Clinical syndromes and complications Flashcards
Spinal shock
Stage occurring after SCI, may last from 24 hrs to 6 weeks.
- areflexia (no reflex activity below level of injury
- bowel/bladder flaccid/atonic
- deep tendon reflexes decreased
- sympathetic functions disturbed
Central Cord Syndrome
Occurs when there is more cellular destruction in the center of the cord than in the periphery
- paralysis, sensory loss greater in UEs (more centrally located) than LEs
- more often in older adults (arthritic changes cause narrowing of spinal canal)
Brown-Sequard Syndrome (lateral damage)
Only one side of cord damaged. Below level of injury:
- motor paralysis, loss of proprioception IPSILATERAL SIDE
- loss of pain, temperature, touch sensation CONTRALATERAL SIDE
Anterior Spinal Cord Syndrome
Results from injury that damages anterior spinal artery or the anterior aspect of cord
- paralysis, loss of pain, temperature, touch sensation
- proprioception preserved
Cauda Equina (peripheral)
Involves peripheral nerves, not the direct involvement of spinal cord.
- typically occurs with fractures below the L2 level, results in flaccid-type paralysis
- associated with better prognosis for recovery (peripheral nerves have regenerating capacity)
- sensory/motor deficits highly varied, asymmetrical
Conus Medullaris Syndrome
Injury of the sacral cord (conus) and lumbar nerve rots within the neural canal
-areflexic bladder, bowel, LEs
Skin breakdown, pressure sores, decubitus ulcers
- what increases risk for skin breakdown?
- what causes pressure sores?
- most likely areas to develop breakdown?
- sensory loss, pressure, heat, shearing
- loss of blood supply to area from pressure, leading to necrosis
- over bony prominences (sacrum, ischium, trochanters, elbows, heels, and others)
Signs of skin breakdown, in order of severity
- area reddened, blanches
- area reddened, no blanching (necrosis begun)
- blister or ulceration appears
Preventing skin breakdown
relieve and eliminate pressure points, protect vulnerable areas from shearing, moisture, and heat
- routine turning in bed
- specialized mattresses, WC cushions, padding for body prominences
- performing weight shifting
- skin inspections
- ct. education for skin inspections and directing caregivers for inspections
Decreased vital capacity
- who is this a problem for?
- weakened muscles
- patterns of weakness
- tx
- people with cervical and high thoracic SCI
- diaphragm, intercostals, lats
- limited chest expansion, decreased ability to cough, reduced activity tolerance
- strengthen sternocleidomastoids and diaphragm, manually assisted cough, deep breathing exercises
Osteoporosis
- cause
- presentation
- tx for slowing progression
- disuse of long bones, mostly in LEs
- pathologic fractures in LEs
- daily standing in standing frame (controversial tx)
Orthostatic hypotension
- definition
- symptoms
- tx
Pooling of blood in abdomen and LEs due to lack of muscle tone, resulting in low BP.
- occurs when moving from supine to upright position or quick changes in body position
- symptoms: dizziness, nausea, loss of consciousness
- recline quickly; if seated in WC: tip back with legs elevated until symptoms subside
Autonomic dysreflexia
- cause
- symptoms
- tx
- phenomenon occurring in people with injuries above T4 to T6 level
- caused by reflex action of autonomic nervous system in response to stimulus such as distended bladder, fecal mass, bladder irritation, pain stimulus etc.
- symptoms: immediate pounding headache, anxiety, perspiration, flushing, chills, nasal congestion, paroxysmal hypertension, bradycardia
- tx: don’t leave ct. alone, medical emergency. Place ct in upright position, remove anything restrictive to reduce BP. Drain bladder, check leg bag tubing, etc. Monitor BP and other symptoms.
Spasticity
- involuntary muscle contraction below level of injury, results from lack of inhibition from the brain
- moderate spasticity can be helpful in therapy: maintains muscle mass, facilitates blood circulation (preventing pressure sores), can assist in ROM and bed mobility
- severs spasticity may need aggressive tx (nerve blocks injected, neurological procedures)
Heterotopic ossification (ectopic bone)
- define
- symptoms
- onset
- tx
Bone that develops in abnormal anatomic locations
- mostly around hip and knee, sometimes elbows and shoulders
- symptoms: swelling, warmth, decreased joint ROM
- onset: 1 to 4 months after injury
- tx: medication, maintain joint ROM to preserve functional ROM for WC positioning, symmetrical position of pelvis, maximum functional mobility.
- can lead to scoliosis and kyphosis, skin breakdown
