Final - Introduction and Classification Flashcards
How many vertebrae are there in each section
7 - cervical
12 - thoracic
5 - lumbar
5 - sacral
where the cervical nerves exit
C1-7 above the corresponding vertebrae
C8 below C7 vertebrae
T1 and below exit below
vascular supply of the SC
2 posterior spinal arteries
1 anterior spinal artery
most susceptible to injury/most common
cervical - poor mechanical stability (C5-6) - flexion injury - head on collision - diving in shallow water - surfing accident
most common COMPLETE SCI
thoracic T12-L1 (where the rib cage ends, most vulnerable) - gunshot wounds - MVA - falls *vessel of Adamkiewicz
most common INCOMPLETE SCI
lumbar abdominal muscles provide support - gunshot wounds - MVA - falls - direct impact from heavy objects
paraplegia
impairment in the thoracic, lumbar, and sacral segments
tetraplegia (quad)
impairment in the cervical segments
neurological level of injury
the most caudal (lowest) level of the spinal cord that has INTACT sensory and motor function bilaterally
“intact”
the key muscle has 3/5 or greater strength and the key muscle above has 5/5
complete
both sensory and motor function are absent in the lowest sacral segments (S4-5)
incomplete
both sensory and motor function is preserved in the lowest sacral segments (S4-5)
zone of partial preservation
only with complete injuries
partial function of sensory and/or motor in segments below neurological level
rehospitalizations
30% in 12 months
- pressure sores
- pneumonia
- infections: UTI, bladder
gender/age/race SCI
older and younger extremes
men - risk taking behaviors
non hispanic black
highest causes of SCI
- car accidents
- falls
other: violence, sports, medical
OT goals
- independence
- accept new lifestyle
- reintegrate into society
central cord syndrome
most common, incomplete, caused by falls; greater weakness in the upper limbs than LE, mostly older people, common with spinal stenosis
Brown-Sequard syndrome
incomplete, damage to half SC causing ipsilateral proprioceptive and motor loss and contralateral loss of pain/temp
anterior cord syndrome
rare, absent blood supply to the cord, loss of motor control, pain, temp below injury (light touch and prop are intact)
cauda equina syndrome
- just nerve roots
LMN injury to lumbosacral nerve roots, areflexic bladder/bowel and paralysis/weakness of lower limbs
conus medullaris syndrome
- tip of the cord plus nerve roots
similar to above but cord is also damaged, some preservation of reflex activity, bladder/bowel/LE impacted
LMN disorder
- disruption of the common motor pathway (what is on its way OUT)
- paralysis, flaccidity, loss of reflexes, muscle atrophy, areflexic atrophy
UMN disorder
- disruption of the descending pathways (IN the cord)
- paralysis, hypertonicity, spasticity, hyperreflexia, reflexive bowel/bladder
autonomic dysreflexia
sudden dangerous increase in BP, levels T6 and above, causes include distended bladder, UTI, bladder or kidney stones, ulcers, etc (symptoms are HTN, headache)
orthostatic hypotension
sudden drop in BP when a person sits upright, T6 and above, caused by impaired autonomic regulation, blood pools in LE when in bed all day
heterotrophic ossification
pathological bone formation in joints, connective tissue calcifies around the joint, usually 1-4 months after injury; symptoms are warm, wollen extremity, fever, ROM limits
recovery within the zone of injury
muscles that are completely paretic have a fair possibility of regaining some motor power (but nonfunctional)
muscles that had even a small contraction have a very good possibility of attaining functional motor power
zone of injury
considered the first 3 abnormal dermatomes or myotomes
What levels of SCI affect respiration?
Lesions above C4 (damage to phrenic nerve results in partial or complete paralysis of diaphragm)
Lower cervical and thoracic can paralyze other breathing muscles
How often should someone turn in bed to avoid pressure sores?
every 2 hours
At what levels are the bowel and bladder controlled?
S2-S5 (so lesions above will lose this function)
What are the 7 key factors in shaping the optimal rehabilitation experience based on Hammell (2007)
The importance of specific staff qualities, the need for a vision of future life possibilities, the importance of peers, the relevance of program content, the institutional context of rehab, importance of reconnecting past to the future, importance of meeting the needs of the real world
What are the main focus areas for OT during acute care recovery?
Focus on support and prevention
Foster autonomy in making decisions
Facilitate solving problems
Engage the person in activities that are personally relevant and meaningful
Provide some environmental controls for the patient
Maintain normal UE joint ROM and preventing edema and deformities, positioning, splinting
What are the main focus areas for OT during rehabilitation?
Educating patients and family Self efficacy and self management skills Choosing appropriate equipment Transitions, home and community roles Adaptation to focus on facilitation/improved quality of life
Describe one assistive device or compensatory method that an individual would use with SCI. At what levels of injury would this device/method likely be appropriate (ie, tetraplegia, paraplegia, etc)?
Mobile arm support (ball-bearing feeder) - C5 tetraplegia
Mechanical device attached to a wheelchair, shoulder and elbow support carries the weight of the arm so that the pt can drive the wheelchair, feed, groom, do tabletop activities
Wrist must be stabilized with splint/orthosis; universal cuff on the palm
