Neuromuscular Flashcards
What is Brown-Sequard Syndrome
Pain and Temperature loss on contralateral side of spinal cord injury
What’s lost with Brown -Sequard syndrome on Right sided Hemisection?
T12 motor function and sensation Right side
+
Pain and temperature on left side
What functions are preserved with Brown-Sequard Syndrome and right sided Hemisection of spinal cord at T12?
Pain and temperature on right side
+
Sensation and motor function
+
Proprioception and vibration
Position of Conus Medullaris/End of spinal Cord
L1
Symptoms of spinal Cord Injury above Conus Medullaris
Act like upper motor neuron injury
Spastic/hyperreflexive bladder
-> empties whit adequate filling pressure
Symptoms of spinal Cord Injury below Conus Medullaris
Act like lower motor neuron injury
Flaccid/areflectic bladder
Treatment/Management of flaccid/hyporeflective bladder
Catheterization
Valsalva maneuver
Treatment/Management of spastic/hyperreflective bladder
Initial catheterization
Suprapubic tapping
Symptoms/Bowel function with SCI above Conus Medullaris
Spastic/hyperreflexive bowel
Defecation when rectum fills
Symptoms/Bowel function with SCI below Conus Medullaris
Flaccid/reflexive bowel
Treatment Bowel function with SCI above Conus Medullaris
Digital stimulation to initiate reflex
Treatment Bowel function with SCI below Conus Medullaris
Manual evacuation
Gentle valsalva maneuver
Bowel program training/Timetable
Diaphragm Innervation
C3/4/5 KEEP THE DIAPHRAGM ALIVE
Pulmonary symptoms with SCI
Decreased diaphragm & intercostals
What’s the pulmonary paradox In cervical or high thoracic SCI?
-> decr. Activity external intercostals
-> upper ribcage moves inwards in Inspiration
-> decr chest wall compliance
+ Incr abdominal compliance
Integumentary prevention in SCI Patients
Pressure relief every 15min
-sideways +forward >45°
- tilt in space >65°
ROM considerations in SCI
-Hamstrings straight leg raise to 100°
-Intrinsic plus position
!!! Avoid overstretching Hamstrings and Quadratus lumborum
What’s the “intrinsic plus” position of the wrist?
20° Ext + 90° flexion MCP + IP slight flex
-> maintains tenodesis grasp control
(Grasp with wrist extension)
What to do when P exhibits any kind of symptoms when in upright positioning Table?
BRING BACK TO SUPINE!
OR TRENDELENBURG POSITION
Let symptoms completely subside before continuing at lesser degree
C1-C4 SCI functions
Respiratory considerations
Dependent for ADL’s
Wheelchair motorized with sip/puff controls/head/chin/tongue
C5 SCI functions
Joystick wheelchair with electronic recline
Car with modifications
Dependent for transfer
Manual WC with safety set up
C6 SCI functions
Mostly independent
Manual wheelchair with modifications
Transfer with slideboard
Car with adaptive equipment
C7 SCI functions
Independent ADL’s
Manual WC
Manual pressure relief
C8 SCI functions
Full wrist/elbow control and most fingers
More independent
T1-T12 SCI functions
Independent or modified independent
L1-L3 SCI functions
Hip flex and knee ext possible
Ambulation with Orthoses (HKAFO/ KAFO) possibly AFO
l4-S1 SCI functions
Full ambulation
Possibly AFO or assistive device
SCI interventions
Rolling through flexion of head/neck
-> rocking/momentum use
Sit (squat) -pivot Transfer (C6 and below)
Head-hip opposition head le + hip ri
How to adjust axle to facilitate a wheelie in WC?
Anteriorly
To decr base of support
C3,C4, C5 keep the …… alive
Diaphragm
L2, L3, L4 keep
The poop of the floor
ULTT 1 & 2
Median Nerve
Gestreckter arm/ABD/supine/elbow EXT/DExt
1.) 90°ABD
2.) 45°ABD
ULTT Radial
Gestreckter arm/ internal rotation/PFlex
ULTT ulnar
Finger tip to ear
90°ABD +ER/ Elbow flex/wrist finger EXT
