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PTA II (Lecture) > Chapter 5. Neuro Rehab for Spinal Cord Injuries > Flashcards

Chapter 5. Neuro Rehab for Spinal Cord Injuries Flashcards

1
Q

What are the most common level for injury

A
  • C1, C2, and C5-7

- T12-L2 (most trunk rotation)

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2
Q

Injuries named are named according to the ___ of fracture

A

vertebral level

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3
Q

*Injuries in the CERVICAL area become _____ and injires in the THORACIC area become ____
Injuries below L1 have ___

A
  • quads/tetraplegia
  • para
  • cauda equina syndrome
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4
Q

*Most common (4) types of forces (mechanisms of injury) are:

A
  1. Cervical rotation flex: (head side to side) transection of SC
  2. Hyperflexion: tear of anterior spinal artery= leading to ANTERIOR CORD SYNDROME
  3. Cervical Hyperextension
  4. Compression (ex.diving into shallow pool)
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5
Q

What leads to an ANTERIOR CORD SYNDROME ?

A

trauma; hyperflexion of your neck causing a tear of the ANTERIOR SPINAL ARTERY

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6
Q

*What is meant by COMPLETE when speaking about SCI subtypes

A

complete transection of motor and sensory tracts

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7
Q

**What are the 4 incomplete syndrome for INCOMPLETE SCI?

A
  1. Central Cord Syndrome
  2. Anterior Cord Syndrome
  3. Posterior Cord Syndrome
  4. Brown Sequard Syndrome
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8
Q

What does the Glasgow Coma state (neurologic examination) test?

A

level of consciousness

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9
Q

What are 6 neurologic exams for SCI?

A
  1. motor strength
  2. sensation
  3. Diaphragm
  4. Reflexes (ex. plantar reflex)
  5. Sacral sparing (ex. incontinence)
  6. Level of consciousness
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10
Q

**What are the Key myotomes (C5-T1)

A 
C5-deltoid
C6-biceps/wrist extensors
C7-triceps
C8-thumb extensors/finger flexors
T1-fingers abd/add
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11
Q

**What are the key myotomes for L2-S1

A 
L2-hip flexors
L3-quads (on the top)
L4-dorsiflexors
L5-big toe extensor 
S1-plantarflexion
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12
Q

*What is the different between Upper vs. Lower Motor neuron weakness

A
  • (UMN) Myelopathy=Spinal cord process

- (LMN) Radiculopathy= Nerve root process

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13
Q

*What are 3 differences between UMN and LMN?

A

UMN: -spasticity

  • tone increases
  • no fasciculations (spontaneous contraction)

LMN:-paresthesias (“pin+needles”)

  • tone decrease
  • fasciculations
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14
Q

**What does ASIA Impairment scale stand for

and what does ‘A’ and ‘E’ stand for (the extremes of the scale)?

A

(American Spinal Cord injury)
A: Complete
E: Normal

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15
Q

What is a Spinal shock?

A

loss of motor and sensory after trauma

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16
Q

Neurogenic shock involves the ___ chain and is associated with __ instability

A
  • sympathetic

- autonomic

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17
Q

Best timing of exam for Spinal/Neurogenic shock for prognosis is?

A

72 hours

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18
Q

What does a COMPLETE cord (impairment) consists of? (3)

A
  1. No sensation
  2. Flaccid Paralysis
  3. Initially areflexia(no normal reflexes)
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19
Q

What is Central Cord Syndrome caused by and what are 3 symptoms?

A
  • Hyperextension injuries
    1. Plegia of arms (UE > LE)
    2. Posterior (back) column spared; 3. Sacral sparing (sensation in sphincter control: are continent)
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20
Q

*Brown – Sequard Syndrome is caused by what?

A
  • trauma (only through gunshot)

- Tumour

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21
Q

What are some Brown – Sequard Syndrome?

A
  • ipsilateral (one-side) motor paralysis
  • ipsilateral hyperanesthesia (excessive sensitivity)
  • contralatera (opp. side) loss of pain and temp.
22
Q

What spinal level is the Conus Medullaris? (cone-shaped end of spinal cord)

A

S3-5

23
Q

What spinal level is the Cauda equina?

What part of the spine is injured, which causes which deficiencies?

A
  • Spinal cord ends at: L2

- lumbosacral roots: problems with sensation in LE (ex. Bowel/bladder deficits)

24
Q

If ___ disc is pinched for longer than ___, than it is permanent

A
  • herniated

- 24-48 hours

25
Q

What is APOPTOSIS?

A

after cells die body goes to “programmed cell death”- (locally all cells die)

26
Q

In the Acute rehabilitation phase the percentage of people having Pressure ulcers is __ and is most common over the ___

A
  • 25%

- sacrum

27
Q

Other than pressure ulcers what other deficits are common in the ACUTE rehab?

A
  • pneumonia
  • DVT
  • Autonomic dysreflexia (excessive high blood pressure)
  • UTI (infection)
28
Q

**What is the leading cause of death for SCI from highest to lowest (4)?

A
  1. Pneumonia
  2. PE (pulmonary embolism)
  3. Heart disease
  4. Sepsis (infection of blood)
29
Q

If appearance of ____ within the cord, there is an unfavorable recovery

A

-hemorrhage

30
Q

???*What is the difference between Autonomic Dysreflexia and Autonomic Hyperflexia?

A

Dysreflexia: high blood pressure due to problem to autonomic nervous system
Hyperreflexia: LIFE THREATENING-exagerated blood pressure in response to pain (below the level of spinal cord injury)- cuz no sensation

31
Q

How can you manage Autonomic Hyperreflexia- since it is caused by painful stimuli?

A
  • place in sitting positiong (decrease intracranial pressure)
  • check for painful stimulus (where is pain)
  • minimize all noxious stimuli
32
Q
  • Neuropathic spinal results from______and is reported in ___ to __ % of patients
  • evaluation must look for other __ of __ (ex. other new conditions such as renal stones)
A

> changes in neuronal function and increased sponatenous activity
6-50%
causes of pain

33
Q

3 types of treatment for Neuropathic Spinal Pain

A
  • Physio Therapy (electro)
  • anticonvulsants
  • antidepressants
34
Q

***Patients without initial position sense of the _______ will likely not regain ____ (peeing) in a SCI

A
  • great toes

- volitional voiding (peeing)

35
Q

What is Hypertrophic Bone formation?

Treatment?

A
  • formation of new bone in soft tissue planes surrounding a joint; most commonly in HIPS
  • Irradiation (radiation), ROM
36
Q

What are 2 positive points on spasticity and 2 negative points

A

POS: -if you have at least a little bit of spasticity you can do transfers (after SCI)
-assists mobility
NEG:- interferes with positioning
-spasms are painful

37
Q

What are 2 ways to treat spasticity?

A
  • muscle stretching=PNF inhibition, joint ROM
  • Botulinum Toxin:blocks release of ACh (TEMPORARY TREATMENT:effects lasts approx. 3 months=collateral sprouting of axon)
38
Q

***What is one type of medication for Spasticity?

A

Baclofen

39
Q

What are the extreme scores of the Muscle Testing for SCI?

A

0=total paralysis

5=active movement, against full resistance

40
Q

What is the minimal score needed to set functional goals with a specific level of injury on the Muscle test?

A

3=active movement against gravity

41
Q

What is a functional goal for C!-C3?

A
  • have control over shoulder elevation

- puff wheelchair (uses ventilator)

42
Q

Those with a C4-T1, what is crucial to teach them as their functional goal?

A

-teach diaphragmatic breathing

43
Q

How many degree of Lateral rotation do you need to have in the for dressing?

A

45 degrees

44
Q

If cervical instability no more than 90 degrees of:

If lumbar instability no more than 90 degrees of:

A
  • Glenohumeral flex/abd

- Hip flexion

45
Q

When needing to exercises but not ready to go against gravity what can you do?

A

-lie down on back

46
Q

How do you modify if no finger flexors are present? What level of innervation is this?

A
  • Velcro

- C8

47
Q

What can be donned (put on) to assist with preventing low BP?

A

Abdominal Binder

48
Q

**What are 5 EARLY treatment exercises for SCI?

A
  1. Mat activites (teach to INDEPENDENTLY roll to prevent pressure sores)
  2. Prone- Scapular stregnthening (prone on elbows)
  3. Supine-onto elbows to the longsitting position
  4. Long sitting: pushup with hands
  5. Transfers
49
Q

*What are 5 Intermediate Treatment exercises?

A
  1. Self ROM
  2. Transfers (w/c to flor/floor to w/c)
  3. Advanced wheelchair skills
  4. Ascend/Descend curbs
  5. Aquatic Therapy
50
Q

*What are 4 Advanced Treatment exercises?
How long is this treatment?
What do you need to have to be able to do these ex.?

A
  1. ambulation training
  2. standing (with KAFO: KNEE ANKLE FOOT ORTHOTIC)
  3. Forearm crutch gait activities
  4. How to get up from floor
  • 2-3 months
  • C8 (abdominal control)

PTA II (Lecture) (13 decks)

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