FINAL: Spinal Cord Injury Flashcards
Whats is the common cause of SCI?
Trauma and disease.
What Is Quadriplegia?
Degree of paralysis in all four limbs
Quadriplegia is also known as?
Tetraplegia
C1-C3 Motor control?
Neck
C4 Motor control
Shoulders
C5 Motor control
Biceps
C6 Motor control
Wrist
C7 Motor control
Triceps
C8-T1 Motor control
Fingers and hands
C3-T11 Motor control
Respiratory
L1-L3 Motor control
Hips
L2-S1 Motor control
Legs
L4-S1 Motor control
Feet and toes
C2-C3 Sensory
Neck and Scalp
C3-C4 Sensory
Shoulders
C5-C7 Sensory
Arms
C8-T1 Sensory
Fingers and Hands
T1-T12 Sensory
Abdomen
T12-L1 Sensory
Hips
L1-L2 Sensory
Groin and scrotum
L2-S3 Sensory
Legs and Feet
S3-Coccyx
Buttocks and Anus
C2-T6 Autonomic
Body temperature and Blood pressure
T10-L2 Autonomic
Psychogenic Sexual Response
S2-S5 Autonomic
Bowel and Bladder
S2-S4 Autonomic
Reflex Sexual response
ASIA Impairment Scale A = Complete
No Sensory or motor function below the level of injury
ASIA Impairment Scale B= Sensory Incomplete
Some sensory is preserved no Motor function
ASIA Impairment Scale C= Motor Incomplete
Motor function is preserved below the level of injury with muscles grade less than 3
ASIA Impairment Scale D= Motor Incomplete
Motor function is preserved below the level of injury and at least half of the key muscles functions below the level of injury have a muscle grade of 3 or more.
ASIA Impairment Scale E=Normal
Motor and sensory functions are normal in all segments.
After SCI a spinal shock occurs from a period of time?
24H to 6 wks.
What SCI spinal shock does?
Ceases reflex activity below the level of injury
In terms of bladder and bowel between T12 and L1?
T12 (UMN) will be spastic
L1 (LMN) will be flaccid
After the SCI what is happening to our reflexes, and sympathetic functions?
Deep tendon reflexes are decreased.
Low BP
Construction of blood vessels
Slower HR
No perspiration below the level of injury
Sympathetic functions become hyperactive.
What is Central Cord Syndrome?
More damage to the center or the cord than the periphery.
Paralysis and sensory loss greater in UE’s
Seen in older people due to arthritic changes narrowing the spinal canal.
Cervical hyperextension without vertebral fx may precipitate central cord damage.
Brown-Square Syndrome?
Ons side of the cord damage typically due to GSW or stabbing.
Motor paralysis and loss of proprioception on ipsilateral side.
Loss of pain, temp, touch sensation on the contralateral side.
Anterior Spinal Cord Syndrome?
Damage to ant spinal artery or cord.
Paralysis and loss of pain, temp, touch sensation, proprioception is preserved
Cauda Equina (Peripheral)
Involvement of peripheral nerves. Occurs with fx below L2 Flaccid like paralysis. Better prognosis due to PN ability to regenerate Patterns vary
Conus Medullaris Syndrome
Injury of the sacral cord and lumbar nerve roots within neural canals.
Results in the areflexic bladder, bowel, and LE’s.
Medical Management of SCI include.
Axial traction of the neck and movement of the spine prevented during transportation to the hospital.
Initial care is focused on preventing further damage and reversing neurologic damage (decompression and stabilization)
Anti-inflammatory drugs/steroids used to minimize swelling.
Catheter placement
Imaging (x-ray, CT scan, MRI)
What are the early medical goals?
Restore normal alignment, maintain stabilization, decompress structures under pressure.
What is rotating kinetic bed used for?
Provide bony realignment and stabilization
Allow skeletal traction and immobilization
What does rotating kinetic bed due?
Bed rotates providing pressure relief, mobilization of respiratory secretions, access for bowl/bladder mgt.
What can be used for external stability for SCI ?
Cervical collar
Halo Vest
Thoracic brace or body jacket.
What external stability will allow for?
transportation to standard hospital bed and wheelchair.
Active therapy
Work on upright sitting posture
What are complications after SCI?
Skin breakdown, pressure sores, decubitus ulcers Decreased vital capacity osteoporosis Orthostatic hypotension Autonomic Dysreflexia Spasticity Heterotopic ossification Sexual Function
Skin Breakdown after SCI?
Can occur within 30 minutes due to sensory loss.
Pressure can cause loss of circulation and leading to necrosis.
Common over body prominences.
What are signs and symptoms of skin breakdown?
Redness, blanching when pressed
Redness does not blanch when pressed (necrosis has begun)
Ulceration appears
Often more severe under the skin
What are the prevention for skin breakdown?
Eliminate pressure areas, shearing, moisture, heat
Turning pt, weight shifting, skin checks, skincare
Special mattresses, cushions, padding over boney prominences
The orthosis can cause skin breakdown
Make sure to have wearing schedule and skincare/check protocol in place.
What factors include decreased vital capacity?
Cervical and high thoracic injuries due to decreased chest expansion and limited ability to cough.
Respiratory tract infections
Decreased endurance for activity
What treatment helps with vital capacity?
Respiratory and physical therapy
Assisted breathing, assisted coughing
Strengthening diaphragm and sternocleidomastoids
Deep breathing exercises.
What causes osteoporosis in SCI?
Disuse of long bones (LE’s)
Patholofic fx can occur a year after injury (LE)
What are the treatments for osteoporosis in SCI?
Daily standing in the standing frame can help slow rate however is a controversial method often not reimbursed.
Orthostatic hypotension is caused by?
Lack of muscle tone in the abdomen and LE leads to pooling of blood.
What are the symptoms of OH?
Dizziness
Nausea
LOC
Autonomic Dysreflexia is caused by?
Injuries above T4/T6
Caused by the reflex action of the autonomic nervous system due to stimuli such as the distended bladder, fecal mass, bladder irritation, rectal manipulation, thermal or pain stimulation or viseral distention.
What are the symptoms of Autonomic Dysreflexia?
Pounding headache Anxiety Perspiration Flushing Chills Nasal Congestion Paroxysmal hypertension and bradycardia
What position does patient need to be placed during AD?
The upright position and remove anything restrictive (abdominal binders, stockings) to reduce BP.
The bladder should be drained or leg bad tubing checked for obstruction.
BP monitored
Spasticity in SCI?
Occurs below the level of injury.
Gradually increases over the first 6 months of SCI and plateauing around 1 year.
MOderate amt of spasticity can be helpful in maintaining mm mass, prevention of ulcers, assist in ROM, and bed mobility.
Ture or False. OT should watch for the sudden increase in spasticity can indicate a medical problem
Ture
What are treatments associated with spasticity in SCI?
Injections, medication, blocks, botox, neurosurgical procedures.
Heterotopic Ossification in SCI?
Bone development in abnormal anatomic locations
In mm around hips, knees, shoulder, and elbow.
Can contribute to skin breakdown.
What are the symptoms of HO?
Swelling, warmth, decreased ROM usually 1-4 mo after injury.
What is the treatment for HO in SCI?
Education, maintaining joint ROM (for wc positioning)
Sexual function and SCI in Men?
Issues with erections, ejaculations, motility of sperm-advancements in infertility treatments
Sexual functions and SCI Women?
Menstruation may cease for weeks to months but comes back to normal
No change in female fertility
Females with SCI can conceive babies and give birth, at risk of complications.
Sexual function what can we educate about?
Awareness and acceptance
Provide information
Access to education and counseling
Sexual function what issues are present with SCI?
Mobility, functional dependency, altered body image, medical issues, lack of sensation, access, interest, satisfaction, social and sexual roles.
What are OT goals for SCI rehab?
Maximize independence in ADLs/IADLs
Functional mobility, health maintenance, and vocational adjustments
Education of patients, family, and caregiver
Adaptive techniques and equipment
Psychosocial adjustment
ROM, strength endurance programs
Preventing secondary complications
Weight shifting, positioning, transferring
Home/environment modification
OT Evaluation start from?
Gather information from the medical chart (dx, personal hx, pertinent medical info)
Occupational profile
Observe the patients psychosocial adjustment
Establish rapport and mutual trust
The patient’s family support, socioeconomic background, education, financial resources, problem-solving abilities, motivations, and determinations can either help or hinder the therapeutic process.
OT Evaluation of Physical Status
Obtain medical precautions (skeletal instability, related injuries and medical complications)
PROM (pain free) look for joint contracture, shoulder pain common in C4-C7 quadriplegia
Strength
Sensation LT, pinprick, anesthesia
Muscle tone (not present if acute) in later stage evaluate spasticity
Gross grasp, pinch
Assessment may be required for oral motor control, head/trunk control, endurance, LE muscle strength, total body functions
SCI and TBI - cognitive and perceptual evaluation.
OT evaluation of the functional status include/
Observation fo ADL’s (determine present/potential level of function)
Interaction with family
caregiver training.
C4 Key muscles innervated by this level
Diaphragm and shoulder elevators
C5 Key muscles innervated by this level
Shoulder flexors, abductors and elbow flexors
C6 Key muscles innervated by this level
Wrist extensors
C7 Key muscles innervated by this level
Elbow extensors
C8 Key muscles innervated by this level
Finger flexors, extensors and intrinsics
T1-T6 Key muscles innervated by this level
Upper trunk muscles
T7-T12 Key muscles innervated by this level
Lower trunk muscles
L1-L2 Key muscles innervated by this level
Hip flexors
L3 Key muscles innervated by this level
Knee extensors
L4 Key muscles innervated by this level
Ankle dorsiflexors
L5 Key muscles innervated by this level
Toe Extensors
S1-S5 Key muscles innervated by this level
Ankle plantarflexors, bowel and bladder
What outcomes measure can be used for SCI?
FIM Barthel Spinal Cord Independence Measure Walking Index for SCI Quadriplegic Index of function
What OT intervention in the Acure Phase should consist of?
Immobilization phase - Pt is either in traction, halo, body jacket or stabilization device.
Flexion, extension and rotary motions of the spine and neck are contraindicated
Eval of position, splinting; Shoulder 80 degrees of and, ER with cap depression and elbow ext intermittently to avoid painful shoulders
Active and AAROM of all joints within tolerance
Muscle re-education techniques for wrist and elbows
Strengthening of wrist
Self-care activities (feeding, hygiene, keyboard, writing, use of universal cuff).
Discuss home dc planning, AE, ECU, Laptops
Orthosis Fabrications for SCI
Correct splinting can enhance the patient’s functional abilities.
Splints shoulder be dorsal and volar
IF ECRL/ECRB is below 3+ and can’t support the hand splint should be fabricated to support the wrist in ext and thumb in opposition (maintain webspace)
If wrist extensions are 3+ or higher fabricate short opponents to avoid a webspace contracture and support the thumb.
OT intervention Active Phase
Mobilization Phase - begins to develop upright tolerance
Wheelchair fitting
Reliving sitting pressure common on the ischial, trochanteric, and sacral bony prominences
If a patient has 3+ shoulder/elbow strength b/l = pressure can be relived on the buttocks by leaning the client forward over feet. cotton webbing loops are secured to the back frame of the wheelchair
Patient with C7 or lower can weight shift by pushing up on the arms of the w/c
Some C6 quads can lock elbows out while ER shoulder to support the weight
Continue with P/AROM and splinting
Avoid elbow contracture
Elbow extension needed for sitting balance
Progressive resistive exercises (shoulder musculature, triceps, pec, latissuimus dorsi needed for transfer and weight shifts, wrist extensions).
A wrist ext will be used for tenodesis grasp.
Tightness is desired to tighten tenodesis grasp. ( finger flex/wrist ext. fingers extend/wrist flex
True or False. Weight shifting should be performed every 30-60 min until skin tolerance is determined
True
ADL’s for the Active Phase include?
Independent feeding with AE Oral and face hygiene UB B UB D Transfer using a sliding board Bowel and bladder care
Adaptive Equipment?
Universal cuff for eating, toothbrush, pens, typing stick.
Add wrist cockup splint for pt with no wrist ext.
Feeding - plate guard, cup holder, extended straw with straw clip, nonskid table mat
Bathing - Wash mitt, soap-on-a-rope
Slide board
Use of mobile arm support
Overhead slings
After Acute Rehab what can be done?
Adaptive driving Home mgt Leisure activities Work skill assessments Vocational training
Symptoms of spinal shock include?
Reflexes are decreased
The purpose of providing external stability after SCI is to?
Allows the pt to participate in therapy
Allow the pt to sit upright
Allows the pt to transfer
Hetrotrophic Ossification is a medical emergency?
False
Skin breakdown can occur in as little as
30 min
Pathologic fractures after SCI can occur due to?
Osteoporosis
Autonomic Dysreflexia occurs in pts with SCI at what level?
T6 and above
An OTR has just began working with a C7 SCI pt and would like to finish up her eval with participating in a basic ADL task. A good selection for her to select would be?
Feeding
At what cervical level can a spinal cord patient use tenodesis?
C6
What position should you place a SC pt to avoid painful shoulders?
Shoulder abd 90, ER with scap depression, elbow ext
You are evaluated a patients wrist ext and reported it was 3+. What type of wrist splint should you fabricate?
Short opponens
