Chapter 5. Neuro Rehab for Spinal Cord Injuries Flashcards
What are the most common level for injury
- C1, C2, and C5-7
- T12-L2 (most trunk rotation)
Injuries named are named according to the ___ of fracture
vertebral level
*Injuries in the CERVICAL area become _____ and injires in the THORACIC area become ____
Injuries below L1 have ___
- quads/tetraplegia
- para
- cauda equina syndrome
*Most common (4) types of forces (mechanisms of injury) are:
- Cervical rotation flex: (head side to side) transection of SC
- Hyperflexion: tear of anterior spinal artery= leading to ANTERIOR CORD SYNDROME
- Cervical Hyperextension
- Compression (ex.diving into shallow pool)
What leads to an ANTERIOR CORD SYNDROME ?
trauma; hyperflexion of your neck causing a tear of the ANTERIOR SPINAL ARTERY
*What is meant by COMPLETE when speaking about SCI subtypes
complete transection of motor and sensory tracts
**What are the 4 incomplete syndrome for INCOMPLETE SCI?
- Central Cord Syndrome
- Anterior Cord Syndrome
- Posterior Cord Syndrome
- Brown Sequard Syndrome
What does the Glasgow Coma state (neurologic examination) test?
level of consciousness
What are 6 neurologic exams for SCI?
- motor strength
- sensation
- Diaphragm
- Reflexes (ex. plantar reflex)
- Sacral sparing (ex. incontinence)
- Level of consciousness
**What are the Key myotomes (C5-T1)
C5-deltoid C6-biceps/wrist extensors C7-triceps C8-thumb extensors/finger flexors T1-fingers abd/add
**What are the key myotomes for L2-S1
L2-hip flexors L3-quads (on the top) L4-dorsiflexors L5-big toe extensor S1-plantarflexion
*What is the different between Upper vs. Lower Motor neuron weakness
- (UMN) Myelopathy=Spinal cord process
- (LMN) Radiculopathy= Nerve root process
*What are 3 differences between UMN and LMN?
UMN: -spasticity
- tone increases
- no fasciculations (spontaneous contraction)
LMN:-paresthesias (“pin+needles”)
- tone decrease
- fasciculations
**What does ASIA Impairment scale stand for
and what does ‘A’ and ‘E’ stand for (the extremes of the scale)?
(American Spinal Cord injury)
A: Complete
E: Normal
What is a Spinal shock?
loss of motor and sensory after trauma
Neurogenic shock involves the ___ chain and is associated with __ instability
- sympathetic
- autonomic
Best timing of exam for Spinal/Neurogenic shock for prognosis is?
72 hours
What does a COMPLETE cord (impairment) consists of? (3)
- No sensation
- Flaccid Paralysis
- Initially areflexia(no normal reflexes)
What is Central Cord Syndrome caused by and what are 3 symptoms?
- Hyperextension injuries
1. Plegia of arms (UE > LE)
2. Posterior (back) column spared; 3. Sacral sparing (sensation in sphincter control: are continent)
*Brown – Sequard Syndrome is caused by what?
- trauma (only through gunshot)
- Tumour
What are some Brown – Sequard Syndrome?
- ipsilateral (one-side) motor paralysis
- ipsilateral hyperanesthesia (excessive sensitivity)
- contralatera (opp. side) loss of pain and temp.
What spinal level is the Conus Medullaris? (cone-shaped end of spinal cord)
S3-5
What spinal level is the Cauda equina?
What part of the spine is injured, which causes which deficiencies?
- Spinal cord ends at: L2
- lumbosacral roots: problems with sensation in LE (ex. Bowel/bladder deficits)
If ___ disc is pinched for longer than ___, than it is permanent
- herniated
- 24-48 hours
What is APOPTOSIS?
after cells die body goes to “programmed cell death”- (locally all cells die)
In the Acute rehabilitation phase the percentage of people having Pressure ulcers is __ and is most common over the ___
- 25%
- sacrum
Other than pressure ulcers what other deficits are common in the ACUTE rehab?
- pneumonia
- DVT
- Autonomic dysreflexia (excessive high blood pressure)
- UTI (infection)
**What is the leading cause of death for SCI from highest to lowest (4)?
- Pneumonia
- PE (pulmonary embolism)
- Heart disease
- Sepsis (infection of blood)
If appearance of ____ within the cord, there is an unfavorable recovery
-hemorrhage
???*What is the difference between Autonomic Dysreflexia and Autonomic Hyperflexia?
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
How can you manage Autonomic Hyperreflexia- since it is caused by painful stimuli?
- place in sitting positiong (decrease intracranial pressure)
- check for painful stimulus (where is pain)
- minimize all noxious stimuli
- 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)
> changes in neuronal function and increased sponatenous activity
6-50%
causes of pain
3 types of treatment for Neuropathic Spinal Pain
- Physio Therapy (electro)
- anticonvulsants
- antidepressants
***Patients without initial position sense of the _______ will likely not regain ____ (peeing) in a SCI
- great toes
- volitional voiding (peeing)
What is Hypertrophic Bone formation?
Treatment?
- formation of new bone in soft tissue planes surrounding a joint; most commonly in HIPS
- Irradiation (radiation), ROM
What are 2 positive points on spasticity and 2 negative points
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
What are 2 ways to treat spasticity?
- muscle stretching=PNF inhibition, joint ROM
- Botulinum Toxin:blocks release of ACh (TEMPORARY TREATMENT:effects lasts approx. 3 months=collateral sprouting of axon)
***What is one type of medication for Spasticity?
Baclofen
What are the extreme scores of the Muscle Testing for SCI?
0=total paralysis
5=active movement, against full resistance
What is the minimal score needed to set functional goals with a specific level of injury on the Muscle test?
3=active movement against gravity
What is a functional goal for C!-C3?
- have control over shoulder elevation
- puff wheelchair (uses ventilator)
Those with a C4-T1, what is crucial to teach them as their functional goal?
-teach diaphragmatic breathing
How many degree of Lateral rotation do you need to have in the for dressing?
45 degrees
If cervical instability no more than 90 degrees of:
If lumbar instability no more than 90 degrees of:
- Glenohumeral flex/abd
- Hip flexion
When needing to exercises but not ready to go against gravity what can you do?
-lie down on back
How do you modify if no finger flexors are present? What level of innervation is this?
- Velcro
- C8
What can be donned (put on) to assist with preventing low BP?
Abdominal Binder
**What are 5 EARLY treatment exercises for SCI?
- Mat activites (teach to INDEPENDENTLY roll to prevent pressure sores)
- Prone- Scapular stregnthening (prone on elbows)
- Supine-onto elbows to the longsitting position
- Long sitting: pushup with hands
- Transfers
*What are 5 Intermediate Treatment exercises?
- Self ROM
- Transfers (w/c to flor/floor to w/c)
- Advanced wheelchair skills
- Ascend/Descend curbs
- Aquatic Therapy
*What are 4 Advanced Treatment exercises?
How long is this treatment?
What do you need to have to be able to do these ex.?
- ambulation training
- standing (with KAFO: KNEE ANKLE FOOT ORTHOTIC)
- Forearm crutch gait activities
- How to get up from floor
- 2-3 months
- C8 (abdominal control)
