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BPK 448 > MT3 > Flashcards

MT3 Flashcards

1
Q

how many vertebrae and segments are in the cervical spine

A

7 vertebrae and 8 cervical segments

C3-T1 are sensation/motor for upper extremity

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2
Q

what is the differnece between tetraplegia and tetraparesis

A

plegia is partial or total voluntary loss in all 4 limbs, while paresis is muscle weakness in all 4 limbs

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3
Q

what is the innervation status of muscles after a spinal cord injury

A

above the SCI - innervated and under voluntary control

at level of SCI (deadband) - denervated

below SCI - paralyzed, but innervated

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4
Q

What is the metamere

A

area of the injured spinal cord

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5
Q

how does ASIA classify an SCI?

A

ASIA A - complete injury
ASIA B - complete motor impairment
ASIA C - key muscles lower than grade 3
ASIA D - key muscles above grade 3

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6
Q

what are the myotomes for c5-t1

A

c5- elbow flexors
c6 - wrist extensors
c7 - elbow extensors
c8 - finger flexors
t1 - small finger abductors

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7
Q

what are the goals for restoring hand function

A

ambulation
ADLs
human contact
picking up/releasing objects

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8
Q

what is tenodesis

A

surgical fixation of a tendon

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9
Q

what is arthrodesis

A

surgical immobilization of a joint by fusing of the adjacent bones

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10
Q

what is the key grip procedure

A

reconstruction to restore lateral pinch in c5-c6 SCI subjects who lost thumb flexion but retained wrist extension

digits flex when wrist is dorsiflexed (extended) and the thumb is adducted

done by fixing distal phalanx of thumb, then attaching the flexor pollicis longus muscle to the radius, and the extensor pollicis longus tendon transfered to stabilize the thumb

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11
Q

what is chronic pain

A

pain lasting 3 months or longer with restricted normal activites

can result from disease or an initial injury that has since healed

can produce psychosocial effects and physical effects

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12
Q

what is the most appropriate step for a man with lower back pain that is acute

A

CT scan

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13
Q

what is a good predictor for a patient with chronic back pain for who is a good candidate for surgery?

A

straight leg raise reproduces pain and paresthesia in the leg at 30-70 degrees of hip flexion

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14
Q

for lower back chronic pain, when is surgery recommended

A

after non operative management has been attempted and the compression still persists

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15
Q

what is the strongest predictor of the outcome for lumbar spinal stenosis surgery

A

comorbid medical conditions (obesity, etc)

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16
Q

What is nociceptive pain

A

pain mediated by nociceptors, caused by tissue trauma or mechanical/thermal/chemical excitation

dull aching throbbing pain, responsive to opiods

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17
Q

what is neuropathic pain

A

pathologic changes in neuro-functional relationships with peripheral or central nervous system

causes burning/shooting pain that may be opiod resistant

also often includes:
radiculopathies (spinal root compression)
neuropathies (diabetes, toxins, etc)
neuralgies (pain from damaged nerves)

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18
Q

what is central sensitization

A

synaptic plasticity and increased neuronal responsiveness in central pain pathways after painful insults

driven by chronic pain and neuroinflammation

causes activation of glial cells which causes the release of proinflammatory cytokines, which promotes chronic pain

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19
Q

what is the gate control theory of pain

A

in absence of slow pain c fiber input, active inhibitory interneurons supress the pain pathway

with strong slow pain c fiber input, inhibitory interneuron is inhibited and a strong pain signal is sent to the brain

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19
Q

what is refered pain

A

sensing pain from internal organs on the surface of the body

nociceptors from several locations converge on a single ascending tract

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20
Q

what is neuromodulation

A

property of nervous system that regulates or modifies electrical impulses by changing them

can be used for pain relief using chemical or electrical stim

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21
Q

What are neurostimulation systems

A

they consist of:
- 1+ stimulating leads that stimulate the spinal cord or nerve

-an extension wire that conducts pulses from power source to lead

  • a power source to generate the electrical pulses
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22
Q

What are the 2 types of neurostim systems

A
  • totally implanted - completely internal system - aid in chronic intractable pain of trunk and limbs
    can be percutaneously implanted (4 or 8 cylindrical electrodes) or surgically ( 4+ plate electrodes for more stim combinations)
    internal power source or radio frequency coupled power source, used for those with high energy requirements

semi implanted - has internal and external components

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23
Q

how does neurostimulation control pain

A

utilizes gate control theory of pain

stimulates pain inhibiting nerve fibers to mask the sensation of pain with tingling

reduces pain and increase activity levels, while also minimizing the use of narcotics

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24
What is DRG stimulation
targets dorsal root ganglion to manage pain used mainly with difficult to target anatomy like the back and the foot therapy can be easily adjusted to cover the broad or specific areas of pain, while limiting uncomfortable postural effects experienced with other spinal cord simulators
25
What is high frequency spinal cord stimulation for pain?
the two leads are sited anatomically in the midline from t8-t11, with no sedation or performing of paresthesia mapping causes parasthesia free pain relief uses frequency of 10000 Hz, allowing it to activate the inhibitory interneurons in the dorsal horn, without activating the rest of the dorsal column fibers. this leads to supression of wide dynamic range neurons which are sensitive in chronic pain states
26
do neuropathic or nociceptive pain having patients benefit more from spinal cord stimulation
neuropathic
27
how are action potentials generated physiologically?
synapse travels down to motor end plates which results in a depolarization of the membrane potentials and influx of Ca2+ into the muscle, initiating contraction
28
what is the size principle
motor units are recruited from smallest to largest depending on the strength of the potential smaller motor neurons have more resistance and slower contraction time compared to larger units, but the larger ones require a greater AP to go suprathreshold in an artificial AP, this is swapped to the larger group having a lower threshold, and are recruited first
29
what is excitation contraction coupling
AP triggers Ca2+ release into muscle, resulting in crossbridge formation and muscle contraction increased AP firing rate results in a greater force output from motor unit
30
what are the 4 types of motor units in order of lowest force generation to highest
type s - slow twitch type FR - fast twitch, resistance to fatigue type FI - fast twitch, intermediate fatigue type FF - fast twitch, fatigable
31
how is an artificial AP produced
negative ions flow from cathode to anode which causes the axon membrane to depolarize under the cathode and hyper polarize under the anode, causing a depolarization in the axon and an impulse. then the positive ions flow back from anode to the cathode,and this causes the the axon membrane to hyperpolarize and end the AP this causes a bidirectional generation of an AP CATHODE SHOULD BE NEAR A NERVE TO STIMULATE AP (CAUSES DEPOLARIZATION)
32
what does disuse do to muscles
causes atrophy and rapid conversion of motor units into fast type fibres therefore exercise when paralyzed using EMS can convert fast fibers to slow fibers, rebuilding force capacity and increasing fatigue resistance
33
what does the strength-duration curve look like? what affects it
electrode position, edemas, denervation/reinnervation, etc is an inverse graph with a steep drop
34
What is the electrically induced H-reflex
indirect muscle recruitment caused by an electrical stimulus causing a bidirectional generation of action potentials similar to stretch reflex, but it bypasses the muscle spindles and can be used to assess the modulation of reflex activity recruits the smallest motor neurons first as it is a physiological pathway (up to spinalcord and then to motor nerve) decreases after a certain intensity as it starts recruiting the larger alpha motorneurons (that the M-wave recruits) At a certain point, the M-wave recruits more and more due to the higher intensity, the h-reflex can no longer recruit any motor groups as the M-wave has recruited all of the motor units in that time
35
what is the M-wave
direct muscle recruitment to motor nerve in a normal person activates different motor neurons to the H-reflex M-wave recruits the largest motor units as the electrical stim increases Mwave increases. at minimal stim M wave is absent and H wave is maximal
36
what are the 2 types of theraputic electrical stimulation
transcutaneous electrical nerve stimulation -stim targets are large sensory nerve axons, used mainly for acute or chronic pain relief transcutaneous electrical muscle stimulation -targets motor nerve axons to increase strength/endurance -requires that the muscle is innervated and can prevent atrophy and increase blood flow, alongside improving resistance to fatigue
37
how does electrical stimulation differ from exercise?
exercise is restricted to employed fibers that are active during exercise only, while electrical stimulation overrides the recruitment order and can activate all fibers, and continuously
38
what is functional electrical stimulation
used to restore voluntary control of paralyzed muscles, restore sensory-motor integration, and alleviate spasticity
39
what is the difference between bipolar electrode config and monopolar electrode config
monopolar feed back to a central common ground electrode from each muscle, while bipolar has a ground electrode alongside a positive on each muscle.
40
how do fes closed loops compensate for unpredictable muscle output
by including sensory feedback to the command interface/control circuitry
41
what causes foot drop
stroke, traumatic injury, brain injury, MS, cerebral palsy, etc causes disruption to the connections from the motor cortex output to the spinal cord leads to weak dorsiflexors
42
How can foot drop be treated with bracing?
Using AFOs, they are cheap and non-invasive, but are uncomfortable, interfere with plantarflexion, and still are energy draining
43
how can neuromuscular stim treat foot drop
theraputic electrical stim can reverse atrophy and strengthen the muscles, bones, and circulation functional electrical stim can allow for voluntary performance for motor activities thru graded recruitment -can also allow for a symmetric,balanced, gait, alongside increased force and ability to walk -must know when activation of muscles is required and a sensor is required to recognize key gait events for timing of stim pulses need to ensure that the stims are positioned correctly for optimal use
44
what are partially implanted fes systems?
stim electrodes are permanently implanted around peroneal nerve while battery and sensors remain outside the body, external unit communicates transcutaneously via RF difficult to obtain balanced dorsiflexion with a single channel of stimulation
45
What are the pros/cons of STIMuSTEP
pros - no irritation, comfortable, and convenient is a partially implanted FES system
46
What is a fully implanted FES system
Neurostep everything is located inside the body (in the thigh) cuffs around nerves to stimulate
47
What is neurostep
first fully implanted FES was able to employ a multi-channel (4 channel)peroneal stimulation for more balanced dorsiflexion the multichambered cuff allowed for expansion of the nerve into the cuff for a snug fit had improved stim selectivity cuffs were protected with teflon heat shield as they were placed around the common peroneal and tibial nerves, the control unit was placed in the medial thigh with the incision closed combined stim of channel 1 and 3 produced best dorsiflexion prevents disuse atrophy and increased force pt condition deteriorated after battery ran out
48
what are the 4 ways to treat foot drop in hemiplegia?
AFO external FES partially implanted FES fully implanted FES
49
what are the pros and cons and risks of using AFO to combat foot drop?
pros: cheap/noninvasive cons: discomfort with plantarflexion/limited plantar flexion, no pain relief risks: disuse atrophy and skin damage
50
what are the pros and cons and risks of using external FES to combat foot drop?
pros: non invasive/not super expensive cons: uncomfortable risks:skin abrasion/burns
51
what are the pros and cons and risks of using partially implanted FES to combat foot drop?
pros: mores stable stim and multi channel stim cons: may be inconvinent and is expensive, also needs surgery risks:nerve damage
52
what are the pros and cons and risks of using fully implanted FES to combat foot drop?
pros: most stable stim with multichannels, always ready to use, comfortable, invisible cons: needs surgery, poor battery life that needs to be changed, not commercially available risks: nerve damage
53
what are the orthotic and therapeutic effects of FES
orthotic: more symmetric balanced gait, ankle flexor activation, synergistic activation of hip and knee flexors therapeutic effects: increased force and endurance of disused muscles, reduced extensor spasticity, improved walking ability if stim stops
54
what is walkaide
external FES that attaches to the tibia and measures tilt, allows for less effort and increased symmetry/speed
55
what is the endurance index
fraction of force that is still being generated after 3.5min of intermittent stimulation graph shows the ankle dorsiflexor force decay of 5 subjects who got stim for 0min, 45min, or 8hrs, and 8 hrs had the lowest decay over the 3.5min while 0min had the largest decay
56
WHat are the controllable electrical stim parameters
pulse amplitude pulse duration pulse polarity inter-pulse interval
57
why are shorter pulses better
safer (less tissue damage and electrode corrosion)
58
why is net zero charge important
minimize damage to tissue
59
How does the H reflex show spasticity
H reflex is significantly larger at baseline intensity of stimulus
60
how is the h-reflex affected by the muscle length
it is significantly weaker when the muscle is lengthened because the spindles are firing at higher frequencies, and are more hyperpolarized, therefore they cannot be fired again as quickly in response to the electrical stimulus
61
what are the 10 locations for fes
Cortex deep brain spinal pattern generators motor nuclei dorsal roots ventral roots peripheral nerves epimysial intramuscular skin surface
62
why are larger motor groups recruited first with electrical stimulation
larger nerve axons have lower internal resistance, so it is easier to introduce an external current than the smaller nerve axons with higher internal resistance

BPK 448 (3 decks)

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