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PT9122 - Rehab > Lecture 11/12 - SCI > Flashcards

Lecture 11/12 - SCI Flashcards

1
Q

Where is the conus medullaris

A

L1

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2
Q

Describe the corticospinal tract

A

Provides voluntary motor function

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3
Q

Describe the dorsal column medial lemniscus tract

A

Fine touch, 2-point discrimination, proprioception, and vibration

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4
Q

Describe the spinothalamic tracts

A

Pain, temperature, noxious stimuli, crude touch

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5
Q

What is an SCI, mechanisms of injury, level of involvement, and level of severity

A
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5
Q

Compare parasympathetic and sympathetic locations in the ANS

A

Parasympathetic: Cervical and sacral
Sympathetic: Thoracic and lumbar

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6
Q

Describe the SCI pathophysiology for a primary injury

A
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7
Q

Describe SCI pathophysiology for a secondary injury cascade (describe the 3 phases)

A
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8
Q

Describe spinal shock and if it ever resolves

A
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9
Q

Describe transverse cord syndrome and areas it impacts

A
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10
Q

Describe central cord syndrome and areas it impacts

A
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11
Q

Describe brown-sequard syndrome and areas it impacts

A
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12
Q

Describe anterior cord syndrome and areas it impacts

A
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13
Q

Describe posterior cord syndrome and areas it impacts

A
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14
Q

Compare conus medullaris and cauda equina syndrome

A
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15
Q

Why is the average age of SCI’s increasing and who does it impact more men or women

A

Why: Life expectancies are higher, older people fall more and that’s the main cause of SCI’s -> less incidence in MVA’s due to safety measures put in place

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16
Q

Social impacts of SCI

A
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17
Q

Secondary complications following an SCI

A
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18
Q

What are some psychosocial and respiratory complications following SCI

A
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19
Q

Describe orthostatic hypotension, its signs/symptoms, and risk factors

A
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20
Q

Describe autonomic dysreflexia

A
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21
Q

Describe pallor and flushing in different skin tones

A
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22
Q

How do we manage autonomic dysreflexia

A
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23
Q

Describe why an SCI causes impaired temperature control

A
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24
Q

What are two main types of pain after SCI

A
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25
Q

Describe spasticity for SCI

A
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26
Q

Describe skin integrity and bone health for SCI

A
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27
Q

Describe neurogenic bladder and bowel complications for an SCI

A
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28
Q

Describe sexual dysfunction and function for an SCI

A
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29
Q

What is the INSCI Assessment

A
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30
Q

What does the INSCI look like?

A
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31
Q

How to determine level of SCI involvement (sensory and motor) and what are the different levels of severity

A
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32
Q

How to perform the sensory exam on the INSCI

A
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33
Q

How to perform the motor exam on the INSCI

A
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34
Q

What are the non-key muscles used in INSCI and what is the root levels respective myotomes

A
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35
Q

How to perform deep anal pressure and voluntary anal contraction

A
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36
Q

Describe the neurological level of injury

A
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37
Q

Describe the AIS scale

A
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38
Q

What is the zone of partial preservation (ZPP)

A
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39
Q

What are some key points about doing the INSCI

A
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40
Q

What is the motor level, sensory level, NLI, and AIS grade

A
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41
Q

What is the motor level, sensory level, NLI, and AIS grade

A
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42
Q

What is the motor level, sensory level, NLI, and AIS grade

A
43
Q

What are some outcome measures to use for SCI

A
44
Q

Describe the spinal cord independence measure (SCIM)

A
45
Q

Describe the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP)

A
46
Q

Describe the SCI Functional Ambulation Profile (SCI-FAP)

A
47
Q

Describe the Standing and Walking Assessment Tool (SWAT)

A
48
Q

Describe the Wheelchair Skills Test (WST)

A
49
Q

Describe the mortality following SCI

A
50
Q

Describe recovery following SCI

A
51
Q

Describe prognosis following complete injuries

A
52
Q

Describe prognosis following incomplete injuries

A
53
Q

Describe ambulation prognosis following an SCI

A
54
Q

Describe prognosis of anterior cord syndrome, central cord syndrome, and brown-sequard syndrome

A
55
Q

Describe how we predict functional abilities following an SCI

A
56
Q

Describe what muscles, movements, capabilities are affected and equipment needed for C1-C4 injury

A
57
Q

Describe what muscles, movements, capabilities are affected and equipment needed for C5 injury

A
58
Q

Describe what muscles, movements, capabilities are affected and equipment needed for C6 injury

A
59
Q

Describe what muscles, movements, capabilities are affected and equipment needed for C7 injury

A
60
Q

Describe what muscles, movements, capabilities are affected and equipment needed for C8 injury

A
61
Q

Describe what muscles, movements, capabilities are affected and equipment needed for T1-T12 injury

A
62
Q

Describe what muscles, movements, capabilities are affected and equipment needed for L1-L3 injury

A
63
Q

Describe what muscles, movements, capabilities are affected and equipment needed for L4-S1 injury

A
64
Q

What is the fall rate for SCI, its causes and consequences

A
65
Q

Describe the neural control of gait (name and describe all the components)

A
66
Q

What are central pattern generators

A
67
Q

Describe the neural mechanisms of reactive balance

A
68
Q

How do neural changes impact motor function

A
69
Q

How does neuroplasticity change following SCI

A
70
Q

Describe the Hebbian Theory (Functional Plasticity)

A
71
Q

Describe structural plasticity in the CNS

A
72
Q

Describe axonal regeneration and sprouting

A
73
Q

How does rehab facilitate neuroplasticity

A
74
Q

What are 2 treatment principles used in rehab for SCI

A
75
Q

What are acute care priorities for SCI

A
76
Q

What are early rehab/low function priorities for SCI

A
77
Q

What are late rehab/high function priorities for SCI

A
78
Q

Describe Activity-Based Therapy (ABT)

A
79
Q

How do we treat sensory cues/afferent proprioceptive inputs for SCI (ABT)

A
80
Q

How do we treat central excitability (neuromodulation) for SCI (ABT)

A
81
Q

Describe functional electrical stimulation (FES) for SCI treatment (ABT)

A
82
Q

Describe combining approaches (ABT)

A
83
Q

Describe effectiveness of ABT

A
84
Q

Describe locomotor training and name some types

A
85
Q

What are the 4 locomotor training principles

A
86
Q

Describe maximize WB (locomotor principle)

A
87
Q

Describe optimizing sensory cues (LT principles

A
88
Q

Describe optimizing kinetics (LT principles)

A
89
Q

Describe minimizing compensation (LT principles)

A
90
Q

Describe the effectiveness of locomotor training

A
91
Q

Describe balance training for SCI

A
92
Q

Describe interval vs external perturbations

A
93
Q

Describe reactive balance training and are physio’s assessing it?

A
94
Q

Describe 3 reactive balance strategies for LE

A
95
Q

Describe the impact of reactive balance training

A
96
Q

Describe acute intermittent hypoxia as a treatment for SCI (emerging technique)

A
97
Q

Describe vagus nerve stimulation for SCI (emerging technique)

A
98
Q

What are the physical activity guidelines for SCI

A
99
Q

Describe aerobic physical activity for SCI

A
100
Q

Describe strength training for SCI

A
101
Q

Describe flexibility training for SCI

A
102
Q
A
  1. Assisted low pivot transfer (2 ppl to 1 ppl transfer). Get him towards sliding board transfer. Build independence by being able to verbalize to care provider what he needs done for ADL’s.
    1. Impacts intercostal and accessory muscle use for breathing. May not be able to use abdominal muscles to effectively cough and increase work of breathing. Perform ACBT. We could use an AB Binder
    2. INSCI, 4+1 assessment, IPPA, general strength and mobility
  2. Grasping and propelling with a wheel chair, wrist extension exercises, apply hooks to wheel chair to help with propelling
103
Q
A
  1. Yes, she would be at risk for autonomic dysreflexia. She may still be in spinal shock but it is not resolved yet, so she would be at risk after that. Also above T6 = higher risk. Educate about noxious stimuli and to remove it to resolve symptoms. Signs and symptoms to expect so will be more sympathetic on top and parasympathetic below
    1. Neuropathic. I would have her do nerve flossing. Electrical stimulation, gabapentin
    2. INSCI, ROM, SCIM, 4+1 assessment,
  2. Perturbations for trunk control (anticipated vs unexpected), gripping ball, reaching and grasping. High reps and task specific -> reaching and grasping for silk above head or out in front
104
Q
A
  1. Use screening questionnaire (PHQ-9 -> mental health), referring to member of multidisciplinary team
    1. Send him cardiovascular guidelines (2 x a week for 20 minutes for strength and 3 x a week for 30 mins for aerobic exercise
    2. 6/2-minute walk test, mini BEST test, SCIM
  2. 3x a week with an RPE at moderate 6/10 , cycling to help with ankle ROM. FITT based on guidelines above and also perceived exhaustion during assessment. Strength: lat pull downs for upper and lower would be a weighted sit-to-stand. Focus more on sustained stretches (Hamstrings, gastrocs, soleus, hip flexors, abductors, adductors, pecs,
105
Q
A
  1. Female, age -> risk of osteoporosis. May have reduce bone density below lesion. Most likely to fracture distal femur and proximal femur usually below lesion area, may also wrist and foot.
    1. Decreased speed, stride length. Hard time to recruit muscle during gait. Start with therapeutic ambulation to start and then work to community ambulation (discuss what community ambulation looks like for her).
    2. INSCI, functional ambulation profile, evaluate UE strength, ROM, ADL’s, SCIM -> go on resources to find for spastic issues or don’t up to you
  2. Work on maintaining cardiovascular health, bodyweight support treadmill, FES, bike -> repetitive, sensory cues, environmentally specific, and what ever the 4th principle is

PT9122 - Rehab (16 decks)

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