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Adult > Exam 2–SCI > Flashcards

Exam 2–SCI Flashcards

1
Q

C1-3: Possible movements

A

Neck flexion, Extension, & Rotation.

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2
Q

C1-3: Patterns of weakness

A

Total paralysis of trunk, UEs, LEs, & dependent on ventilator.

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3
Q

Functional Expectations of a C1-C3 injury

A

Respiratory: Ventilator dependent.

ADLs: Dependent.

Wheelchair mobility:
* Independent with power WC with alternative control (sip n puff & proportional chin control)
* Dependent with manual WC (tilt in space WCs to assist with weight shifts for pressure ulcers).

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4
Q

C4: Function gained from C1-3

A

Scapular elevation & better inspiration.

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5
Q

C4: Muscles innervated

A

Upper traps; diaphragm; cervical paraspinal muscles

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6
Q

C4: Patterns of weakness

A

Paralysis of trunk, UEs, LEs, inability to cough, endurance & respiratory reserve low secondary to intercostals.

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7
Q

C4: Functional expectations

A

Respiratory: MAY be able to breathe independently (no coughing)

ADLs: Dependent.

WC Mobility:
* Independent with power WC & alternative controls (sip n puff & proportional ching control).
* Dependent with manual WC (tilt in space, assisting with weight shifting for pressure ulcers

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8
Q

C1–C4: Therapy Focus

A

Pt Education: Teach pt how to direct own care (turning, weight shifting, bowel & bladder mgmt, routines)

Caregiver Training: Training others the proper techniques for dressing, hygiene, WC positioning & maintenance.

Ordering & training use of appropriate equipment for pt & caregivers

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9
Q

Equipment for C1–C4

A

Tilt-in-space Manual WC: Useful for brand-new injuries (still dependent).
* Allows weight shifting off of ischial tuberosities (pressure ulcers).

Tilting shower commode chair available for this population

Transportation
* Lowered-floor minivan
* Full-size van with raised roof: lowering powered ramp.
* EZ lock tie-down system.

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10
Q

C5: Function gained from C4

A

Deltoids
Biceps

Hand to mouth pattern ability

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11
Q

C5: Patterns of weakness

A

Elbow extension
Pronation
Wrist & hand movement

Total paralysis of Trunk & LEs

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12
Q

C5: Functionally relevant muscles innervated:

A

Deltoid
Biceps
Brachialis
Brachioradialis
Rhomboids
Serratus anterior (partially innervated)

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13
Q

Functional Expectations of C5

A

Respiratory: Independent breathing, weak cough = assistance clearing secretions.

ADLs:
* Feeding: Setup
* Grooming: Partial to total assist
* Dressing:
– UE: Partial assistance
– LE: Total assistance
* Toileting: total assistance
* Bathing: total assistance

WC Mobility:
* Independent with Power WC
* Some may self-propel Manual WC (unless terrain)

Transportation:
* Some may drive independently with highly specialized equipment (most don’t)

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14
Q

Adaptive Equipment for C5

A

U-Cuff: W/ deltoid & bicep but no wrist movement.
Button-hook zipper pull.

Plate Guard: Push food to it rather than off the plate.
Mobile arm support: Deltoid & bicep support. Helps strengthen C5 muscles appropriately, avoiding development of compensatory movements (shoulder hiking).

Due to inability to operate standard joystick on a power WC:
* Goal post handle
* Ball handle

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15
Q

C6: Functionally relevant muscles innervated

A

Clavicular pectoralis supinator
Extensor carpi radialis longus & brevis (Radial wrist extension)***
Serratus anterior (Scapular protraction)
Latissimus dorsi (Horizontal adduction)

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16
Q

C6: Movements possible, gained from C5

A

Scapular protraction
Some horizontal adduction
Forearm supination
Radial wrist extension***
– Allows for Tenodesis Grasp

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17
Q

C6: Patterns of weakness

A

Wrist flexion
Elbow extension
Hand movement

Total paralysis of trunk & lower extremities

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18
Q

What is the most important concept for a C6?

A

Ability for Radial Wrist Extension = Tenodesis Grasp.
* Stretching: Don’t overstretch flexor tendons
* Splinting: Maintain thumb opposition

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19
Q

C6: Functional expectations

A

ADLs:
* Feeding: Partial assist to independent
* Grooming: Partial assist to independent
* Dressing:
–UE: Independent
* LE dressing, Bowel & Bladder Management: Partial assist (some may achieve independence)

WC Mobility:
* Power WC independence
* Manual WC: Partial assist to independent with custom setup

Transportation:
* Independent: may transfer or drive from WC

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20
Q

C6: Adaptive Equipment

A

Built-up handle utensils, e.g. rocker knife (Tenodesis grasp)

(or educate them how to use utensils using Tenodesis grasp)

Driving Equipment: Spinner knob, tri-pin for steering wheel.

Bathing: (Always padded) tub transfer bench, rolling shower commode chair (for roll-in shower)

Manual WC:
* Rigid frame: Light-weight & sturdy
* Folding frame: (easier to get into car)

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21
Q

C7–C8: Movements possible

A

Elbow extension
Wrist extension (ulnar side)
Finger flexion & extension
Thumb flexion, extension, & abduction

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22
Q

C7–C8: Patterns of weakness

A

Paralysis of trunk & LEs
Limited grasp release & dexterity secondary to intrinsic muscles of the hand

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23
Q

C7–C8: Functional expectations

A

ADLs:
* Feeding: Independent
* Grooming: Independent
* Dressing:
– UE: Independent
* UB Bathing: Independent.
* LE dressing, LB bathing, Bowl & Bladder management: Partial assist to independent.

WC Mobility:
* Manual WC: Independent indoors (not if terrain)

Transportation:
* Independent with specialized equipment

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24
Q

T1–T9: Functionally relevant muscles innervated

A

Intrinsics of the hand
Lumbricals
Pollicis muscles (^^full independence in UEs)
Intercostals (increased endurance)
Erector spinae (upper/partial trunk stability)

25
Q

T1–T9: Movement possible

A

UEs full functioning
Limited upper trunk stability (erector spinae)
Endurance increased secondary to intercostals

26
Q

T1–T9: Patterns of weakness

A

Lower trunk paralysis
Total paralysis of LEs

27
Q

T1–T9: Functional expectations

A

ADLs: Independent
WC: Independent
Transportation: Independent in driving, including loading & unloading WC

28
Q

T10–T11: Functionally relevant muscles innervated

A

External obliques
Rectus abdominis
Intact intercostals

29
Q

T10–T11: Movement possible

A

Good trunk stability

30
Q

T10–T11: Patterns of weakness

A

Paralysis of LEs

Good trunk stability emerges here (external obliques, rectus abdominis)

31
Q

T10–L1: Functional expectations

A

(muscles gained: external obliques, rectus abdominis, & intact intercostals = Good trunk stability & possible standing!)
ADLs: Independent

WC: Independent

Transportation: Independent including loading & unloading WC.

Standing/ambulation: Supervision to independent using bracing (crutches or walker)

32
Q

L2–S5: Movement possible

A

Gooder trunk stability
Partial control of LEs

33
Q

L2–S5: Patterns of weakness

A

Partial paralysis of LEs

34
Q

L2–S5: Functional expectations

A

ADLs: Independent
WC: Independent
Transportation: Independent including loading & unloading WC
Standing/Ambulation:
* Standing: Independent
* Ambulation: Independent to some assist

35
Q

When does feeding & grooming independence emerge?

A

C6 (Partial/setup assist to Independent)

36
Q

When does manual WC independence emerge?

A

C6: partial to independent
C7–C8: Independent indoors

37
Q

When does the hand-to-mouth pattern emerge?

A

C5 (deltoid & bicep functiion)

38
Q

When does full independence in all ADLs emerge?

A

T1–T9

39
Q

When does respiratory independence emerge?

A

C4 (may require assistance clearing secretions)

40
Q

When does driving independence emerge?

A

C5 (with highly specialized equipment–stay in chair using tie-down system)

41
Q

When does FULL driving independence emerge?

A

T1–T9 (including loading & unloading)
– Full-hand functioning
– Limited trunk stability (erector spinae)

42
Q

ASIA A

A

Complete = No motor or sensory function is preserved in sacral segments S4–5.

43
Q

ASIA B

A

Incomplete: Sensory intact but no motor function preserved below neurological level.

44
Q

ASIA C

A

Incomplete: Motor preserved below neurological level, more than half of key muscles below level of injury are muscle grade of <3.

45
Q

ASIA D

A

Incomplete: Motor preserved below neurological level, more than half of key muscles below level of injury are muscle grade of >3.

46
Q

ASIA E

A

Normal sensory & motor return.

47
Q

ASIA Sensory Grading

A

0 – Absent
1 – Altered
2 – Normal

48
Q

ASIA Muscle Grading

A

0 – Total paralysis
1 – Palpable or visible contraction
2 – Active movement, full ROM with gravity eliminated
3 –Active movement, full ROM, against gravity
4 –Active movement, full ROM, against gravity, providing some resistance
5 – Active movement, full ROM, against gravity, providing normal resistance

49
Q

Decubitus: what/why? prevention?

A

What: ulcer from constant pressure in a static position without shifting.

Prevent by shifting weight:
–Seated: one minute/hour
– In bed: change position every 2 hours

50
Q

Central cord SCI

A

Most common

Incomplete = sacral sensory sparing

Caused by falls (common in older people)

Greater weakness in UE than LE

Results in cervical stenosis.

51
Q

Brown-sequard SCI

A

Incomplete

Damage to half the cord =
Ipsilateral proprioception & motor loss
Contralateral loss of sensation

Common cause is knife or gunshot wound

52
Q

Anterior cord SCI

A

Incomplete

All motor functions absent below injury level

Proprioception & sensation remain.

53
Q

Conus medullaris

A

Injury to the Sacral Cord = flaccid paralysis of LEs

54
Q

Cauda equina

A

Injury to lumbosacral nerve roots in the spinal canal

Areflexic bladder & bowel; paralysis or weakness of LEs

55
Q

Tetraplegia vs. Paraplegia

A

Tetraplegia: Injury to the cervical spinal cord = Impaired UE, LE, & trunk function

Paraplegia: Impaired LE function & possibly trunk

56
Q

Common tests related to SCI?

A

ROM

MAS: Modified Ashworth Scale (spasticity)

SCIM: Spinal Cord Independence Measure.

GRASSP: Graded Redefined Assessment of Strength, Sensibility & Prehension
– Measures hand function (designed for patients with Tetraplegia)

57
Q

Common tests related to SCI?

A

ROM

MAS: Modified Ashworth Scale (spasticity)

SCIM: Spinal Cord Independence Measure.
– Questionnaire for functional independence.

GRASSP: Graded Redefined Assessment of Strength, Sensibility & Prehension.
– Measures hand function (for pts with tetraplegia)

58
Q

Complications of SCI?

A

*Autonomic Dysreflexia (find & eliminate the cause–bladder, drainage obstructions. Have pt maintain upright position)

*DVT: Deep Vain Thrombosis (blood clot, usually in leg–anticoagulants)

*Heterotrophic Ossification (bones forming where they shouldn’t)

*Orthostatic Hypotension (lay back down)

*Pressure ulcers (decubitus ulcers)

*Pain

*Spasticity

*Temperature Regulation (educate neutral temperatures)

Adult (4 decks)

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