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Neuromuscular Conditions II > Intro to SCI > Flashcards

Intro to SCI Flashcards

1
Q

Traumatics SCI

A
  • most common
  • high impact forces
  • Occur at path of least resistance (C5-6; T12-L1)
  • Cause hemorrhage, edema, necrosis of gray matter at/around site
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2
Q

Path of Least Resistance

A
  • C5-6
  • C4
  • T12-L1

(areas of mobility, instability)

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3
Q

Traumatic SCI causes:

A
  • hemorrhage
  • edema
  • necrosis of gray matter around/at site
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4
Q

Why are L-spine injuries more likely incomplete?

A

-cauda equina

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5
Q

Why are T-spine injuries more likely complete?

A

-ribs increase stability so very high forces cause SCI there

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6
Q

About ____% of patients with SCI also have_____

A
  • 50%

- TBI (mod to severe)

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7
Q

SCI can occur with other injuries like:

A
  • fractures of other bones
  • abdominal injuries
  • TBI
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8
Q

Flexion Injury

A
  • most common
  • tend to cause wedge fracture (ant vert body)
  • spine forced into flexion
  • anterior cord syndrome
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9
Q

Compression Injury

A
  • vertical forces
  • burst fracture (shatters)
  • tear drop fracture (piece breaks off)
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10
Q

Flexion with Rotation Injury

A
  • post to ant

- fracture of lamina, peduncle, facets (avulsion)

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11
Q

Hyperextension

A
  • due to falls
  • involve CS
  • fracture of post elements
  • avulsion of anterior elements
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12
Q

Non-traumatic SCI

A
  • Less common
  • Caused by SC pathology
  • Tumor, transverse myelitis, syringomyelia, vertebral subluation (RA), infection, vascular malformations (AVM)
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13
Q

Syrinx

A

Cyst in spinal cord

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14
Q

Complete SCI

A
  • motor and sensory function absent below injury (including lowest sacral levels–S4/5)
  • Compensation in rehab
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15
Q

Incomplete SCI

A

-some motor and sensory function preserved below level of injury (including lowest sacral levels–S4/5)

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16
Q

Zone of Partial Preservation

A
  • pts with complete SCI who have partial preservation/sparing of motor and/or sensory function below level of injury
  • (some little neuron getting through to make connection)
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17
Q

Damage to DC/ML

A

-ipsilateral loss of discrimminative touch, vibration, proprioception arms/legs

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18
Q

Damage to Lateral Corticospinal Tract

A

-Ipsilateral spastic paresis

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19
Q

Damage to Spinocerebellar tract

A

-Ipsilat loss of position and motion sense

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20
Q

Damage to Spinothalamic tract

A

-contralat loss pain/temp one segment below lesion

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21
Q

Somatotopic Arrangement of Corticospinal tract

A
  • -lateral fibers to S4/5 (LE)

- -medial fibers to higher up in spinal cord (UE)

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22
Q

Anterior Cord Syndrome

A

-Loss: motor function, pain, temp, crude touch below below injury level

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23
Q

Central Cord Syndrome

A
  • Hyperextension injuries
  • Weak UE
  • Ok LE
  • Sparing sacral motor/sensory function
24
Q

Brown-Sequard Syndrome

A
  • Hemisection of cord (stab/gunshot)
  • Ipsilateral Loss: proprioception, deep/discrim touch, vibration, motor
  • Contralateral Loss: pain, temp, crude touch

-Usually not perfect hemisection

25
Q

Posterior Cord

A
  • post spinal Aa strokes, tumors

- Loss: propioception, deep/discrim touch, vibration below injury

26
Q

Deadliest time for SCI pts

A
  • 1st 24 hours

- hypotension & neurogenic shock

27
Q

Primary Injury

A
  • due to insult–>local deformation of cord

- irreversable

28
Q

Secondary Injury

A
  • after initial trauma
  • ischemia, axonal degeneration, inflammation
  • may be reversable
29
Q

Diagnostic Imaging Used

A
  • CT (good at seeing whole spine and Bone)

- MRI–Soft tissue

30
Q

ASIA Index

A
  • Standardized test for SCI
  • Tests myotomes/dermatomes to find sensory and motor levels (may be different)
  • Rostral-caudal sequence
31
Q

Stabilization Devices

A
  • Internal/External

- stabilize spine

32
Q

Halo

A
  • C-spine
  • External
  • jacket with metal posts; ring screwed into cranium
  • Very stable; allow mobility (not neck)
  • 12 Week duration
33
Q

Cervical Traction

A
  • tongs/halo
  • in ER
  • when medical problems don’t allow for other devices
  • increased immobility/bedrest
34
Q

Cervical Surgery

A
  • enter ant/post/both
  • in halo after (or other)
  • increased body mobility after
35
Q

Minerva Orthosis

A

-body jacket with straps to head

36
Q

Cervical Collars

A

Less stabilization

37
Q

Thoracolumbar Orthosis

A
  • many types
  • stable/unstable fractures
  • limit certain motions/complete stability
38
Q

Harrington Rods

A
  • rods attached to lamina above and below injury level

- avoid torque forces

39
Q

Loque Rods

A

?

40
Q

Pre-Stabilization

A

C SPINE

  • no neck ROM
  • Shoulder flex/abd to 90*
  • ER may be limited

T/L SPINE

  • no hip flexion past 90*
  • SLR limited to 30*
41
Q

Long Sitting ROM Requirements

A
  • Full shdr extension and ER
  • Full elbow extension
  • Hamstrings to 110*
42
Q

Transfer ROM Requirements

A

-neutral DF with knee flexed

43
Q

ADL ROM Requirements

A
  • tight long finger flexors needed

- full (or more) hip ER for dressing

44
Q

Tenodesis Grasp

A
  • fingers flex passively with wrist extension

- don’t over stretch long finger flexors!

45
Q

Body Function/Structure Impairments with SCI

A
  1. Mm weakness
  2. Loss sensation
  3. Loss ROM
  4. Pain
  5. Respiratory/cardiovascular dysfunction
  6. Balance
  7. Endurance
  8. Alterations to Mm tone
46
Q

Activity Limitations with SCI

A
  • Directly related to impairments

- –bed mobility, transfers, gait, ADL/IADL, bowel/bladder, sexual functioning

47
Q

Pain

A
  • various types

- due to injury to cord/nerves/other (including overuse)

48
Q

_____% of pts have chronic pain

A

70%

49
Q

In the first month after injury pressure ulcers form in ______% of patients

A

30-50%

50
Q

Ectopic Ossification

A
  • (heterotopic bone)
  • Ossification of soft tissues below level of injury
  • larger joints involved
  • Initially: hot, red, swollen, decrease ROM
  • Cause? Excessive ROM?
  • Rx=meds, PT, surgery
51
Q

Other Complications of SCI

A
  • Ectopic Ossification
  • Postural Hypotension
  • Autonomic Dysreflexia
  • Anxiety/Depression
  • Respiratory Problems
  • DVT
  • Contractures
52
Q

Autonomic Dysreflexia

A

-pathology of ANS above T6

53
Q

Autonomic Dysreflexia: Trigger

A

noxious stimulus below level of injury

54
Q

Autonomic Dysreflexia: Reaction to Trigger

A
  • HTN, profuse sweating

- can cause stroke, blindness, death

55
Q

Autonomic Dysreflexia: Treatment

A
  • monitor BP
  • sit up (45*)
  • remove noxious stimulus
  • inform nurse/MD
56
Q

84% of patients with _____ injuries and 60% of ____ injuries have respiratory problems

A

–Upper CS

–Lower CS

57
Q

95% of patients with injuries above ____ require mechanical ventilation

A

C5

Neuromuscular Conditions II (15 decks)

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