Medical and Surgical Management

Question 1

Emergency Care

Answer 1

tx as if SCI has occurred
immobilize entire spine at scene
ensure circulation/ventilation are adequate

Question 2

Hospital Care goals

Answer 2

tx life-threatening conditions
preserve neuro function- stabilize spine
ventilation/circulation- blood gases
Neuro assessment- motor/sensory/reflexes, LOC, cranial nerves, Glascow coma scale

Question 3

Imaging, etc

Answer 3

CT entire spine
MRI of areas known or suspected of SCI
evaluation of other systems
methylprednisolone?? steroid first 8 hrs post trauma to decrease secondary damage but increase risk infection

Question 4

Fx Management

Answer 4

reduce and stabilize
combo of traction, positioning, surgery, orthoses
non-surgical is traction, manipulation
surgical is fusion of spine

Question 5

turning frames/beds

Answer 5

immobilization during acute phase
allows for positional changes
striker frame, roto-rest system

Question 6

Surgical management

Answer 6

indications- unstable fx, cord compression, deteriorating neuro function
optimal timing up for debate
spine usually fused

Question 7

Jefferson fracture

Answer 7

burst fracture of C1- vertical compression force from occiput to lateral masses of atlas; unstable

Question 8

odontoid fractures

Answer 8

65% usually dens comes off
30% subdentate fx
5% chip of dens comes off

Question 9

hangman’s fracture

Answer 9

most common cervical injury; hyperextension injury under chin (on dashboard); unstable
C2 moves anterior on C3 and displacement of posterior aspect of C2

Question 10

Flexion Tear drop fx

Answer 10

Cervical vertebral body fracture
vertebral body collides with one below
Anterior displacement of a wedge-shaped fragment

Question 11

Extension tear drop fx

Answer 11

abrupt neck extension causes ALL to pull the anterioinferior corner away from remainder of vertebral body

Question 12

Compression fracture

Answer 12

usually no neuro damage

Question 13

wedge fracture

Answer 13

tx like compression fx

brace to prevent flexion

Question 14

burst fracture

Answer 14

high force vertical compression

increase risk SC damage d/t pieces

Question 15

Chance fracture

Answer 15

lumbar spine; high force decceleration injury (pelvis stable and torso forward)
Fx of lamina, pedicles, and interspinous ligament has splayed the posterior elements

Question 16

Spinal Orthoses indications

Answer 16

spinal immobilization after surgery or after traumatic injury
compression fx management
pain relief
mechanical unloading
kinesthetic reminder to avoid certain mvts

Question 17

characteristics of orthoses

Answer 17

weight, adjustability, functional use, cosmesis, durability, ease of donning/doffing, acess to trach tube, drain sites, and sx sites, aeration

Question 18

Halo

Answer 18

4 steel screws, att to body jacket, early mobilization and upright posture, wrench secured to jacket

Question 19

Minerva

Answer 19

full SH ROM, better stabilization than Halo except C1-2

Question 20

SOMI

Answer 20

sternal occipital mandibular immobilization
transitional from HALO
wear when upright, off if supine

Question 21

Cervical collars

Answer 21

cups mandible and occiput

Miami J collar and Philadelphia collar

Question 22

body jacket

Answer 22

TLSO- thoracolumbar stabilization

trimline may prevent SH, hip mvt

Question 23

Examples of TLSO

Answer 23

body acket, jewett brace, cash brace

Question 24

Complications of orthoses

Answer 24

discomfort, skin breakdown, nerve compression, ms atrophy, decrease pulmonary capacity, increase energy consumption, difficulty with transfers, psychological/physical dependence, increase segmental motion above/below, pt compliance

Question 25

PT Exam- history

Answer 25

demographics, hx current condition (date injury, cause and type), PMH, meds, review imaging, hx PT, social hx

Question 26

PT Exam- arousal, attention, cognition

Answer 26

orientation, awareness of environment, ability to process commands, communication, motivation, affect, can have TBI

Question 27

PT Exam- respiratory

Answer 27

muscle function- watch breathing pattern

chest expansion- level of axilla and xiphoid process normal= 2.5-3 in; use as baseline

Question 28

Cough quality

Answer 28

functional- loud and forceful, 2 or more exhales
weak function- soft, less forceful, 1 exhale, clear throat, assist needed for large amt secretions
nonfunction- sigh or throat clearing, no true coughs

Question 29

Pulmonary function test

Answer 29

vital capacity- air exhaled after max inspiration
correlates with most PFTs
FEV1 and peak cough flow
hand held spirometer

Question 30

Integumentary Check

Answer 30

check under braces, splints
clothing seams, tags, zippers
LOOK

Question 31

PRISM

Answer 31

patient reported impact of spasticity measure; seft report measures impact spasticity on social avoidance/anxiety, daily activities, need for positioning, also + factors

Question 32

Sensation testing

Answer 32

test all sensory modalities- light touch, pin prick, proprioception, vibration- dorsal column, all major jts
assess/ rate pain
sensory level may not correspond to motor level

Question 33

PROM

Answer 33

impact on function- use alternate positioning methods, dressing
precautions- HALO, cervical SCI has SH limits, lumbar SCI may have hip limits

Question 34

MMT

Answer 34

distinguish MMT from ASIA scale
full MMT in standard position
stabilize when necessary, doc accommodations
follow precautions
reassess for any new trace ms and palpate

Question 35

Mobility and ADLs

Answer 35

bed mobility and transfers- surface material, use of AD, amt assistance, strategy
grooming, bathing, toileting, eating- ok to doc if don’t see
equipment assessment