Pathology III - PPT for SCI FUNCTIONAL OUTCOMES Flashcards
What type of spina bifida is characterized by an incomplete fusion of the posterior vertebral arch with no neural tissue protruding?
Occulta
What type of spina bifida is characterized by an incomplete fusion of the posterior vertebral arch with neural tissue/mininges protruding outside the neural arch?
Meningocele
SPINAL CORD IS not protruding like in myelomenigocele
What type of spina bifida is characterized by an incomplete fusion of the posterior vertebral arch with both meninges and SPINAL CORD protruding outside the neural arch?
Myelomeningocele
SPINAL CORD ITSELF IS PROTRUDING
Low levels of what is thought to contribute to the devleopment of spina bifida?
folic acid
In what percent of cases of myelomenigocele is a shunt required for hydrocephalus?
90%
What are 3 orthopedic conditions associated with spina bifida?
- scolosis
- hip dysplasia
- clubfoot
What condition is characterized by a failed closure of the cranial end of the neural tube in which most are born stillborn or die shortly after birth?
Anencephaly
What are the expected deficits with Brown-Sequard’s Syndrome?
Paralysis and loss of vibration/proprioception on the same side
Contralateral loss of pain and temperature
An injury occuring below what spinal level is considered a cauda equina injury?
L1
What are three characteristics of cauda equina injuries?
CONSIDERED A PERIPHERAL NERVE INJURY
- Flaccidity
- Areflexia
- Impairment of bowel and bladder funciton
What 3 things are lost with Posterior Cord syndrome and what is preserved?
- loss of proprioception
- Loss of two-point discrimination
- loss of sterognosis ( the ability to perceive and recognize the form of an object in the absence of visual and auditory information)
MOTOR FUNCTION IS PRESERVED
What is another name for heterotopic ossification whihc is a common complication of SCI?
Ectopic bone
Heterotopic ossification typicaly invovles pharmacological intervention with what drug?
Diphosphates
Autonomic dysreflexia can occur at what level?
T6 and above
How often should someone with an SCI change position? and how often should they weight shift in sitting?
Change position every 2 hours
Weight shift in sitting every 15-20 minutes
What 3 drugs are commonly used to treat spasticity after SCI?
Dantrium, Lioresal, and Baclofen
What is a surgical procedure that severs certain tracts within the spinal cord in order to decrease spasticity and improve function?
Myelotomy
What is a surgical procedure that involves removal of a segment of a nerve in order to decrease spasticity and improve function?
Neurectomy
What is a bladder that is flaccid as a result of cauda equina or conus medullaris lesion and the sacral reflex arc is damaged?
Neurogenic nonreflexive bladder
What is a bladder that empties reflexively for a patient with an injury above the level of T12 and the sacral reflex remains intact?
Neurogenic reflexive bladder
What is paradoxical breathing?
an abnormal form of breathing that is common in tetraplegia where the abdomen rises and the chest is pull inward during inspiration. With expriation the abdomen falls and the chest expands
What is the term for an incomplete lesion where some of the innermost tracts remain innervated?
Sacral sparing
What is a physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks presenting with total flaccid paralysis and loss of all reflexes below level of injury?
Spinal shock
What is a surgical release of a tendon in order to decrease spasticity and improve function?
Tenotomy
What is the zone of preservation?
a term used to describe poor or trace motor or sensory funciton for up to three levels below the neurologic level of injury
After a C7 complete tetraplegia injury what is the most distal segment of the spinal cord that both motor and sensory components remain intact?
C7
What are cardiopulm considerations with a C7 spinal cord injury?
impaired cough and ability to clear secretions, altered breathing pattern and poor endurance
If the removal of noxious stimuli does not occur quickly with autonomic dysreflexia what is the patient at risk for?
subarachnoid hemmorage
What 3 drugs are started immediately after SCI?
methylprednisolone (corticosteroid)
Lipid peroxidation inhibitors
opiate receptor blockers
With C7 tetraplegia what is the expected functional outcome for feeding, grooming, and dressing?
indepent
C7 function with self-ROM, WC mobility, and driving?
independent with all with adaptive equpiment
Patients with complete L3 paraplegia will have at least partial innervation of what 5 lumbar/lower extremity muscles?
- Gracilis
- iliopsoas
- quadratus lumborum
- rectus femoris
- sartorious
What type of bladder dysfunction is expected with a complete L3 paraplegia?
nonreflexive bladder
Is cauda equina syndrome a central or peripheral nerve injury?
peripheral
What is the term for the end of the spinal cord and what is beyond that?
Spinal cord ends at L1 with the CONUS MEDULLARIS
The cauda equiina extends beyond this with paired lower lumbar, sacral, and coccygeal nerve roots
Why are nerves of the cauda equina more susceptible to damage?
these nerve roots have poorly developed protective epineurium and the tendency to form edema even with mild injury
What is the function of the cauda equina with bowel/bladder?
parasympathetic innervation to the bowel and bladder adn voluntary control over the associated sphincters
What are sources of compression of cauda equina nerve roots?
Spinal struture pathology (disk, fracture stenosis), trauma, infectious disease, tumor
What is one symptom of cauda equina syndrome that can mimic other conditions?
severe bakc pain
What condition is characterized by progressive degeneration of the anterior horn cell due to an autosomal recessive genetic inheritance?
Spina Muscular Atrophy (SMA)
What are the 3 categories of Spinal Muscular Atrophy(SMA)?When do they occur?
Acute Infantile SMA - birth and two months. <1 year life expectancy
Chronic Childhood SMA - presents after 6 months - 1 year. Can survive into adulthood
Juvenile SMA - occurs 4-17 years old. Typically survive into adulthood
What are characteristics of SMA?
progressive muscle weakness and atrophy, diminished or absent DTRs, intact sensation, and normal intelligence
Nerve injury with throacic outlet syndrome can result in neuropraxia and progress to?
Axonotmesis
with TOS diffuse pain in the arm is often experienced most often when?
at night
Why might individuals with TOS have difficulty sleeping?
due to excessive pillows or malpositioning of the arm
What is the ratio of men to women with TOS?
women affected 2-3x more than men
If a patients symptoms with TOS persist for how long is surgical intervention warranted?
persisting 3 to 4 months
Hypoxia, drug overdoes, near drowing, and acceleration/deceleration injuries are examples of what type of brain injury?
Closed injury
Hematoma, hypoxia, ischemia, increased intracranial pressure, and post-traumatic epilepsy can result in what after an initial brain injury?
secondary injury
What is the difference between an epidural and subdural hematoma?
Epidural: between skull and dura matter
Subdural: due to venous rupture between the dura and arachnoid
What is the term for a state of genreal unresponsiveness with arousal occuring from repeated stimuli?
Stupor (not a coma, cause wouldnt arouse)
What is the term for a state of consciousness that is characterized by a state of sleep, reduced alterness to arousal , and delayed responses to stimuli?
Obtundity
What is the term for a state of consciousness that is characterized by disorientation, confusion, agitation, and loudness?
delirium
What is the term for a sate of consciousness that is characterized by quiet behavior, confusion, poor attentions, and delayed responses?
Clouding of consciousness
What is the term for a state of altertness, awareness, orientation, and memory?
consciousness
What are the names of the 8 levels of the RLA Levels of Cognitive Functioning?
I. No response II. Generalized response III. Localized Response IV. Confused - Agitated V. Confused - Inappropriate VI. Confused - Appropriate VII. Automatic - Appropriate VIII. Purposeful - Appropriate
What are the possible grades of a concussion?
Grade I
Garde II
Grade III
What defines the different grades of concussion?
Grade I: transient confusion lasting 15 minutes of less
Grade II: confusion lasts longer than 15 minutes and may have retrograde and anterograde amnesia
Grade III: any form of loss of consciousness, form of injury resulting from diffuse axonal injury.
Bizzare and non-purposeful behavior along with often nonexistent selective attention characterizes which RLA Level of Cognitive Functioning?
IV. confused-agitated
pg. 304
What stage of Cognitive Functioning is characterized by going through a daily routine automatically, frequently robot like and showing minimal to no confusion but judgement remains impaired?
VII. Automatic Appropriate
pg. 304
What stage of Cognitive Functioning is characterized by ability to reponsed to simple commands consistently but with lack of external structure or increased complexity has non-purposeful random responses. Also is highly distractible and lacks the ability to focus attention on specific tasks?
V. Confused - Inappropriate
pg. 304
What stage of Cognitive functioning do they show gaol directed behavior that is dependent on external input or direction?
VI. Confused - Appropriate
pg. 304
What stage of Congnitive functioning do they recall and integrate past and recent events and are aware of and responsive to environment showing carryover for new leaning?
VIII. Purposeful - Appropriate
pg. 304
What are the different ranges on the Glasgow Coma Scale and what are the 3 categories on the scale?
Possible range of scores?
range from 3 to 15
<8 Severe brain injury
9-12 moderate brain injury
13-15 mild injury
Eye Opening, Best Motor Response, and Verbal Response
what is the inability to create new memory?
Anterograde memory
What is the time between injury and wehn the patient is able to recall recent events?
Post-traumatic amnesia
what is the inability to remember events prior to injury?
Retrograde amnesia
What type of memory is usually the last to recover after a comatose state?
Anterograde memory
What causes trigeminal neuralgia?
Abnormal pressure or irritation of the trigeminal nerve
Is trigeminal neurogalia typically unilateral or bilateral?
unilateral
with trigeminal nerualgia how are chronic vs. episodic symptoms described?
Chronic: persistent aching or burning sensations
Episodic: sharp, jolting, stabbing, or shock like
What 3 things are the most common causes of vestibular disorders in younger inviduals?
- ear infection
- whiplash injury
- head injury
