Exam 2 SCI Flashcards
What controls bowel and bladder?
Conus medularis
Does spastic bladder occur above or below conus medularis? What about flaccid bladder?
Above
Below
Spastic bladder
Reflexively empty at certain point
Pull hair
Tap pubis
Stroke abdomen
Flaccid bladder
Valsalva to raise bp
Creed maneuver: above pubis curl stomach and push in and down
Catheterization intermittently
Timed voiding
Every x number of hours try and go to restroom, start 2 hr increments, use techniques, cathertize if need be
Other bowel and bladder programs
Meds
Bladder intermittent catherterization
Bowel, adult diapers
Do men have greater erection capacity above or below cm? What about lower capacity?
Above
Below
Erection type: reflexogenic
Occur in response to external physical stimulation of genitals
Must have intact reflex arch
Psychogenic erection type
Occur through cognitive activity
More difficult to attain
Ejaculation
More likely if below CM
Lower level vs. higher level
Incomplete
Spasm, so backdown prevents ejaculation
Children and sexual dysfunction
Generally spermatogenesis decrease
Ejaculation difficult: improve with vibration
IVF best option
Menstruation
Interrupted for 1-3 months after injury Conception unimpaired Arousal and female sexual response occur if injury above CM May not feel labor Labor cause AD C sections common
Osteogenesis
Soft tissues below level of spinal lesion (soft tissues ossify)
Heterotrophic ossification
Always extra articular
Always extra capsular
Occurs adjacent to large joints: hip knee and spine
Interventions:
Surgery meds PT for ROM for deformity and fxn limits
Pressure ulcers
Pressure and shearing forces
Delayed rehab, infection, and death
Develop over bony prominence
10-15 seconds pressure relief every 10 minutes
Cushion best for pressure relief
Air, adjustable, do not max fill
Conservative traction
Cervical subluxation
Fraction dislocation
Surgery for fx stability
Unstable fx
Gross malalignment
Cord compression
Deteriorating status
Minerva
Type of cervial brace provides stability in all planes for fx
Somis
Does not limit motion in all planes, provide some stability post up weeks
More for scoliosis patients
Miami J
1st rigid collar developed, not used much anymore, keeps Cspine from moving
Vista
Rigid collar, more comfort than Miami J, questionable stability, thermal plastic does prevent cspine motion, may eventually crack
Aspen
Most commonly collar used, extremely stable, more comfort than Miami J, for non displaced fx or dislocation without fx
Bathing collar
More stability as muscles get stronger, before just wet wipes before
Soft collar
No stability at all, comfort for patient
TLSOs
Body jacket, need to be supine to don,Doff, graduate to the other one, flexible plastic, reminder to not bend, flex/extend spine
Jewett
For scoliosis, not as affective as TLSO for stability, OP tend to fx, this stops them
Early mobility contra
L spine
Pelvic rotation
SLR greater than 60
Hip flexion beyond 90 with knee extension
C Spine
Motion of head and neck
Shoulder flexion and abduction greater than 90
Special skills
Tenodesis grip: c spine injuries, wrist extensors, so not stretch extensors! Make tighter
SLR of >100 para
WC skills test
32 skills
3 levels of difficulty
Indoor, community, and advanced
Higher the score the better
Walking index for SC injury
Looks at AD and amount of assistance required for 10M walktest
Scores range 0-20
Walking ability post spinal cord
Traumatic or non
Spinal cord injury independence scale
19 areas - FIM 15 Measures independence Sub categories: self care, respiration and sphincter management, mobility Score 0-100 Based off FIM, adjusted for WC
Neuromuscular recovery scale
Measures recovery not compensation
Meant to target true recovery
14 items: 4 on body wt treadmill, 10 tested on ground
No use of devices
What is the most common side effect of long term WC use?
Shoulder pain, strengthen RC muscles
NDT
Neuro-developmental treatment
Bobath
Concepts NDT
Facilitate
Activate key muscles, create correct movements
Inhibit
Inhibit some muscles, to create movements
Handling
Clinically: hands used to support and assist movement from one position to another
Application: use of hands, light touch, intermittent touch or form manual contact to guide and assist movements
How many cases of stroke SCI per year?
11,000
Who is most likely for SCI?
White male
Age of SCI?
1970 28
2005 38
What percent are tetra and para?
56%
43%
Complete SCI?
1970 52%
2008 44%
Life expectancy
Non SCI 78.6 Incomplete 72.6 Complete para 65.2 Low tetra 60 High tetra 55.7
Traumatic injury
Result from an external force acting on the body
Most common causes of injury
MVA 40.4%
Falls 27.9
Violence 15%
Sports 8%
Non traumatic
Disease or pathological influence causing SCI
39% of all SCI
Causes no trauma
Neoplasms Vascular dysfxn- SC stroke RA OA ALS MS infection
How many vessels supply spinal cord?
3- 2 posterior
1- anterior
Neurological level:
most caudal level of SC with normal motor and sensory control bilaterally
Motor level:
Most caudal segment of SC with normal motor function bilaterally
Test: MMT 6 pt scale
Sensory level
Most caudal segment SC with normal sensory function bilaterally
Test: light touch and pin prick
0 absent 1 impaired 2 normal
Complete injury:
NO sensory or motor function is preserved in lowest sacral segment S4S5
Incomplete Injury
Motor and/or sensory function preserved below neurological level including sensory and motor S4S5
Some motor and sensory spared at S4S5
Zones of partial preservation
Areas of intact motor and/or sensory function preserved below neurological level but no motor or sensory at S4S5
Dorsal column
UE Sensory Proprio, vibration, deep touch, posterior column Medial and lateral Lemniscus Ascending
Spinothalamic, spinoreticular,
Spinotectal
Pain, temp, crude touch
UE and LE the same
Ascending sensory
Spinocerebellar
Unconscious proprioception
Ascending sensory
Medial and lateral reticulospinal
Unconscious automatic posture adjustment, balance and automatic gait related movements
Descending motor
UE LE c spine and lumbar same
Medial and lateral vesibulospinal
Only through CSpine Descending motor Lateral stays ipsilateral Medial does both Position of head and neck, posture and balance
Lateral corticospinal
“Pyramidal Tract”
Descending motor
Voluntary movement
85% cross after medulla
Anterior corticopsinal
Voluntary movement (limb)
Descending motor
Axial muscles
Rubrospinal
Movement of limbs
Descending motor
All movements in neuroplasticity unconscious
Anterior cord injury lose what?
Motor function
Spinal cord syndrome
1/5 of all incomplete fall with in brown sequard
Anterior, posterior, central cord
Cauda equine
Brown Sequard
Spinal cord trisected Tracts: spinothalamic both sides Cortical spinal and medial Lemnos is lateral side Impair: pain temp course touch bil Fine touch proprio motor ipsilateral
Anterior cord
Tracts: spinothalamic and descending motor
Impair: pain, temp, and motor control
Happen anywhere along cord
MVA because forced flexion, fall over railing, compression, bladder incontinence
Posterior cord
Lose sensation can lose motor too depending on how far
Extremely rare because forced extension
Central cord
Hyper extension of c spine Over age 50 Only in c spine Tracts: ascending spinothalamic Lateral cortical spinal Impair: pain, temp, motor control Disrupts flow to anterior spinal cord Can return if just pinched off
Cauda Equina
Potential impact for all nerve roots below L2
Saddle
Impair: loss sensation, loss motor, bowl and bladder loss
Considered part of CNS
Severe disc rupture in L spine
Stenosis, tumor
ASIA
Scores are letter and number
Grade A: complete
Low enough to raise leg bil KfO use abs to move foot
B: incomplete sensory preserved
Not fxn walk, stand abs pull forward
C: incomplete motor preserved below grade 3
Not fxn walk, walk for exercise WC primary mobility
D: incomplete above grade 3
Fxn walk need bracing
E: normal
ASIA for nerve root
C5 elbow flexion C6 wrist extension C7 elbow extensors C8 ginger flexors CT1 finger abductors L2 hip flexors L3 knee extensors L4 ankle df L5 long toe extensors S1 ankle pf
Spinal shock
Period or areflexia following SCI
Autonomic regulation impaired
Revolves 1-3 days
Areflexia 24hrs
Autonomic dysreflexia
Lesions above T6 more common in Chronic and complete
Cause: irritation below level of injury bladder distension or blocked catheter, pressure ulcer, kidney Malfxn, labor, estim, pain
Symptoms: headache, sweat, increased spasticity, vasoconstrict below injury, blur vision, increase bp, constricted pupils
Interventions AD
Emergency! Monitor vitals Bring to upright posture Loosen any tight clothing Check source: bladder and bowels
Spastic hypertonia
65% individuals with SCI
More common incomplete
Up to 50% individuals report spasticity to problem for daily life
Interventions: stretch, Meds, Botox, surgical procedures
