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7313 Pathophysiology Shappy_Bringman > Exam 1 Lecture 4: spinal cord > Flashcards

Exam 1 Lecture 4: spinal cord Flashcards

1
Q

MOI of SCI

A

Traumatic

  • –MVA, Falls, GSW (gun shot wounds), war injuries

Non-traumatic

  • –Vascular, vertebral subluxations, infections, abscesses, neoplasms, diseases (MS or ALS)
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2
Q

What is the most common age and gender?

A

•Males 16-30 Y/O

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3
Q

Employment rates 8 years post injury

A

–37% employment- paraplegic
–30% employment- tetraplegia/quadriplegia

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4
Q
  • Precent of discharge from total stay (trauma & rehab)
A

•D/C from total stay (trauma and rehab)

  • –89% home
  • –5% nursing home
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5
Q

Average stay in acute hospital

A

•Acute hospital stay 15 day average

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6
Q

Rehabilitation stay average

A

•Rehabilitation average stay 44 days

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7
Q

Metical Cost (1st year & subsequent years)

A

–1st year

  • •Quadriplegia
    • –$300,000 to $400,000
  • •Paraplegia
    • –$150,000

–Subsequent years

  • •Quadriplegia
    • –$30,000 to $75,000
  • •Paraplegia
    • –$15,000 to $20,000

Numbers are out of date, so we don’t really need to know them

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8
Q

Life expectancy (increased, decreased, same)

A

decreased (didn’t say how much)

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9
Q

SCI Classifications

A

•Quad or Tetraplegia- all 4 extremities involved and trunk

  • –Partial or complete cervical cord
    • •Sensory, autonomic, motor

•Paraplegia- LE’s and possibly trunk involved

  • –Partial or complete Thoracic or Lumbar cord or sacral roots
    • •Sensory, autonomic, motor

•Named for the level of last intact or partially intact nerve root

  • –C7 complete vs incomplete (can they possibly walk? How?)
  • –L2 complete vs incomplete (can they walk? How?)
  • –Oblique name each side separately
    • •C5 on R (incomplete) and C6 on L (complete)

•Sacral Sparing- signs that lesion is incomplete

  • –Toe flexion, perianal sensation, sphincter contraction (wink)
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10
Q

Bowel & bladder training

A

learn to keep track of intake and output so you can go void before it happens on its own

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11
Q

Classification:

•Quad or Tetraplegia

A

Quad or Tetraplegia- all 4 extremities involved and trunk

  • Partial or complete cervical cord
    • •Sensory, autonomic, motor

She has never heard of anything called

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12
Q

Classification: Paraplegia

A

•Paraplegia- LE’s and possibly trunk involved

  • –Partial or complete Thoracic or Lumbar cord or sacral roots
    • •Sensory, autonomic, motor
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13
Q

How are SCI named?

A

•Named for the level of last intact or partially intact nerve root

  • –C7 complete vs incomplete (can they possibly walk? How?)
  • –L2 complete vs incomplete (can they walk? How?)
  • –Oblique name each side separately
    • •C5 on R (incomplete) and C6 on L (complete)
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14
Q

Sacral Sparing

A

•Sacral Sparing- signs that lesion is incomplete

  • –Toe flexion, perianal sensation, sphincter contraction (wink)
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15
Q

Can you use a manual wheelchair with a quadriplegic?

A

Yes it might be possible. Quadriplegict just means all four limbs are involved, not neccesarily useless.

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16
Q

what might we use with paraplegic complete with orthostatic hypotension?

A

Abdominal binder

arm movements

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17
Q

Can a C7 SCI patient walk?

A

there is new technology where we can imbed electrodes into leg muscles on a walker that are being created. Problem is there is no sensory feedback or correction

It is wireless now

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18
Q

AFO

A

Ankle Foot Orthosis

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19
Q

KAFO

A

Knee Ankle Foot Orthosis

20
Q

KO

A

Knee Orthosis

21
Q

Brown Sequard Syndrome

A

Rare (could be from stabbing or other)

Hemi-ipsilateral and contralateral loss (depending on site of lesion and what has crossed and not crossed)

  • –Motor- strength deficit or loss
  • –Lateral column damage- areflexia, clonus, +Babinski
  • –Dorsal column damage- lack of proprioception, kinesthesia, vibration sense
  • –Spinothalamic tract- Contralateral (2-4 segments above is damaged) therefore sensory loss in dermatome distribution opposite side
    • •Pain and temperature, sensation
22
Q

Anterior Cord Syndrome: Everything

A

•Mechanism of injury

  • –Anterior spinal artery damage
  • –Cervical flexion injury

•Corticospinal tract- carries what information?

  • –Motor loss

•Spinothalamic tract- carries what information?

  • –Pain and temperature, sensation
    • •contralateral

•DCML involved? NO

  • –Posterior spinal artery
23
Q

Central Cord Syndrome

A

•Hyperextension injury or narrowing of spinal canal

  • –Congenital or stenosis
  • –Sulcus arteries
  • –Most often in cervical region

Very Rare

24
Q

Diplegia

A

Name for when both UE are paralized but not Lower extermities.

25
Q

Posterior Cord Syndrome

A
  • •Rare
  • •Posterior spinal artery
  • •Motor intact
  • •Pain and light touch intact
  • •Dorsal columns involved
    • –Proprioception, vibration
26
Q

Cauda Equina Injruies

A
  • •Can be complete, usually incomplete
  • •LMN lesion- significant due to possible regeneration
  • •MOI- traumatic fracture or dislocation

Has the potential to regenerate because it is a lower motor neuron

27
Q

Clinical Manifestations of SCI

A

•Spinal Shock

  • –Post injury areflexia
  • –Hours to weeks symptoms resolve (acute care)

•Motor and Sensory Impairments

  • –Complete or partial loss below level of injury ie. C7 and below

•Body temperature regulation

  • –Hypothalamus can not control blood flow or sweating
    • •Diaphoresis (excessive sweating) above level of lesion

•Respiratory dysfunction

  • –C1 and C2 possibly C3 lesions- phrenic nerve loss
    • •Ventilator
    • •Risk for pneumonia, pulmonary embolism, infections, atelectasis
    • •Coughing, deep breathing, accessary muscle issues

•Spasticity

  • –Hypertonicity, hyperactive stretch reflex and clonus
    • •Can help or hurt with function
    • •Can be treated with medication
      • –Nerve blocks, intrathecal injections
    • •Surgeries for spasticity
      • –Myotomy- muscle release
      • –Neurectomy- cut involved nerve/s (partial or complete)
      • –Tenotomy- lengthening of a tendon

Clinical Manifestations (continued)-Bowel and Bladder dysfunction (see another slide for details)

28
Q

Clinical Manifestations of SCI: Spinal Shock

A

–Post injury areflexia
–Hours to weeks symptoms resolve (acute care)

First stage

Want it to stop here

29
Q

Clinical Manifestations of SCI:
•Motor and Sensory Impairments

A

–Complete or partial loss below level of injury ie. C7 and below

30
Q

Clinical Manifestations of SCI: Body temperature regulation

A
  • –Hypothalamus can not control blood flow or sweating
    • •Diaphoresis (excessive sweating) above level of lesion
31
Q

Clinical Manifestations of SCI: Respiratory Dysfunction

A
  • –C1 and C2 possibly C3 lesions- phrenic nerve loss (if pt lives)
    • •Ventilator
    • •Risk for pneumonia, pulmonary embolism, infections, atelectasis
    • •Coughing, deep breathing, accessary muscle issues
32
Q

Clinical Manifestations of SCI: Spacticity

A

–Hypertonicity, hyperactive stretch reflex and clonus

  • •Can help or hurt with function
  • •Can be treated with medication
    • –Nerve blocks, intrathecal injections
  • •Surgeries for spasticity
    • –Myotomy- muscle release
    • –Neurectomy- cut involved nerve/s (partial or complete)
    • –Tenotomy- lengthening of a tendon
33
Q

Clinical Manifestations of SCI: Bowel Dysfunction

A

•Bladder- UTI risk due to lack of muscle tone

  • –UMN spastic bladder- automatic or reflex voiding- suprapubic stimulus may elicit this
  • –LMN flaccid bladder (caudia equina)- Valsalva or manual abdominal pressure to elicit voiding

•Bladder training programs- D/C catheter if possible; if not cath or adult diaper

  • –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan
34
Q

Clinical Manifestations of SCI: Bladder Dysfunction

A

•Bowel

  • –UMN spastic bowel- above conus medullaris
  • –LMN flaccid bowel- below conus medullaris
    • •Bowel training program- suppositories or digital stimulation; control diet, fluids, stool softeners, timing, etc.
  • •Sexual function- Patients will ask
35
Q

Bladder training programs (or what you must use instead)

A

• D/C catheter if possible; if not cath or adult diaper

  • –Timed voiding- attempt urination prior to cath, control intake, monitor with bladder scan
36
Q

List some Indirect Impairments & Complications (9)

A
  1. Presure Sores
  2. •Autonomic dysreflexia- can kill your patient
  3. •Postural hypotension (orthostatic hypotension)-
  4. •Heterotopic ossification-
  5. Contractures
  6. DVT
  7. Pain
  8. •Osteoporosis and
  9. Renal Calculi (kidney stone)
37
Q

Indirect impairments and Complications: Autonomic dysfreflexia

A

•Autonomic dysreflexia- can kill your patient

  • –Increased BP due to vasoconstriction initiated from noxious stimulation (bladder when cath is pinched or elevated, rectal, pressure sores/infection, urinary stones, temperature elevation)
  • •Symptoms- increased BP, decreased HR, HA, sweating, spasticity, restless, flushing- due to vasodilation above lesion, vasoconstriction below lesion, pupil constriction, nasal congestion, piloerection, blurred vision, syncope.
    • •Intervention- Check cath, sit up if lying down (raise the head), loosen clothing and abdominal binders, get help!
  • MAKE SURE YOU NEVER EVER PUT CATHETER BAG ABOVE BLADDER
38
Q

Indirect impairments and complications: Pressure sores

A

•Pressure sores- pressure or shearing forces combined with bowel and bladder dysfunction, decreased sensation, etc.

  • –Location- bony prominences
  • –Best treatment is prevention- turning schedules, pressure relief, skin care
39
Q

Indirect impairments and complications: Postural Hypotension

A

•Postural hypotension (orthostatic hypotension)- decrease in BP supine to sit or sit to stand

  • –Tilt table progression, compression hose, abdominal binder, gradual progression
40
Q

Indirect impairments and complications: Heterotopic ossification

A

•Heterotopic ossification- growth of bone outside the skeleton ie. muscles, tendons, connective tissue

41
Q

Indirect impairments and complications: Contractures

A

•Contractures- change in muscle length, change in capsular and pericapsular structures

42
Q

Indirect impairments and complications: DVT

A

•DVT- can cause death if thrown- pulmonary embolus

  • –Loss of muscle pump, stasis of blood, increase in thrombin
    • •Symptoms- swelling, erythema, heat
    • •Intervention- Drugs, hose, turning program, ROM, elevation of LE’s
43
Q

Indirect impairments and complications: Pain

A

–Traumatic pain- injury ie. MVA, fall, etc.
–Nerve root pain- radiating, burning, etc.
–Spinal cord Dysesthesias- Deep pain from areas that lack sensation
–Musculoskeletal pain ie. shoulder, elbow, or wrist pain from assistive device with walking or W/C propulsion, transfers, etc.

44
Q

Indirect impairments and complications: Osteoporosis & REnal Calculi (kidney stone)

A

•Osteoporosis and Renal Calculi (kidney stone)

  • –Calcium metabolism issues- break down bone, increased calcium in blood, deposits in kidney

(these are related)

45
Q

Multi podus boot

A
46
Q

TLSO

A

TLSO = Thoracic Lumbar Sacral Orthosis

47
Q

Philadelphia Collar

A

A hard cervical collar

7313 Pathophysiology Shappy_Bringman (13 decks)

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