Chp 23 SCI Flashcards
Etiology (How do we come about spinal cord injuries)
11,000 new case of SCI annually in the US
225,000 -288,000 individuals living with SCI in us currently
Male 78.3% vs Female 21.7%
White 66.5%, African American 26.8%, Hispanic 8.3% Asian 2%
Traumatic SCI (61%) MVA 40.4% Falls 27.9% Violence 15.0% Sports 8.0%
Non Traumatic SCI (39%) AVM Vertebral Subluxations Spinal Neoplasm Syringomyelia Abscess Infections Neurological Diseases such as MS or ALS Tetraplegia/Quadriplegia 56% Paraplegia 43%
Incomplete Lesions 53% (2008)
Incomplete lesions increasing 44% in 1970 to 53% today. Why?
Complete Lesions 47%
Hospital LOS is decreasing
Life Expectancy is increasing but depends upon age at injury and level of injury.
Financial Impact:
First Year
Lifetime
Classification of SCI ( Difference between a tetraplegia, and paraplegia
Tetraplegia – refers to complete paralysis of all 4 extremities and trunk, including respiratory muscles and results from a lesion of the cervical spine/cord.
Paraplegia – refers to complete paralysis of all or part of the trunk and of both lower extremities, resulting from lesions of the thoraco/lumbar cord or cauda equina
Classification of SCI not really much to recite here but where does the injury usually affect?
Neuroanatomical Organization
and Structure
This is information we discussed in
Neuroscience
Cervical Thoracic Lumbar Sacral Cauda Equina
Pairs of spinal nerves
Where they exit the spine
Neuroanatomical Organization
and Structure
Primary Ascending/Sensory Tracts:
Dorsal Column
Antero/lateral systems
Primary Descending/Motor Tracts Lateral Corticospinal Anterior Corticospinal Medial Vestibulospinal Lateral Vestibulospinal Lateral and Medial Reticulospinal Rubrospinal
What is ASIA and is it important for the PT to be able to distinguish the level of lesion and why
Primary Ascending/Sensory Tracts:
Dorsal Column
Antero/lateral systems
Primary Descending/Motor Tracts Lateral Corticospinal Anterior Corticospinal Medial Vestibulospinal Lateral Vestibulospinal Lateral and Medial Reticulospinal Rubrospinal
What do does Dr. Fineman define as a “key” muscle
Neurological Level:
Most caudal level of the spinal cord with normal motor and sensory function on both the left and right sides of the body.
Motor Level:
The most caudal segment of the spinal cord with normal motor function bilaterally
“Key” Muscles are tested
A key muscle is defined as having intact innervation if it has a manual muscle test of at least 3/5 (fair) and the next most rostral muscle exhibits 5/5 (normal ) strength.
How to test Sensory levels and what is the scale of a 0-2
Sensory Level:
The most caudal segment of the spinal cord with normal sensory function bilaterally
Sensory level is determined by testing the patient’s sensitivity to light touch and pin prick on both sides of the body at key dermatome levels. Scoring is based on a 3-pt ordinal scale:
0 = Absent
1 = Impaired
2 = Normal
There is an ISNCSCI form for use during the evaluation to determine this classification.
Define a complete injury, incomplete injury, and a zone of partial perservation
Injuries: Complete, Incomplete and Zones of Partial Preservation
Complete Injury:
Having NO Sensory or motor function in the lowest sacral segments (S4 and S5)
Sensory and Motor Function at S4/5 are determined by anal sensation and voluntary external anal sphincter control.
Incomplete Injury:
Having motor or sensory function including motor and/or sensory function at S4/5.
Zone of Partial Preservation:
If a patient has motor and/or sensory function below the level of the lesion, but does not have function at S4/5 - the areas of intact motor and/or sensory function are called Zones of partial preservation
Levels of the ASIA scale
Complete Injury- NO sensory or Motor function. Sacral segements are preserved in S4-S5
B- Incomplete - Sensory but not motor function is preserved and S4-S5 is preserved
C-Incomplete- Motor function is preserved below the neurological level in the “key” muscles and more than half of the muscles have a muscle grade less than 3/5
D- Incomplete - Motor function is pereserved in the key muscles below the neurological level and at least half of the muscles have a muscle grade of 3/5 or higher
E- Motor and Sensory Functions are Normal
Neurological Complications and Associated Conditions
Spinal Shock Motor and Sensory Impairments Autonomic Dysreflexia ***** Initiating Stimuli Symptoms Intervention Refer to slide 14 for more review Postural Hypotension (Orthostatic Hypotension) Impaired Temperature Control Cardiovascular Impairment Spasticity/ Spastic Hypertonia
Bladder and Bowel Dysfunction (see table 23.3 & 23.4 5th Ed.)
Dysfunction UMN Bladder LMN Bladder Management Intermittent Catheterization Supra-pubic Tapping Valsalva Maneuver
Sexual Dysfunction
what if C1-C2 was injured what about C3-C4, C5-C8, T1-T5, T6-T10, T11 and below
C1-C2- SCM, Neck extensors and upper traps C3-C4 - Diaphragm would be impaired along with Scalenes, and LS C5-C8- Diaphargm Serratus Anterior, and Lats, Pec Major and Minor
T1-T5- Intercostals and Erector Spinae
T6-T10- intercostals and Abdominals
T11- all the above muscles? this what the chart says but, I think it meant all the below muscles
Secondary Complications of SCI
Pressure Sores Deep Vein Thrombosis Pain Nociceptive Pain Traumatic Pain Musculoskeletal Pain Neuropathic Pain Nerve Root Pain SC Dysesthesias Contractures Heterotopic Ossification Osteoporosois/ Fractures Renal Calculi Respiratory Complication
How much recovery of function will occur after an SCI?
motor function will usually plateau 12-18 months post injury
Early Medical and Rehabilitation Management: Acute Stage
Emergency Care Immobilization of the spine Stabilization of the patient Cardiac Hemodynamic Respiratory Prevent progression of neurological impairment Urinary catheter High does of methylprednisolone
Fracture Stabilization
Early Surgical Decompression
Cervical Tongs
Halo
Physical Therapy Examination: Acute Stage what to look for during intial eval think like ROM, Reflexes what else
Motor and Sensory Function using ISNCSCI
Respiratory Strength of intact muscles of respiration Chest Expansion Breathing Patterns Cough Vital Capacity
Integument Skin Inspection Sensation Tone and DTR ROM/MMT Functional Status
Physcial Therapy Intervention/Management: Acute Stage
Motor and Sensory Function using ISNCSCI
Respiratory Deep Breathing Exercises (DBE) Glossopharyngeal Breathing Airshift Maneuver Respiratory Muscle Strengthening Assisted Coughing Abdominal Support Stretching
Integument
ROM, Proper positioning, Pressure Relief
Physical Therapy: Active Rehabilitation testing procedures there are lotsssss like Berg Balance scale etc…
Physical Therapy Examination: Aerobic Capacity and Endurance 6-min arm test Arousal, Attention & Cognition Mini Mental Montreal Cognitive Assessment Environmental or Work Barriers, Gait, Locomotion & Balance Wheelchair skills test Wheelchair circuit Modified Functional Reach test Berg Balance Scale Walking Index for SCI SCI Functional ambulation inventory 10 Meter walk test, 6 minute walk test Neuromuscular Recovery Scale
What scales are available for skin, muscles, motor function and pain
Integument Braden Scale SCI Pressure Ulcer Scale SCI – Presure Ulcer Scale – Acute Motor Function Modified Ashworth Scale SCI Spasticity Evaluation Tool Muscle Performance ASIA ISNCSCI MMT Hand held dynamometer Pain VAS International SCI Basic Pain Data Set W/C Users Shoulder Pain Index
What tests are used for Self Care/ Level of independence, ROM, and Ventilation
Physical Therapy Examination: Range of Motion Goniometer Self-Care and Home Management FIM SCI Independence Measure Quadriplegia Index of Function Capabilities of UE Instrument Ventilation Chest Circumference with tape measure Vital Capacity with hand held dynamometer Respiratory rate
What scales do you use to see if the individual is ready to return to work or social environments
Work, Community and Leisure Integration or Re-Integration
CRAIG Handicap Assessment and Reporting Technique
Assessment of Life Habits
Reintegration to Normal Living Index
Factors that will effect functional outcome
Motor Level of Injury Age Concomitant injury Pre-existing health conditions Secondary complications Body type Psychosocial Support Refer to : O’S & S Table 23.3 (5th Ed.) or Table 20.5 6th Ed. For a projection of available movements, functional capabilities and required assistance at each level of SCI.
Levels of Progression for someone with SCI starting with prone all the way to the W/C
Continue with activities from the Acute phase of intervention Skin Inspection Cardiovascular /Endurance Training Bed Mobility Skills Rolling Prone on Elbows Prone on Hands (Paraplegia) Supine on Elbows Pull-Ups Sitting Balance – Long Sit and Short Sit Positions Quadruped Kneeling Transfers Wheelchair (W/C) prescription and cushion W/C Skills Standing Ambulation Stairs, Curbs, Ramps Prevention, Health Promotion , Fitness and Wellness
