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Physical Disabilities > FINAL: Spinal Cord Injury > Flashcards

FINAL: Spinal Cord Injury Flashcards

1
Q

Whats is the common cause of SCI?

A

Trauma and disease.

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2
Q

What Is Quadriplegia?

A

Degree of paralysis in all four limbs

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3
Q

Quadriplegia is also known as?

A

Tetraplegia

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4
Q

C1-C3 Motor control?

A

Neck

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5
Q

C4 Motor control

A

Shoulders

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6
Q

C5 Motor control

A

Biceps

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7
Q

C6 Motor control

A

Wrist

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8
Q

C7 Motor control

A

Triceps

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9
Q

C8-T1 Motor control

A

Fingers and hands

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10
Q

C3-T11 Motor control

A

Respiratory

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11
Q

L1-L3 Motor control

A

Hips

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12
Q

L2-S1 Motor control

A

Legs

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13
Q

L4-S1 Motor control

A

Feet and toes

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14
Q

C2-C3 Sensory

A

Neck and Scalp

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15
Q

C3-C4 Sensory

A

Shoulders

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16
Q

C5-C7 Sensory

A

Arms

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17
Q

C8-T1 Sensory

A

Fingers and Hands

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18
Q

T1-T12 Sensory

A

Abdomen

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19
Q

T12-L1 Sensory

A

Hips

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20
Q

L1-L2 Sensory

A

Groin and scrotum

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21
Q

L2-S3 Sensory

A

Legs and Feet

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22
Q

S3-Coccyx

A

Buttocks and Anus

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23
Q

C2-T6 Autonomic

A

Body temperature and Blood pressure

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24
Q

T10-L2 Autonomic

A

Psychogenic Sexual Response

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25
Q

S2-S5 Autonomic

A

Bowel and Bladder

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26
Q

S2-S4 Autonomic

A

Reflex Sexual response

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27
Q

ASIA Impairment Scale A = Complete

A

No Sensory or motor function below the level of injury

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28
Q

ASIA Impairment Scale B= Sensory Incomplete

A

Some sensory is preserved no Motor function

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29
Q

ASIA Impairment Scale C= Motor Incomplete

A

Motor function is preserved below the level of injury with muscles grade less than 3

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30
Q

ASIA Impairment Scale D= Motor Incomplete

A

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.

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31
Q

ASIA Impairment Scale E=Normal

A

Motor and sensory functions are normal in all segments.

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32
Q

After SCI a spinal shock occurs from a period of time?

A

24H to 6 wks.

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33
Q

What SCI spinal shock does?

A

Ceases reflex activity below the level of injury

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34
Q

In terms of bladder and bowel between T12 and L1?

A

T12 (UMN) will be spastic

L1 (LMN) will be flaccid

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35
Q

After the SCI what is happening to our reflexes, and sympathetic functions?

A

Deep tendon reflexes are decreased.
Low BP
Construction of blood vessels
Slower HR
No perspiration below the level of injury
Sympathetic functions become hyperactive.

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36
Q

What is Central Cord Syndrome?

A

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.

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37
Q

Brown-Square Syndrome?

A

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.

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38
Q

Anterior Spinal Cord Syndrome?

A

Damage to ant spinal artery or cord.

Paralysis and loss of pain, temp, touch sensation, proprioception is preserved

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39
Q

Cauda Equina (Peripheral)

A 
Involvement of peripheral nerves. 
Occurs with fx below L2
Flaccid like paralysis.
Better prognosis due to PN ability to regenerate 
Patterns vary
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40
Q

Conus Medullaris Syndrome

A

Injury of the sacral cord and lumbar nerve roots within neural canals.
Results in the areflexic bladder, bowel, and LE’s.

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41
Q

Medical Management of SCI include.

A

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)

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42
Q

What are the early medical goals?

A

Restore normal alignment, maintain stabilization, decompress structures under pressure.

43
Q

What is rotating kinetic bed used for?

A

Provide bony realignment and stabilization

Allow skeletal traction and immobilization

44
Q

What does rotating kinetic bed due?

A

Bed rotates providing pressure relief, mobilization of respiratory secretions, access for bowl/bladder mgt.

45
Q

What can be used for external stability for SCI ?

A

Cervical collar
Halo Vest
Thoracic brace or body jacket.

46
Q

What external stability will allow for?

A

transportation to standard hospital bed and wheelchair.
Active therapy
Work on upright sitting posture

47
Q

What are complications after SCI?

A 
Skin breakdown, pressure sores, decubitus ulcers 
Decreased vital capacity 
osteoporosis 
Orthostatic hypotension 
Autonomic Dysreflexia 
Spasticity 
Heterotopic ossification 
Sexual Function
48
Q

Skin Breakdown after SCI?

A

Can occur within 30 minutes due to sensory loss.
Pressure can cause loss of circulation and leading to necrosis.
Common over body prominences.

49
Q

What are signs and symptoms of skin breakdown?

A

Redness, blanching when pressed
Redness does not blanch when pressed (necrosis has begun)
Ulceration appears
Often more severe under the skin

50
Q

What are the prevention for skin breakdown?

A

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.

51
Q

What factors include decreased vital capacity?

A

Cervical and high thoracic injuries due to decreased chest expansion and limited ability to cough.
Respiratory tract infections
Decreased endurance for activity

52
Q

What treatment helps with vital capacity?

A

Respiratory and physical therapy
Assisted breathing, assisted coughing
Strengthening diaphragm and sternocleidomastoids
Deep breathing exercises.

53
Q

What causes osteoporosis in SCI?

A

Disuse of long bones (LE’s)

Patholofic fx can occur a year after injury (LE)

54
Q

What are the treatments for osteoporosis in SCI?

A

Daily standing in the standing frame can help slow rate however is a controversial method often not reimbursed.

55
Q

Orthostatic hypotension is caused by?

A

Lack of muscle tone in the abdomen and LE leads to pooling of blood.

56
Q

What are the symptoms of OH?

A

Dizziness
Nausea
LOC

57
Q

Autonomic Dysreflexia is caused by?

A

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.

58
Q

What are the symptoms of Autonomic Dysreflexia?

A 
Pounding headache 
Anxiety 
Perspiration 
Flushing
Chills
Nasal Congestion 
Paroxysmal hypertension and bradycardia
59
Q

What position does patient need to be placed during AD?

A

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

60
Q

Spasticity in SCI?

A

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.

61
Q

Ture or False. OT should watch for the sudden increase in spasticity can indicate a medical problem

A

Ture

62
Q

What are treatments associated with spasticity in SCI?

A

Injections, medication, blocks, botox, neurosurgical procedures.

63
Q

Heterotopic Ossification in SCI?

A

Bone development in abnormal anatomic locations
In mm around hips, knees, shoulder, and elbow.
Can contribute to skin breakdown.

64
Q

What are the symptoms of HO?

A

Swelling, warmth, decreased ROM usually 1-4 mo after injury.

65
Q

What is the treatment for HO in SCI?

A

Education, maintaining joint ROM (for wc positioning)

66
Q

Sexual function and SCI in Men?

A

Issues with erections, ejaculations, motility of sperm-advancements in infertility treatments

67
Q

Sexual functions and SCI Women?

A

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.

68
Q

Sexual function what can we educate about?

A

Awareness and acceptance
Provide information
Access to education and counseling

69
Q

Sexual function what issues are present with SCI?

A

Mobility, functional dependency, altered body image, medical issues, lack of sensation, access, interest, satisfaction, social and sexual roles.

70
Q

What are OT goals for SCI rehab?

A

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

71
Q

OT Evaluation start from?

A

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.

72
Q

OT Evaluation of Physical Status

A

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.

73
Q

OT evaluation of the functional status include/

A

Observation fo ADL’s (determine present/potential level of function)
Interaction with family
caregiver training.

74
Q

C4 Key muscles innervated by this level

A

Diaphragm and shoulder elevators

75
Q

C5 Key muscles innervated by this level

A

Shoulder flexors, abductors and elbow flexors

76
Q

C6 Key muscles innervated by this level

A

Wrist extensors

77
Q

C7 Key muscles innervated by this level

A

Elbow extensors

78
Q

C8 Key muscles innervated by this level

A

Finger flexors, extensors and intrinsics

79
Q

T1-T6 Key muscles innervated by this level

A

Upper trunk muscles

80
Q

T7-T12 Key muscles innervated by this level

A

Lower trunk muscles

81
Q

L1-L2 Key muscles innervated by this level

A

Hip flexors

82
Q

L3 Key muscles innervated by this level

A

Knee extensors

83
Q

L4 Key muscles innervated by this level

A

Ankle dorsiflexors

84
Q

L5 Key muscles innervated by this level

A

Toe Extensors

85
Q

S1-S5 Key muscles innervated by this level

A

Ankle plantarflexors, bowel and bladder

86
Q

What outcomes measure can be used for SCI?

A 
FIM 
Barthel 
Spinal Cord Independence Measure 
Walking Index for SCI
Quadriplegic Index of function
87
Q

What OT intervention in the Acure Phase should consist of?

A

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

88
Q

Orthosis Fabrications for SCI

A

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.

89
Q

OT intervention Active Phase

A

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

90
Q

True or False. Weight shifting should be performed every 30-60 min until skin tolerance is determined

A

True

91
Q

ADL’s for the Active Phase include?

A 
Independent feeding with AE
Oral and face hygiene 
UB B
UB D
Transfer using a sliding board 
Bowel and bladder care
92
Q

Adaptive Equipment?

A

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

93
Q

After Acute Rehab what can be done?

A 
Adaptive driving 
Home mgt 
Leisure activities 
Work skill assessments 
Vocational training
94
Q

Symptoms of spinal shock include?

A

Reflexes are decreased

95
Q

The purpose of providing external stability after SCI is to?

A

Allows the pt to participate in therapy
Allow the pt to sit upright
Allows the pt to transfer

96
Q

Hetrotrophic Ossification is a medical emergency?

A

False

97
Q

Skin breakdown can occur in as little as

A

30 min

98
Q

Pathologic fractures after SCI can occur due to?

A

Osteoporosis

99
Q

Autonomic Dysreflexia occurs in pts with SCI at what level?

A

T6 and above

100
Q

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?

A

Feeding

101
Q

At what cervical level can a spinal cord patient use tenodesis?

A

C6

102
Q

What position should you place a SC pt to avoid painful shoulders?

A

Shoulder abd 90, ER with scap depression, elbow ext

103
Q

You are evaluated a patients wrist ext and reported it was 3+. What type of wrist splint should you fabricate?

A

Short opponens

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