Physical Effects Flashcards
Primary physical effects
motor function, muscle tone, sensation, breathing/coughing, B&B, genital function, CV, thermoregulation
Motor function
primary effect, paralysis of voluntary ms
Ant horn cell and out (LMN)- flaccid, denervation atrophy
descending tracts (UMN)- paralysis, spasticity, increase DTR, clonus, Babinski, dususe atrophy
Most SCI are a combo of UMN and LMN d/t disruption of both gray and white matter at LOL
muscle tone
primary effect; flaccidity with spinal shock
progress to spasticity (more common in cervical, thoracic, and incomplete lesions and ASIA B&C)
flaccid paralysis with more caudal lesions
Spasticity
primary effect; hyperactive stretch reflexes and clonus, increases after 6 mo, varies in severity, can assist in functional activities
Spasticity affected by:
positional changes, cutaneous stimuli, environmental temp, tight clothing, fecal impaction/catheter blockage, bladder/kidney stones, UTI, pressure ulcer, emotional stress
Management of Spasticity
drug therapy: diazepam, baclofen, dantrolene
injected agents: peripheral N block, intrathecal pump
surgery: tendon releases, sever N roots
PT: stretching, positioning, WB
Sensation
primary effect; impaired body awareness, vulnerable to trauma, usually improves over time
Breathing
primary effect; range of severity, above T12 affects ms of respiration
paradoxical breathing- depress rib cage and distend abdominal region with inhalation
sleep apnea- obesity, M>F
Ms of respiration
SCM, trap, scalene, pec minor, serratus anterior, diaphragm, intercostals, abs
C1-C2 innervates
partial SCM and traps
requires ventilatory support
no forced expiration
assist for airway clearance
C3
full SCM partial scalenes/diaphragm possible I breathing, fatigues ventilatory support acutely assist for airway clearance
C4
partial innervation of diaphragm
no abs- lose length tension for diaphragm
no intercostals
breathe I but need airway clearance
C5-8 Innervates
full diaphragm, most accessory ms, no intercostals, no abdominals
cough still impaired
T1-T5 innervates
some intercostals
no abdominals
impaired cough
T6-T12 innervates
some abdominals/intercostals- start at T6
L1 below: respiratory muscles intact
small lung capacity
Positional factors with SCI
breathe easier supine
sitting causes viscera to slide down, flattening diaphragm and losing length-tension relationship
B&B
requires intact sacral cord most SCI leads to loss of voluntary B&B control increase infection risk autonomic disreflexia skin breakdown
Normal bladder function- storage phase
sympathetic efferents- relax detrusor, contract bladder neck
tonic contraction of external sphincter and pelvic floor ms (somatic control)
Normal bladder- urination
detrusor contracts and bladder neck relaxes
parasympathetic stimulation
sphincter relaxes (somatic control)- reflex
Areflexive bladder
LMN; T12 or below, no parasympathetic stimulation
bladder is flaccid
bladder just keeps storing urine
overflow or dribbling incontinence
reflexive bladder
UMN; C/T injuries S2-S4 reflex arc intact lost descending input detrusor contracts, bladder neck relaxes d/t parasympathetic stim bladder empties reflexively no voluntary control
Detrusor-sphincter dyssynergia
may present with reflexive bladder
involuntary external sphincter and detrusor contracts same time
high post void residuals- urine left in bladder after empty
UTI, sepsis, autonomic dysreflexia, renal damage
Bladder Management goals
complete bladder emptying at appropriate intervals
low pressure voiding and storage of urine
prevention of urinary incontinence
Normal bowel function
intrinsic system- smooth ms control, GI tract has own N system
autonomic system:
- sympathetic- decrease peristalsis
-parasympathetic- excitatory effects
somatic system- voluntary control, external anal sphincter/pelvic floor S2-S4
Reflexes of bowel
intrinsic defecation reflex- mediated by intrinsic system; relax of internal anal sphincter, peristalsis
parasympathetic defecation reflex- relax of internal anal sphincter, intensification of peristalsis
Genital function
innervation from thoracolumbar and sacral region
disrupts sexual response
fertility unchanged in women, men likely infertile
cardiovascular effects
lasting- decrease exercise tolerance, exercise hypotension, decrease venous return, SV and CO, autonomic dysreflexia
Postural hypotension
common early on, slow progression to vertical, monitor BP, compression hose/ abdominal binder helps
Thermoregulation
towards hyperthermia
lose sympathetic control of sweat glands- no sweat below LOL, excess sweat above LOL
varies with LOL- higher lesions more problematic
Complications post SCI
autonomic dysreflexia, pressure ulcers, respiratory, contractures, HO, osteroporosis/fx, pan, GI, UTI, DVT/PE, CV disease
