Neuromuscular II SCI Unit Exam Flashcards
what is SCI?
damage to the spinal cord resulting in symptoms below the level of injury
SCIs are most common between what age range?
16-30
what age do most SCIs occur? why?
19, frontal lobe development and myelination
do SCIs occur more in males or females?
males (80%)
what are the most common traumatic mechanisms of injury with SCIs?
MVA
falls
violence
sports related injuries
what are some non-traumatic mechanisms of injury of SCIs?
AVM
thrombus, embolus, hemorrhage to arterial supply
infection
tumor
MS lesions
ALS
spinal stenosis
incomplete SCIs have a _______ life expectancy than complete
longer
paraplegia has a ______ life expectancy than tetraplegia
longer
higher cervical tetraplegia has a ________ life expectancy than lower cervical tetraplegia. why?
shorter (innervation to vital organs)
________ rate is highest in the first year after spinal cord injury
mortality
happens immediately after SCI
spinal shock
a period of _______ lasts around 24 hours after spinal cord injury where everything is flaccid
areflexia
how many days does it take for reflexes to gradually return after spinal shock?
1-3 days
__________ may be present for 1-4 weeks after reflexes return following injury
hyperreflexia (high tone)
when is the ideal timeframe to administer an asia exam?
1-3 days
looks at motor and sensory levels bilaterally as well as sacral tone and sensation to determine SCI level, etc.
asia exam
asia exam determines what 5 naming categories of SCI
motor level of injury
sensory level of injury
neurologic level of injury
complete or incomplete
zone of partial preservation
asia C5 motor level
elbow flexors
asia C6 motor level
wrist extensors
asia C7 motor level
elbow extensors
asia C8 motor level
finger flexors
asia T1 motor level
finger abductors
asia L2 motor level
hip flexors
asia L3 motor level
knee extensors
asia L4 motor level
ankle dorsiflexors
asia L5 motor level
long toe extensors
asia S1 motor level
ankle plantar flexors
no voluntary anal contraction or deep anal pressure
noon sign
what does the noon sign indicate?
complete SCI
no motor or sensory function is preserved in the sacral segments S4 to S5
asia A complete
sensory but not motor function is preserved below the neurological level and includes the sacral segments S4 to S5
asia B incomplete
(motor complete)
more than half of the key muscles below the neurological level have a muscle grade less than 3 (all 1s and 2s)
asia C incomplete
at least half of the key muscles below the neurological level have a muscle grade of 3 or higher
asia D incomplete
asia level where motor and sensory function is normal
asia E
what is the motor level of injury?
lowest level that has a grade of 3 or higher if the level above it is a 5
what is the sensory level of injury?
lowest level of intact sensation (light touch and pink prick) (all 2s)
what is the neuralgic level of injury?
lowest level with normal motor and sensory function both on the right and left sides of the body (all 5s and 2s)
what is the zone of partial preservation?
levels below the motor or sensory level of injury that may be partially innervated
B loss of corticospinal and spinothalamic tracts
anterior cord syndrome
UEs more affected than LEs with varying degrees of sensory impairment, sacral sparing
central cord syndrome
ipsilateral DCML and corticospinal tract loss and contralateral spinothalamic tract loss
brown sequard syndrome
B loss of DCML
posterior cord syndrome
injury to this part of the spinal cord presents as mixed LMN and UMN signs
conus medullaris
injury to this part of the spinal cord presents with LMN signs, flaccid paresis, and saddle anesthesias
cauda equina
above conus medullaris
UMN
below conus medullaris
LMN
below which level generally presents as LMN?
T12
below T12
hyporeflexia
flaccidity
decreased tone
LMN
LMN bowel and bladder
flaccid
LMN sexual function
psychogenic responses
above T12
hyperreflexia
spasticity
increased tone
UMN
UMN bowel and bladder
spastic or hyperreflexive
UMN sexual function
reflexogenic arcs
ICU/floor setting that lasts for 1-3 weeks, working on upright tolerance and basic mobility
acute care
in this setting for 4-12 weeks learning ADLs, mobility, wheelchair training, and bracing
acute rehab
patients with higher level SCIs with complications, vents, or flap surgeries go to this setting
LTACH
setting that works on community integration, MSK injury prevention, and sports
outpatient
cardiopulmonary secondary complications
pneumonia (PNA)
aspiration
diaphragmatic muscle impairment
PE/DVT
BP management
what is autonomic dysreflexia?
sympathetic stimuli ascends to the brain but parasympathetic response cannot descend past the level of injury
autonomic dysreflexia can occur wits SCIs above what level? why?
T6 and above
sympathetic chain
if BP is skyrocketing in a patient with autonomic dysreflexia, what should the PT do?
sit the patient up to induce orthostasis
autonomic secondary complications
autonomic dysreflexia
BP management
sweating response
lack of higher center inhibition
loss of descending control of ascending sympathetic reflexes
symptoms of autonomic dysreflexia
hypertension
bradycardia
headache (severe + pounding)
profuse sweating
increased spasticity
vasodilation above LOI (flushing)
constricted pupils
nasal congestion
pilorection
blurred vision
dry pale skin below LOI (vasoconstriction)
what is hypertension characterized by?
raise of 20-30mmHg systolic
autonomic dysreflexia typically occurs how many months after injury?
3-6 months
may be chronic
neurologic secondary complications
tone/spasticity chances (UMN vs LMN)
neuropathic pain
sensory loss
musculoskeletal secondary complications
motor loss
osteoporosis
osteomyelitis
secondary overuse injuries
heterotropic ossification (HO)
why are patients with SCIs at an increased risk of developing osteoporosis?
not enough load through joints
why are standing frames so important for patients with SCI?
