Lecture 11/12 - SCI Flashcards
Where is the conus medullaris
L1
Describe the corticospinal tract
Provides voluntary motor function
Describe the dorsal column medial lemniscus tract
Fine touch, 2-point discrimination, proprioception, and vibration
Describe the spinothalamic tracts
Pain, temperature, noxious stimuli, crude touch
What is an SCI, mechanisms of injury, level of involvement, and level of severity
Compare parasympathetic and sympathetic locations in the ANS
Parasympathetic: Cervical and sacral
Sympathetic: Thoracic and lumbar
Describe the SCI pathophysiology for a primary injury
Describe SCI pathophysiology for a secondary injury cascade (describe the 3 phases)
Describe spinal shock and if it ever resolves
Describe transverse cord syndrome and areas it impacts
Describe central cord syndrome and areas it impacts
Describe brown-sequard syndrome and areas it impacts
Describe anterior cord syndrome and areas it impacts
Describe posterior cord syndrome and areas it impacts
Compare conus medullaris and cauda equina syndrome
Why is the average age of SCI’s increasing and who does it impact more men or women
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
Social impacts of SCI
Secondary complications following an SCI
What are some psychosocial and respiratory complications following SCI
Describe orthostatic hypotension, its signs/symptoms, and risk factors
Describe autonomic dysreflexia
Describe pallor and flushing in different skin tones
How do we manage autonomic dysreflexia
Describe why an SCI causes impaired temperature control
What are two main types of pain after SCI
Describe spasticity for SCI
Describe skin integrity and bone health for SCI
Describe neurogenic bladder and bowel complications for an SCI
Describe sexual dysfunction and function for an SCI
What is the INSCI Assessment
What does the INSCI look like?
How to determine level of SCI involvement (sensory and motor) and what are the different levels of severity
How to perform the sensory exam on the INSCI
How to perform the motor exam on the INSCI
What are the non-key muscles used in INSCI and what is the root levels respective myotomes
How to perform deep anal pressure and voluntary anal contraction
Describe the neurological level of injury
Describe the AIS scale
What is the zone of partial preservation (ZPP)
What are some key points about doing the INSCI
What is the motor level, sensory level, NLI, and AIS grade
What is the motor level, sensory level, NLI, and AIS grade
What is the motor level, sensory level, NLI, and AIS grade
What are some outcome measures to use for SCI
Describe the spinal cord independence measure (SCIM)
Describe the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP)
Describe the SCI Functional Ambulation Profile (SCI-FAP)
Describe the Standing and Walking Assessment Tool (SWAT)
Describe the Wheelchair Skills Test (WST)
Describe the mortality following SCI
Describe recovery following SCI
Describe prognosis following complete injuries
Describe prognosis following incomplete injuries
Describe ambulation prognosis following an SCI
Describe prognosis of anterior cord syndrome, central cord syndrome, and brown-sequard syndrome
Describe how we predict functional abilities following an SCI
Describe what muscles, movements, capabilities are affected and equipment needed for C1-C4 injury
Describe what muscles, movements, capabilities are affected and equipment needed for C5 injury
Describe what muscles, movements, capabilities are affected and equipment needed for C6 injury
Describe what muscles, movements, capabilities are affected and equipment needed for C7 injury
Describe what muscles, movements, capabilities are affected and equipment needed for C8 injury
Describe what muscles, movements, capabilities are affected and equipment needed for T1-T12 injury
Describe what muscles, movements, capabilities are affected and equipment needed for L1-L3 injury
Describe what muscles, movements, capabilities are affected and equipment needed for L4-S1 injury
What is the fall rate for SCI, its causes and consequences
Describe the neural control of gait (name and describe all the components)
What are central pattern generators
Describe the neural mechanisms of reactive balance
How do neural changes impact motor function
How does neuroplasticity change following SCI
Describe the Hebbian Theory (Functional Plasticity)
Describe structural plasticity in the CNS
Describe axonal regeneration and sprouting
How does rehab facilitate neuroplasticity
What are 2 treatment principles used in rehab for SCI
What are acute care priorities for SCI
What are early rehab/low function priorities for SCI
What are late rehab/high function priorities for SCI
Describe Activity-Based Therapy (ABT)
How do we treat sensory cues/afferent proprioceptive inputs for SCI (ABT)
How do we treat central excitability (neuromodulation) for SCI (ABT)
Describe functional electrical stimulation (FES) for SCI treatment (ABT)
Describe combining approaches (ABT)
Describe effectiveness of ABT
Describe locomotor training and name some types
What are the 4 locomotor training principles
Describe maximize WB (locomotor principle)
Describe optimizing sensory cues (LT principles
Describe optimizing kinetics (LT principles)
Describe minimizing compensation (LT principles)
Describe the effectiveness of locomotor training
Describe balance training for SCI
Describe interval vs external perturbations
Describe reactive balance training and are physio’s assessing it?
Describe 3 reactive balance strategies for LE
Describe the impact of reactive balance training
Describe acute intermittent hypoxia as a treatment for SCI (emerging technique)
Describe vagus nerve stimulation for SCI (emerging technique)
What are the physical activity guidelines for SCI
Describe aerobic physical activity for SCI
Describe strength training for SCI
Describe flexibility training for SCI
- 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.
- 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
- INSCI, 4+1 assessment, IPPA, general strength and mobility
- Grasping and propelling with a wheel chair, wrist extension exercises, apply hooks to wheel chair to help with propelling
- 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
- Neuropathic. I would have her do nerve flossing. Electrical stimulation, gabapentin
- INSCI, ROM, SCIM, 4+1 assessment,
- 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
- Use screening questionnaire (PHQ-9 -> mental health), referring to member of multidisciplinary team
- Send him cardiovascular guidelines (2 x a week for 20 minutes for strength and 3 x a week for 30 mins for aerobic exercise
- 6/2-minute walk test, mini BEST test, SCIM
- 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,
- 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.
- 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).
- 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
- Work on maintaining cardiovascular health, bodyweight support treadmill, FES, bike -> repetitive, sensory cues, environmentally specific, and what ever the 4th principle is