5 Spinal Cord Injury Flashcards
1
Q
Major causes of SCI
A
- MVA 36.5%
- falls 28.5%
- violence 14.3%
2
Q
Most SCIs are…
A
- quadriplegia 52% (cervical injuries)
- incomplete 59.3% (lumbar more common than thoracic)
3
Q
Steroids for SCI
A
-methyprednisolone given within 8 hours and continued only 24-48 hours after injury
4
Q
Incidence of DVT
A
-49-100% in first 12 weeks after SCI, highest rate in first 2 weeks
5
Q
Autonomic dysreflexia
A
- only for injuries T6 or above
- pounding headache, chills, anxiety, nausea
- sit person up and identify irritant
6
Q
Respiratory impairment
A
-those above C4 cannot breathe independently
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
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
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
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
11
Q
C5 capabilities
A
- bed- some A
- transfers- total A
- power wheelchair- hand control independent, power tilt
- manual wheelchair- total A
- no ambulation
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
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
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
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
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
CPG for acute SCI
- 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
SCI EDGE highly recommended acute care
- 6MWT
- 10MWT
- ASIA
- hand held myometry
- TUG (>14 seconds)
- walking index for SCI II
27
Walking index for SCI II
- 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
SCI EDGE highly recommended for sub-acute
- 6MWT
- 10MWT
- ASIA
- hand held myometry
- TUG
29
SCI EDGE highly recommended for chronic
- 6MWT
- 10MWT
- ASIA
- hand held myometry
- numeric pain rating scale
- world health organization quality of life- BREF
30
Numeric pain rating scale
- subjective intensity of pain
- 0-10 (worst)
- mild 1-3
- mod 4-6
- severe 7-10
31
World health organization quality of life- BREF
- 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
Motor complete highly recommended measures
- ASIA
- handheld myometry
- WHO QOL- BREF
33
Motor incomplete highly recommended
- 6MWT
- 10MWT
- ASIA
- hand held myometry
- TUG
- WISCI II
- WHO QOL- BREF
