Autonomic Dysreflexia

Question 1

Autonomic Dysreflexia can develop with injury at what level

Answer 1

at or above T6

Question 2

Ischemic Cardiac symptoms in SCI pt

Answer 2

dyspnea, nausea, increased tone

Question 3

Autonomic Dysreflexia characterized by

Answer 3

-unopposed sympathetic response to a noxious stimulus below the injury level resulting in an increase in blood pressure >20 mmHg above baseline
-associated with headache and vision changes.

Question 4

SCI patient experiencing Autonomic Dysfunction with elevated BP

Answer 4

pt with SCI is experiencing AD, the noxious stimulus should be identified and addressed so blood pressure will go down as result.
-If stimulus cannot be identified, and blood pressure remains elevated, administer a vasodilatory agent (nitropaste, clonidine, or hydralazine) and continue to look for the stimulus.

Question 5

compensatory parasympathetic response of autonomic dysreflexia

Answer 5

headache, nasal congestion, flushing
this is an emergency

Question 6

Potential issues due to a cervical SCI and impaired diaphragm function

Answer 6

Impaired diaphragm function 2’ to cervical SCI associated with ventilation impairment, dysphagia, and aspiration risk.
-Providers should encourage chest physiotherapy, deep breathing exercises, monitor for signs of pulmonary infection, encourage vaccination against influenza and pneumococcus.

Question 7

individuals with spinal injury above S2-S4, an upper motor neuron bladder can lead to

Answer 7

Neurogenic bladder from injury above S2-S4, typically have an upper motor neuron bladder which can result in high bladder pressures and contribute to vesicoureteral reflux.
-should be evaluated by urology, undergo urodynamic studies regularly, undergo an annual renal ultrasound.
-Pts will often require chronic intermittent catheterization or indwelling catheters for bladder maintenance.

Question 8

Where are individuals with SCI at the highest risk for heterotopic ossification?

Answer 8

Hip joint

Question 9

woman with SCI experiencing shoulder pain

Answer 9

most likely rotator cuff

Question 10

Managment of spasticity

Answer 10

-consequence is contracture
-Spasticity often requires systemic meds (eg baclofen, localized chemodenervation with phenol or botulinum toxin), or intrathecal baclofen.
Untreated spasticity puts pts at risk for contractures, prevents adequate hygiene, causes pain.
-increase in spasticity can be the hallmark symptom of other pathology eg infections or pain.

Question 11

management of individual with SCI experiencing neurogenic bladder

Answer 11

-may not exhibit typical signs of urinary tract infections. should be monitored for alternative symptoms
-Individuals with SCI often experience both neurogenic bladder and neurogenic bowel, which requires close management.
-at risk for urinary tract infections, hydronephrosis, nephrolithiasis, and pyelonephritis.
-may not exhibit typical signs so monitor for alternative symptoms such as fatigue, malaise, increased spasticity, fevers.
-these patients will also have chronic asymptomatic bacteriuria and careful examination and history should be done to rule out other causes of infection

Question 12

orthostatic hypotension several years post injury and without prior history of orthostatic hypotension

Answer 12

Consider an MRI imaging to r/o development of syrinx

Question 13

SCI and osteoporosis risk

Answer 13

-risk of osteoporosis below level of injury, therefore at risk for osteoporotic fractures
-monitor vitamin D levels and assess for additional risk factors

Answer 14

U.S. Access Board finalized voluntary standards for Accessible Medical Diagnostic Equipment in January 2017
-benefits for providers and patients include reducing disparities in access to preventive health care for people with mobility-related disabilities
-providing opportunities to reduce potential workplace injuries, liability, and employee attrition by curtailing the need for clinic staff to physically transfer patients to and from inaccessible examination equipment with cost-effective alternatives.

Question 15

Immunization in pt w SCI

Answer 15

As normal, pt w/ SCI require immunizations and are at higher risk for respiratory compromise and a higher risk of pulmonary infection.
-highly recommended to receive the annual influenza vaccine, as with general population.
-Pts with injury above T8 are considered high risk so consider pneumococcal vaccine earlier than the general population.

Question 16

Physical activity guidelines in SCI

Answer 16

Standardized guidelines:
-150 minutes/week of moderate-intensity aerobic exercise or 60-75 minutes/week of vigorous activity.
-should include resistance training 2 days per week and stretching 2 days per week.

Question 17

Diet modifications in pt w SCI

Answer 17

-Increased fiber often recommended for individuals with low HDL
-however, effect on pt with SCI’s bowel regimen could be detrimental to daily lives.
-low salt diets, generally recommended for heart health, can potentiate hypotension in pt with SCI.
-Additionally, vitamin deficiencies can be present and should be repleted through diet. Deficiencies in vitamins A, D, E, C, B5, and Biotin are most common.
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Question 18

Reducing cardiovascular risk

Answer 18

-via combination of medication, weight loss, and nutritional modifications
-SCI pt have lower baseline energy requirement due to decreased metabolic activity therefore require lower caloric threshold (~10% lower than the general population)

Question 19

At risk for cardiometabolic syndrome in pt w SCI

Answer 19

-BMI > 22 kg/m2 or
-waist circumference >94 cm

Question 20

Routine Screening for pt w SCI, no co-morbidities

Answer 20

Pt w SCI are at risk for many cardiovascular and metabolic issues, including hyperlipidemia, obesity, and insulin resistance.
-conditions can be accelerated in pts with SCI and they should be screened regularly.
-Risk factors prompting more frequent lipid screening: 1) FHx heart disease
2) FHx ypercholesterolemia
3) Diabetes
4) Older age
5) Being male
6) overweight/obesity
7) h/o elevated cholesterol
-Lipid screening should be done for all adults with SCI If normal then repeat every 3 years
If multiple risk factors then repeat annually.
-similar target measures to the general population for cardiometabolic abnormalities, including lipid markers, blood sugars, and blood pressur
-cutoffs for BMI and waist circumference (WC) in pt w SCI differ from general population
Individuals with an SCI and BMI > 22 kg/m2 or a WC >94 cm should be considered at risk of cardiometabolic syndrome.