Case 2: SCI (exam 3) Flashcards
Which of the following tests is used to determine the level and severity of SCI in the pediatric population?
A. WeeFIM
B. Spinal Cord Independence Measure (SCIM)
C. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)
D. Functional Independence Measure (FIM)
C. ISNCSCI most common method for determining level and severity of SCI in ped population
SCIM, FIM, WeeFIM are measures of function.
Which of the following is a true statement regarding autonomic dysreflexia?
A. It is always characterized by an increase in blood pressure and a decrease in heart rate.
B. It most commonly affects patients with SCI level at or above T12.
C. Distention of the bowel or bladder is a common cause.
D. Signs and symptoms are more obvious in younger children than in adolescents and adults.
C. distension of bowel/bladder
*commonly experienced by patients with SCI at or above T6
*characterized by increased BP and EITHER tachy or bradycardia
*SS more **subtle **in infants/young children
Which of the following does **NOT **contribute to potential for SCIWORA?
A. Kyphoscoliosis in young child
B. Disproportionately large head relative to the child’s body
C. Horizontally oriented facet joints in a child
D. Motor vehicle collision
D. MVA usually cause injuries seen on MRI
SCIWORA are injuries without xray abnormalities.
SCIWORA are common in children due to immaturity of child’s spine (A), inherent elasticity along with disproportionately large head of young child (B), and ligament laxity/horizontally oriented facet joints of an immature spine (C).
These features render the child’s spine vulnerable to deforming forces and damage that may not be evident on imaging.
What is autonomic dysreflexia?
occurs with SCI at or above what level?
life-threatening condition triggered by noxious stimulus below SCI level/lesion.
* headache
* elevated BP
* bradycardia or tachycardia
* flushing/red above level of injury
AT OR ABOVE T6
COMPLETE AND INCOMPLETE INJURIES
AD is less diagnosed in children with SCI: T or F
True: signs are more subtle
*caregiver education!
elevate bed, sit up, loosen clothing, empty b&b, remove noxious stimuli
Cardiovascular complications of SCI:
T or F: ped SCI at greater risk for later cardiovascular disease than adult
True
*DVT/pulm embolism: less frequent in children with SCI
Development of new, ectopic bone within soft tissues around peripheral joints in people with neuro disorders
HO (heterotopic ossification)
What is SCIWORA?
What is the MOI?
SCI without Radiograpic Abnormalities
*SS of SCI but lack x-ray evidence of bony injury
MOI: whiplash, high impact with hinge force (extreme stretch, whipping of child’s head and neck)
Why do SCIWORA happen almost exclusively in children?
(SCIWORA is reported in 19-34% of all children with SCI)
skeletal immaturity
*ligament laxity
large head, small body
elasticity of vertebral column
horizontally oriented facet joints create fulcrum for sagittal force
What are precautions for SCI populations during PT?
- MONITOR for AD
- care with transfer/handling patients to prevent iatrogenic FRACTURES due to decreased bone mineral density (BMD)
- orthostatic hypotension
Common causes of non traumatic SCI
myelopathies (cord compression)
neuroinflammatory disorders
vascular (spinal arteriovenous malformation or tumor)
What are complications interfering with PT for SCI population?
- AD
- long bone fractures
- scoliosis
- hip sublux/dislocation
- skin breakdown
- contractures
- spasticity
- OTHN
an acute traumatic lesion of the spinal cord and nerve roots in children from newborn to 15 years old –> National SCI Association definition
pediatric SCI
divided into traumatic and atraumatic
Traumatic SCI common causes
MVA
falls
gunshot wounds
sports related injuries
T or F: SCI in pediatric population is common
F: rare (only 3.5% in children younger than 15 years)
occurs in 2: 100,000 US children
pediatric SCI more common in males: T or F
True, in adolescent years due to increased risk taking of boys
1st most common cause of ped SCI
2nd most common cause of ped SCI
1st: MVA (40-50%)
2nd: accidental falls
3rd: gunshot and sports
ISNCSCI exam is a reliable tool used to determine severity of SCI injury in children older than _ years
10 years
*grade B evidence *
SCIM Spinal Cord Independence Measure is a reliable and valid tool to assess and track ____ in individuals with SCI.
functional independence
(grade A evidence)
A standing program for _ per day, _ days per week may help prevent loss of bone mineral density in individuals with acute SCI.
60 minutes per day, 5 days per week
grade B evidence
T or F: Body-weight-support treadmill training provides benefits for pediatric patients with SCI
True
*grade C evidence *
_ **with lower extremity functional electrical stimulation (FES) and/or neuromuscular electrical stimulation (NMES) increases lower extremity muscle volume in children with SCI.
cycling with FES/NMES
grade B evidence
ISNCSCI review:
assessment includes _, _ and _ testing
Neurological level:
Sensory level:
Motor Level
ASIA Impairment Scale (AIS)
pinprick, light touch, motor exam
neuro level: most caudal segment with intact motor and sensory bilaterally
sensory level: most caudal segment of cord where there is intact bilateral sensory
motor: “ “ for motor
AIS: A complete, B sensory C motor incomplete, D motor incomplete, E
ASIA has poor reliability for children younger than _ years, secondary to child’s inability to comprehend instructions of exam.
Children younger than _ years may have unreliable pinprick exam secondary to anxiety
Anal motor exam may be hard to assess in children injured prior to achieving bowe continence (potty training)
**4 years **
10 years (may have unreliable sensory)
T or F: younger children (8 and younger) are more likely to have upper cervical injuries, resulting in more complete level injuries
True due to large head and less neck muscles developed
(2/3rds have complete)
hip subluxation and dislocation:
aggressive prevention recommended prior to age __ due to high high risk (93% children under age _ develop hip sublux/dislocation)
under 10: high risk
over 10: low, 9% of children
Tx: hip abduction orthosis, spasticity control, stretching. Sx if functional improvement but rarely indicated
Scoliosis affects 46% to 98% of children who sustain an SCI prior to their ____
adolescent growth spurt
*scoliotic curve under 20, 20-40: brace
*beyond 40: bracing not recommended due to skin breakdown
respiratory support for ped SCI
injuries at C3 and above: will need _
injuries at C5 and above: will have risk of _
C3: ventilatory support
C5: respiratory insufficiency (phrenic nerve, respiratory mm compromised)
Chronic fatigue, irritability, and inattention are more subtle signs and symptoms of respiratory insufficiency that may occur in children with tetraplegia and are often overlooked
