2.29 SCI 2 Flashcards
How do we classify SCI?
ASIA
ASIA
American Spinal Injury Association
incomplete SCI
- has sacral sparing (sensation and/or motor at S4-S5 - anus)
- tested with gloved finger inserted
After a pt survives an SCI, what generally happens?
surgeons will typically stabilize the injury (bones)
surgical stabilization: c-spine
- ACDF (anterior cervical disc fusion)
- may do a PLIF (posterior lumbar interbody fusion) if ACDF doesn’t work
c-spine stabilizaztion: post surgical issues (c-spine specific)
- low speech volume
- pain
- difficulty swallowing
- raspy voice
should not have voice issues weeks later
surgical stabilization: thoracic/lumbar
- typically start with PLIF
- put as much metal in the back as possible if there’s bone to screw into
What happens if the SCI pt is hypermobile after a PLIF?
- they’ll do an ALIF (anterior)
- hugely invasive, going through viscera
general post-surgical issues
abdominal swelling, bloating
gastric issues during surgery
- sepsis
- lack of peristalsis
ileus
- peristalsis stops
- stomach doesn’t process anything into the intestines
reverse peristalsis
- start vomiting like crazy
- can get reverse peristalsis from intestines and vomit feces (usually circling death’s door)
tx for an ileus?
NG tube to suck up stomach acid and other crap from the stomach
How could a PT dx an ileus?
- ask if they’re having bowel movements or farting
- listen to bowel sounds (rumbling, grumbling
What will you hear if there’s an ileus with bowel sounds?
won’t hear anything
PT and cervical traction
- PT won’t be moving them while they’re in cervical traction
- waiting for surgery
Orthoses for post surgery
- halo
- Minerva
- SOMI
- soft collar
- Philadelphia collar, Miami J collar, Aspen collar
- CTO
- TLO
- TLSO
- LSO
halo
- 4-6 holes in the cranium
- metal uprights hold the head completely stable
- limits all cervical movement
- heavy and it sucks ass
halo effect on PT
moving and txfs are very difficult
Minerva
- prefab (off the shelf)
- not as much stability as the halo, but removable
- likely had some fixation surgery and we don’t want them to move a lot
- Minerva is a type of CTO
What SC levels is the Minerva commonly used for?
C1-C6
SOMI
sternal occipital mandibular immobilizer
What is a SOMI?
- primarily limits flexion, they can extend
- can be used for a lot of patients
- more than likely, have been stabilized
soft collar
- just a piece of foam and fabric to remind you to not do a lot of fast/large movements
- annoying, rub on the skin
- likely will only wear for a few days
Philadelphia collar, Miami J collar, Aspen collar
- off the shelf
- restrict some movement in all planes, but don’t completely immobilize the joint
- may worry about skin breakdown around the foam
tissue at sternum can rub as well
CTO
cervical thoracic orthosis
What is a CTO?
additions to Philadelphia etc. that can be added to the collar to make it more immobile between cervical and thoracic
TLO
thoracolumbar orthosis
example of a TLO
Jewett brace
What is a Jewett brace
- has 3 points: primarily limits flexion
- allows for full extension
- unloads vertebral bodies
What are Jewett braces good for?
- anyone at risk for/or has had a compression fx
- also for SCI from compression fx
TLSO
- moulded thermoplastic
- 2 halves with 3-4 straps on each side
- think what Matt had
Which of the orthoses are not commonly seen with SCI?
LSOs
