Neuro SCI, Parkinson's, MS Flashcards by Kara Stanton

Asia A

Complete: No sensory or motor function is preserved in sacral segments S4-55.

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Asia B

Sensory Incomplete:
Sensory function is preserved below the neurologic level, including S4-55, AND no motor function is preserved more than 3 levels below the motor level on either side of the body.

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Asia C

Motor Incomplete:
Motor function is preserved for voluntary anal contraction, OR the patient meets “Sensory Incomplete” status and has motor function more than 3 levels below the motor level on either side of the body. Less than half of key muscle functions below the neurologic level have a muscle grade ≥ 3.

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Asia D

Motor Incomplete:

“Motor Incomplete” status as defined above, with at least half (half or more) of key muscle functions below the neurologic level having a muscle grade greater than or equal to 3.

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Asia E

Normal:
Sensory and motor functions are normal in a pt that had prior deficits

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How to determine SCI motor level

Most caudal key muscles that have a strength of 3 or greater with the superior segment tested as a 5

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How to determine SCI sensory level

Most caudal dermatome with a normal score of 2/2 for pinprick AND light touch

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Key muscles tested for SCI motor level determination

C5 -Elbow flexors (biceps, brachialis)

C6 -Wrist extensors (extensor carpi radialis longus and brevis)

C7 - Elbow extensors (triceps)

C8 -Finger flexors (flexor digitorum profundus) to the middle finger

TI - Small finger abductors (abductor digiti minimi)

L2 -Hip flexors (iliopsoas)

L3 - Knee extensors (quadriceps)

L4 -Ankle dorsiflexors (tibialis anterior)

L5 -Long toe extensors (extensor hallucis longs)

S1 -Ankle plantar flexors (gastrocnemius, soles)

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Main sensory areas tested for SCI (that have fairly specific locations)

C2 - occipital protuberance
C3 - supraclavicular fossa
C4 - top of AC joint
C5 - lateral antecubital fossa
C6 - dorsal thumb (proximal phalanx)
C7 - Dorsal middle finger (proximal phalanx)
C8 - Dorsal little finger (proximal phalanx)
T1 - medial side of antecubital fossa
T2 - apex of axilla
T3-5 - spots of the ribs that associate
T 6 - level of xiphesternumb
T 7-9 - their adjoining rib spaces
T 10 - level of umbilicus
T12 - midpoint inguinal ligament
L1 - anteromedial thigh
L3 - medial femoral condyle
L4 - medial malleolus
L5 - dorsal surface of 3rd MTP
S1 - lateral heel
S2 - popliteal fossa at midline
S3 - ischial tuberosity
S4-5 - perianal area

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Scoring given to sensory testing when testing light touch and pinprick for SCI

0 = Absent
1 = imparied/hypersthesia
2 = intact

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What does ASIA stand for

American Spinal Cord Injury Association

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SCI C4 (complete) Gross functional outcome

•Bed Mobility: dependent
.Transfers: dependent
•Weight Shift: modified independent with power recline/tilt weight shifts; dependent for manual shifts
• Wheelchair Management: dependent
•Wheelchair Mobility: supervision to modified independent with power wheelchair
•ROM/positioning: dependent

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SCI C5 (complete) Gross functional outcome

•Bed Mobility: moderate to maximal assist
•Transfers: maximal assist with sliding board
•Weight Shift: modified independent with power recline/tilt weight shifts
•Wheelchair Management: dependent
• Wheelchair Mobility: modified independent with manual wheelchair on smooth surface in forward direction; maximal assist in all other situations
•ROM/positioning: dependent

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SCI C6 (complete) Gross functional outcome

Bed Mobility: minimal assist to modified independent with equipment
•Transfers: minimal assist to modified independent with sliding board
•Weight Shift: modified independent with power recline/tilt weight shift, minimal assist to modified independent with side to side or forward lean shift
• Wheelchair Management: some assistance required
•Wheelchair Mobility: modified independent on smooth surface with power and manual wheelchair; may need assist with rough terrain and ramps
•ROM/positioning: moderate assist to modified independent with all

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SCI C7-C8 (complete) Gross functional outcome

•Bed Mobility: independent
•Transfers: modified independent to independent with level surface transfers
Weight Shift: modified independent with side to side, forward lean, and depression weight shift
•Wheelchair Management: may require assist with cushion adjustment, anti-tip levers, and maintenance
•Wheelchair Mobility: modified independent on most to all surfaces
•ROM/positioning: minimal assist to modified independent with all

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SCI Paraplegia (complete) Gross functional outcome

•Bed Mobility: independent
•Transfers: independent for level surfaces and with car transfers
•Weight Shift: modified independent with depression weight shift
• Wheelchair Management: independent
•Wheelchair Mobility: independent on all surfaces; minimal assist to modified independent for curbs
•ROM/positioning: independent
•Gait: varies on level of injury from standing only to community ambulation with or without orthoses

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A patient with which 2 level SCI would be most reliant on tenodesis

C6 and C7

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What are the symptoms of spinal shock?

areflexia
impairment in autonomic regulation which causes the following:
hypotension
loss of control of sweating
loss of cremasteric reflex
loss of Babinski response.

Spinal shock occurs in the first 24 hours post SCI

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Which statement regarding sexuality in males is most accurate following a spinal cord injury?

the ability to ejaculate is more common with incomplete lower motor neuron lesions

Ejaculation is a complicated neurological process. Following a spinal cord injury in males, there is a higher likelihood of ejaculation with incomplete lower motor neuron lesions compared to upper motor neuron lesions as well as complete lesions. Lower motor neuron lesions may have psychogenic erections which increase the capacity for ejaculation.

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Which SCI level is the highest level that will household ambulate with KAFOs?

Partial innervation of the gracilis, iliopsoas, QL, RF, and sartorius. Hip flexion, add, knee extension.

Will use KAFO and Lofstrands (forearm crutches)

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Sensory testing for S3 (ASIA scale)

Ischial tuberosity

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Sensory testing for S1 (ASIA scale)

Lateral heel

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Sensory testing for S2 (ASIA scale)

Popliteal fossa midline

Key muscles tested for C8 with ASIA scale

Finger flexors (flexor digitorum profundus) to the middle finger

Sensory testing for L5 (with ASIA scale)

dorsum of foot 3rd MTP

Sensory testing for L3 (with ASIA scale)

medial femoral condyle

Sensory testing for L2 (ASIA scale)

anteromedial thigh

Sensory testing of L4 (ASIA scale)

Medial malleolus

What lesion(s) does autonomic dysreflexia occur?

T6 and above

Autonomic Dysreflexia

Vasodilation above NLI (parasympathetic) - increased BP, flushed face, HA, distended neck veins, decreased HR, increased sweating Vasoconstriction below NLI (sympathetic) - pale, cool, no sweating * Sudden rise in systolic blood pressure of 20-40 mm Hg above baseline observation of signs and symptoms. * Signs and symptoms of AD include bradycardia, hypertension, increased spasticity, blurred vision, constricted pupils, nasal congestion and feeling of anxiety.

Steps for Autonomic Dysreflexia

1) Sit patient UP 2) Check for stimulus - full bladder, UTI, fecal impaction, restrictive clothing, pressure areas 3) Activate EMS **Must react quickly due to increased BP may cause hemorrhagic CVA

AD vs OH

AD: flushed/red face, increased BP, sit pt up **If face goes red - raise the head OH: pallor, diaphoresis, decreased BP, position changes, lie pt down **If face goes pale - raise the tail

Brown Sequard Syndrome

Cause: gunshot or knife wound injuries Contralateral loss of pain, temperature and crude touch (Antero-lateral system) Ipsilateral loss of vibration, proprioception, 2 touch discrimination, fine touch (Dorsal Column-medial lemniscus)

What will be the presentation of a SCI pt with Brown Sequard Syndrome at right T12?

Left sided loss of pain and temperature Right sided loss of motor, fine touch, and proprioception

Central Cord Syndrome

Most common cause: extension injury UE > LE deficit Distal muscle deficit > Proximal mm Still have have fine touch, vibration, and proprioception due to dorsum column intact Hand function last to come back Normally ambulates

Anterior Cord Syndrome

Rare Complete loss of motor, pain, and temperature below injury Retains proprioception and vibration sensory Cause is due to flexion or vascular injury Poor prognosis Damages anterior spinal artery (which feeds 2/3 of SC)

Posterior Cord Syndrome

Rare Cause: Compression due to disc which impacts the posterior spinal artery; Vit. B12 deficiency; Infarction Presentation: loss of vibration, proprioception, light touch, and 2 point discrimination.

Cauda Equina Syndrome

Impacts lumbosacral region Below the SC (L1 or L2) LMN lesion Presentation: Areflexic Bowel and bladder; saddle anesthesia

Conus Medullaris Syndrome

Combo of UMN and LMN s/s Lesion right at the end of the SC = L1, L2

How much hamstring flexibility for SCI?

about 100 deg.

Lesion to S2-S4 above L1 will cause: Spastic or flaccid bladder/bowel?

Spastic/hyperreflexive bladder and bowel Lesion above conus medullaris (L1)

Is a spastic bladder an UMN or LMN lesion?

UMN

Tx for spastic bladder

tapping without dyssynergia

Lesion of S2-4 below L1 will cause: Spastic or flaccid bladder/bowel?

Flaccid/areflexic bladder and bowel

Flaccid bladder is an UMN or LMN lesion?

LMN

Tx for flaccid bladder?

catheter or valsalva

Tx for spastic bowel

reflex def or digital stimulation

Tx for flaccid bowel

manual evac or gentle valsalva

Sclerotic plaques throughout CNS Most common - relapsing remitting block neural transmission, inflammation, and demyelination Progressive Disability overtime

MS s/s

fatigue spasticity weakness optic neuritis heat intolerance unilateral visual loss paresthesia ataxia bowel and bladder dysfunction

Best tx for MS

Cool environment Can use cooling vest In the morning due to fatigue

destruction in substantia nigra decreased Dopamine - initiation of movement

PD cardinal signs

Rigidity Bradykinesia/akinesia Tremor (pin rolling) Postural instability (causes falling) **TRAP

PD clinical manifestations

fatigue; contractures (hip flexors) freezing gait; start hesitation kyphosis, forward head, scapular protraction tonal asymmetries decreased stride and cadence shuffling; festinating gait decreased trunk rotation

PD interventions

Early - determine need for AD and environmental modifications Middle - body moves more slowly, increased stiffness Late/advances - hospital bed, w/c, lift; requires full-time assistance Cueing strategies - rhythmic auditory stimulation, amplitude-based behavioral interventions, big & loud Flexibility exercises - hip rotation, hip extension (prone lying) Resistance training - bilateral D2 flexion; chop and lift Bed mobility skills - bridges; rolling Balance training

Hoehn and Yahr Scale

1 - unilateral involvement 2 - bilateral involvement without balance affected 3 - balance is affected 4 - requires AD or assistance 5 - w/c bound

What level of assistance with a C8 SCI require for using a manual w/c while negotiating curbs initially?

Moderate assistance ...a pt with a complete C8 SCI may be able to achieve modI. Question from PTFE