobility
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36
Q

What are risk factors for DVT in the SCI population?

A
  • Male
  • Flaccid paralysis
  • Complete lesions
  • Paraplegia
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37
Q

What are symptoms of PE in the SCI population?

A

Chest pain, SOB, tachycardia, sweating, apprehension, fever, cough

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38
Q

What is the most common cause of of death in people who live 30+ years with a SCI?

A

Cardiovascular disease

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39
Q

Why are SCI patients more likely to develop cardiovascular complications?

A

Sedentary lifestyle, higher percentage of body fat, lipid abnormalities, altered glucose metabolism, insulin resistance, diabetes

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40
Q

What are the two pediatric cardiovascular considerations?

A
  • Higher BP compared to adults
  • High risk for developing obesity
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41
Q

What are the four risk factors for respiratory complications?

A
  1. Higher LOI
  2. Increased age
  3. Thoracic trauma
  4. Prior history of respiratory disease, aspiration, smoking
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42
Q

What pulmonary impairments are most common in cervical LOI?

A
  • Pneumonia
  • Ventilatory failture
  • Atelectasis
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43
Q

What pulmonary impairments are most common in thoracic LOI?

A
  • Pleural effusion
  • Atelectasis
  • Pneumothorax/hemothorax
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44
Q

What LOI will require mechanical ventilation?

A

C1-C2

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45
Q

What are three pulmonary effects of higher lesion?

A
  • Elevated resting bronchomotor tone
  • Loss of expiratory reserves
  • No cough effectiveness
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46
Q

What happens to rib motion with higher LOI?

A

Paradoxical rib motion - decrease as time passes

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47
Q

What sleep disorder is common in higher level cervical SCI?

A

Sleep apnea

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48
Q

What are the pulmonary impairments with lower thoracic/lumbar SCI?

A

Most muscles of inhalation are intact, but can have impaired function of muscles of forces exhalation

49
Q

What lower LOIs will will have decreased cough effectiveness and decreased rib stability?

A

T1-T5

50
Q

Why does SCI result in thermoregulation complications?

A

Interruption in communication between the spinal cord and the hypothalamus

51
Q

What systems control temperature?

A

Sympathetic and somatic nervous systems

52
Q

What thermoregulation impairment will happen initially with SCI?

A

Hypothermia and peripheral vasodilation

53
Q

How will thermoregulation impairments change over time with SCI?

A

Will have hyperthermia below the LOW due to lack of sympathetic control of sweat glands - exercise induced

54
Q

What is osteoporosis?

A

Reduction in bone mass due to loss of calcium and collagen

55
Q

When do SCI patients see the greatest reduction in bone mass?

A

The first few months following the injury

56
Q

Where will osteoporosis develop in a patient with SCI?

A

Extremities below the LOI, more severe in LE

57
Q

What does osteoporosis increase the likelihood of in SCI patients?

A

Fracture and kidney/bladder stones

58
Q

What population is at higher risk of fractures related to osteoporosis after SCI?

A

Motor complete, paraplegia, white, greater time since injury, advanced age, female, lower BMI

59
Q

What is heterotopic ossification?

A

Formation of new bone within the soft tissue

60
Q

What are the four causes of heterotopic ossification?

A
  1. Tissue hypoxia
  2. Abnormal Ca metabolism
  3. Microtrauma, vigorous stretching
  4. Local pressure
61
Q

Where will heterotopic ossification develop?

A

Always below the LOI, most likely large proximal joints

62
Q

What are symptoms of heterotopic ossification?

A

Pain, erythema, swelling, decreased ROM, local warmth

63
Q

What are causes of DJD?

A

Mechanical stress, muscle imbalance, spasticity or flaccidity, improper ADL, incorrect exercise, pre-existing conditions

64
Q

What are complications associated with DJD?

A

Bursitis, tendonitis, arthritis, impingement

65
Q

What are the two types of nociceptive pain?

A

Musculoskeletal and visceral

66
Q

What is neuropathic pain?

A

Damage or impingement of nerve roots of SC at or near the LOI

67
Q

What is syringomyelia?

A

Formation of cyst or cavity within the spinal cord

68
Q

What happens to syringomyelia over time?

A

Expands due to pressure in the epidural veins and compresses the spinal cord

69
Q

What symptoms are associated with syringomyelia?

A

Pain, sensory loss, weakness

70
Q

What are causes of genitourinary complications with SCI?

A

Abnormal bladder function requiring prolonged use of indwelling catheter, intermittent catheterization, improper management

71
Q

What are common urinary tract complications associated with SCI?

A

Urinary retention, bladder infection, reflux or urine into ureters

72
Q

What can urinary tract infection result in?

A

Kidney/bladder stones, hydronephrosis, pyelonephritis, kidney failure, septicemia, death

73
Q

What are the most common GI complications?

A

GI bleed and stress ulcers in the stomach and duodenum

74
Q

When are GI bleeds and stress ulcers likely to develop?

A

Within the acute phase following SCI

75
Q

What are causes of GI complications in SCI?

A

Shock, emotional stress, circulating catecholamines, steroids, mechanical ventilation, unopposed parasympathetic input to stomach

76
Q

What GI complications are associated with spinal shock?

A

Paralytic ileus, gastric dilation

77
Q

What are other GI complications that are associated with SCI?

A

Fecal impaction, bowel obstruction, superior mesenteric artery syndrome, pancreatitis, esophagitis, gallstone disease, chronic constipation, hemorrhoids

78
Q

When will a patient with SCI have a neurogenic bowel and bladder?

A

Lesions above the conus medullaris and sacral segments

79
Q

Describe neurogenic bladder

A

Contracts and reflexively empties in response to certain level of filling pressure

80
Q

What muscle is hyperactive with neurogenic bladder?

A

Detrusor - increased tone of sphincter

81
Q

What happens to the detrusor muscle with neurogenic bladder?

A

Contraction with small urine volumes, lack of coordination between detrusor and sphincters

82
Q

Describe a neurogenic bowel

A

Reflex defecation when rectum fills with stool

83
Q

When will a patient with SCI have a flaccid bladder and bowel?

A

Lesion of sacral segments or conus medullaris

84
Q

What is a flaccid bladder?

A

No reflex action of detrusor muscle with inability to store urine

85
Q

What is an areflexive bladder?

A

Excessive expansion

86
Q

What is a flaccid bowel?

A

Bowel does not reflexively empty, feces impacted, incontinence due to external sphincter flaccidity

87
Q

How will SCI affect male fertility?

A

Likely infertile

88
Q

What is the state of the UMN sexual response in males with SCI?

A
  • Intact reflexogenic response
  • Impaired psychogenic response
89
Q

What is the state of the LMN sexual response in males with SCI?

A
  • Impaired reflexogenic response
  • Preserved psychogenic response
90
Q

How will SCI affect female fertility?

A

Unchanged

91
Q

What is the state of the UMN sexual response in females with SCI?

A
  • Intact reflexogenic response
  • Impaired psychogenic response
92
Q

What is the state of the LMN sexual response in females with SCI?

A
  • Impaired reflexogenic response
  • Preserved psychogenic response
93
Q

How is menstruation effected by SCI?

A

Interrupted 4-5 months

94
Q

What is the most common congenital anomaly associated with myelomeningocele?

A

Arnold Chiari

95
Q

What are four NMR considerations for myeloningocele?

A
  • Arnold Chiari
  • Hydrocephalus
  • Hydromyelia
  • Tethered cord
96
Q

What are the effects of MSK impairments associated with myelomeningocele?

A

Positioning, body image, weightbearing, ADLs, energy expenditure, mobility, joint contractures, pathologic fractures

97
Q

What are common spinal deformities and postural problems associated with myelomeningocele?

A

Forward head, rounded shoulders, kyphosis, scoliosis, excessive lordosis, anterior pelvic tilt

98
Q

What are hip deformities associated with myelomeningocele?

A

In-toeing, out-toeing, windswept, hip flexion, contractures, hip dysplasia

99
Q

What are knee deformities associated with myelomeningocele?

A

Tibial torsion, flexion contractures

100
Q

What are foot and ankle deformities associated with myelomeningocele?

A

Equinus, club foot, calcaneal deformity, cavo-varus deformity, plano-calgus deformity

101
Q

What are four MSK pediatric considerations?

A
  1. Hip subluxation/dislocation
  2. Fracture is osteopenic extremities
  3. NMR scoliosis
  4. Pseudo hip flexion contractures if flaccid
102
Q

What children with SCI develop scoliosis?

A

Almost all children, 67% will progress to require fusion

103
Q

What are four components of initial management of SCI in acute care?

A
  • ABC (airway, breathing, circulation)
  • Management of life threatening injuries
  • Spinal stabilization
  • Transportation
104
Q

Why are spine boards for infants and toddlers modified?

A

Allow for neutral alignment of c-spine

105
Q

How are spine boards modified for infants and toddlers?

A

Occipital cut out or elevating torso

106
Q

What radiographs are indicated following SCI?

A

Whole spine - C1 to sacral vertebrae

107
Q

When is MRI indicated for children with SCI?

A

All children

108
Q

What is there a high incidence of in MRI’s of children < 10?

A

SCIWORA (radiologic abnormalities)

109
Q

What % of children will have multiple, non contiguous fractures?

A

30%

110
Q

What is monitored in the ICU following SCI?

A

Respiratory status, organ function, cardiovascular status, bowel and bladder management, integument

111
Q

What is acute pharmacologic management for SCI?

A

High dose steroids and other medications for secondary complications

112
Q

How are fractures stabilized?

A

Open reduction, or closed reduction with traction devices and immobilization

113
Q

When is surgical decompression and stabilization recommended?

A

Within 24 hours

114
Q

When is immobilization indicated?

A

Both open and closed reduction

115
Q

What orthotics can be used for immobilization?

A

Halo, Minerva, Miami J collar, Jewett, custom body jacket

116
Q

When does cervical traction have increased risk?

A

Increased risk in children < 12 when compared to adults

117
Q

What type of traction is preferred in children?

A

Halo

118
Q

How is halo traction modified in children?

A

Increased number of pins to decrease the torque on each pin

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