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NCS Prep > 5 Spinal Cord Injury > Flashcards

5 Spinal Cord Injury Flashcards

1
Q

Major causes of SCI

A
  • MVA 36.5%
  • falls 28.5%
  • violence 14.3%
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2
Q

Most SCIs are…

A
  • quadriplegia 52% (cervical injuries)

- incomplete 59.3% (lumbar more common than thoracic)

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3
Q

Steroids for SCI

A

-methyprednisolone given within 8 hours and continued only 24-48 hours after injury

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4
Q

Incidence of DVT

A

-49-100% in first 12 weeks after SCI, highest rate in first 2 weeks

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5
Q

Autonomic dysreflexia

A
  • only for injuries T6 or above
  • pounding headache, chills, anxiety, nausea
  • sit person up and identify irritant
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6
Q

Respiratory impairment

A

-those above C4 cannot breathe independently

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7
Q

Bladder innervation

A
  • parasympathetic- pelvic nerve arising from S2-4 nerve roots
  • sympathetic- hypogastric nerve arising from T11-L2 nerve roots
  • somatic- pudendal nerve arising S1-4 nerve roots
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8
Q

Bowel innervation

A
  • parasympathetic- pelvic nerve from S2-4, vagus nerve
  • sympathetic- hypogastric nerve T11-L2; superior and inferior mesenteric nerves T9-12
  • somatic- pudendal nerve S1-4
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9
Q

Expected motor recovery for complete SCI

A
  • greatest change in first 3 months, may continue up to 2 years especially if strength is >0/5
  • motor recovery not likely to continue if initial strength is 0/5
  • preservation of sensation increases chance of motor recovery
  • most patients regain 1 motor level
  • 95% of 1-2/5 muscles improve to 3/5

-vertebral displacement <30% is positive prognostic factor

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10
Q

C1-4 capabilities

A
  • bed- total A
  • transfers- total A
  • wheelchair- power independent with head, chin, mouth, breath, power tilt/recline. Manual total A
  • no ambulation
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11
Q

C5 capabilities

A
  • bed- some A
  • transfers- total A
  • power wheelchair- hand control independent, power tilt
  • manual wheelchair- total A
  • no ambulation
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12
Q

C6 capabilities

A
  • bed- some A
  • even transfers- some A to independent
  • uneven transfers- some to total A
  • power wheelchair- independent hand control, power tilt
  • manual wheelchair- independent indoors, some to total A outdoors
  • no ambulation
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13
Q

C7-8 capabilities

A
  • bed- independent to some A
  • even transfers- independent
  • uneven transfers- independent to some A
  • manual wheelchair- independent indoors and outdoors on level terrain, some A uneven terrain
  • no ambulation
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14
Q

T1-9 capabilities

A
  • bed- independent
  • transfers- independent
  • manual wheelchair- independent for all
  • ambulation- not functional, may be able to walk limited distance in parallel bars
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15
Q

T10-L1 capabilities

A
  • bed, transfers, wheelchair independent
  • some A to independent in functional ambulation with KAFOs and walker/forearm crutches
  • T11-12- limited household
  • L1- household, possible limited community
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16
Q

L2-S3 capabilities

A
  • bed, transfers, wheelchair independent
  • ambulation- some A to independent with KAFOs and walker/crutches
  • L2- household, limited community
  • L3- household, limited to independent community
  • L4- household, community
17
Q

Brown-Sequard syndrome

A
  • one side of SC
  • ipsilateral loss of proprioception, vibratory sense, deep touch, discriminative touch, voluntary motor control
  • contralateral loss of pain, temperature, crude touch
  • traffic accidents or gunshot/stab wounds
18
Q

Anterior cord syndrome

A
  • variable loss of motor function and pain and temperature sensation with intact proprioception and light touch
  • mostly with flexion teardrop and burst fractures, anterior spinal artery damage
19
Q

Central cord syndrome

A
  • more weakness in UE vs LE
  • sacral region spared
  • cervical spine common with extension injury more than flexion
20
Q

Posterior cord syndrome

A
  • rare- lesion in posterior cord of occlusion of spinal artery
  • loss of proprioception, vibratory sense, and discriminative touch only
21
Q

Spinal cord syndrome incidence/prognosis

A
  • 1/5 of all patients in McKinley study had symptoms consistent with clinical syndrome
  • CCS- lowest level at admission
  • CES- highest functional level at admission
  • BSS- greatest functional improvement at discharge
  • ACS- longest LOS
22
Q

Guidelines for locomotor training in SCI

A
  • maximize load through LEs
  • optimize sensory cues- normal speeds, facilitate agonist
  • promote normal kinematic- weight shifts
  • minimize compensatory strategies- use vertical support
23
Q

Guidelines for shoulder strengthening after SCI

A
  • strengthen posterior shoulder for power and endurance
  • strengthen external rotators of shoulder
  • stretch anterior shoulder
  • biofeedback training
  • arm ergometry
24
Q

PT management of spasticity

A
  • electrical stimulation- antagonist, tetanic of agonist, FES, TENS- lasts 10 minutes to 3 hours
  • epidural spinal cord stimulation
  • cold/heat application
  • splinting/orthoses
25
Q

CPG for acute SCI

A
  • timing- offer rehab as soon as medically stable and can tolerate intensity (weak, no studies)
  • BWSTT- offer in addition to overground walking (weak, low quality). BWSTT can improve spatial-temporal gait parameters
  • FES- acute or subacute cervical SCI use FES to improve hand and UE function (weak, low quality)
  • unsupported sitting- no need for additional unsupported sitting training beyond what is currently in standard rehab (weak, low quality)
26
Q

SCI EDGE highly recommended acute care

A
  • 6MWT
  • 10MWT
  • ASIA
  • hand held myometry
  • TUG (>14 seconds)
  • walking index for SCI II
27
Q

Walking index for SCI II

A
  • amount of physical assistance and reliance on ambulatory aids for walking following SCI-related paralysis
  • 0-20 (severe to least severe impairment) for walking 10 meters
28
Q

SCI EDGE highly recommended for sub-acute

A
  • 6MWT
  • 10MWT
  • ASIA
  • hand held myometry
  • TUG
29
Q

SCI EDGE highly recommended for chronic

A
  • 6MWT
  • 10MWT
  • ASIA
  • hand held myometry
  • numeric pain rating scale
  • world health organization quality of life- BREF
30
Q

Numeric pain rating scale

A
  • subjective intensity of pain
  • 0-10 (worst)
  • mild 1-3
  • mod 4-6
  • severe 7-10
31
Q

World health organization quality of life- BREF

A
  • measures QOL based on culture, values, and goals
  • 26 items self-report in 4 domains (physical, psychological health, social relationships, environment)
  • max score 100 each domain (high quality of life)
32
Q

Motor complete highly recommended measures

A
  • ASIA
  • handheld myometry
  • WHO QOL- BREF
33
Q

Motor incomplete highly recommended

A
  • 6MWT
  • 10MWT
  • ASIA
  • hand held myometry
  • TUG
  • WISCI II
  • WHO QOL- BREF

NCS Prep (19 decks)

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