Physical Effects

Question 1

Primary physical effects

Answer 1

motor function, muscle tone, sensation, breathing/coughing, B&B, genital function, CV, thermoregulation

Question 2

Motor function

Answer 2

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

Question 3

muscle tone

Answer 3

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

Question 4

Spasticity

Answer 4

primary effect; hyperactive stretch reflexes and clonus, increases after 6 mo, varies in severity, can assist in functional activities

Question 5

Spasticity affected by:

Answer 5

positional changes, cutaneous stimuli, environmental temp, tight clothing, fecal impaction/catheter blockage, bladder/kidney stones, UTI, pressure ulcer, emotional stress

Question 6

Management of Spasticity

Answer 6

drug therapy: diazepam, baclofen, dantrolene
injected agents: peripheral N block, intrathecal pump
surgery: tendon releases, sever N roots
PT: stretching, positioning, WB

Question 7

Sensation

Answer 7

primary effect; impaired body awareness, vulnerable to trauma, usually improves over time

Question 8

Breathing

Answer 8

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

Question 9

Ms of respiration

Answer 9

SCM, trap, scalene, pec minor, serratus anterior, diaphragm, intercostals, abs

Question 10

C1-C2 innervates

Answer 10

partial SCM and traps
requires ventilatory support
no forced expiration
assist for airway clearance

Question 11

C3

Answer 11

full SCM
partial scalenes/diaphragm
possible I breathing, fatigues
ventilatory support acutely
assist for airway clearance

Question 12

C4

Answer 12

partial innervation of diaphragm
no abs- lose length tension for diaphragm
no intercostals
breathe I but need airway clearance

Question 13

C5-8 Innervates

Answer 13

full diaphragm, most accessory ms, no intercostals, no abdominals
cough still impaired

Question 14

T1-T5 innervates

Answer 14

some intercostals
no abdominals
impaired cough

Question 15

T6-T12 innervates

Answer 15

some abdominals/intercostals- start at T6
L1 below: respiratory muscles intact
small lung capacity

Question 16

Positional factors with SCI

Answer 16

breathe easier supine

sitting causes viscera to slide down, flattening diaphragm and losing length-tension relationship

Question 17

B&B

Answer 17

requires intact sacral cord
most SCI leads to loss of voluntary B&B control
increase infection risk
autonomic disreflexia
skin breakdown

Question 18

Normal bladder function- storage phase

Answer 18

sympathetic efferents- relax detrusor, contract bladder neck

tonic contraction of external sphincter and pelvic floor ms (somatic control)

Question 19

Normal bladder- urination

Answer 19

detrusor contracts and bladder neck relaxes
parasympathetic stimulation
sphincter relaxes (somatic control)- reflex

Question 20

Areflexive bladder

Answer 20

LMN; T12 or below, no parasympathetic stimulation
bladder is flaccid
bladder just keeps storing urine
overflow or dribbling incontinence

Question 21

reflexive bladder

Answer 21

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

Question 22

Detrusor-sphincter dyssynergia

Answer 22

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

Question 23

Bladder Management goals

Answer 23

complete bladder emptying at appropriate intervals
low pressure voiding and storage of urine
prevention of urinary incontinence

Question 24

Normal bowel function

Answer 24

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

Question 25

Reflexes of bowel

Answer 25

intrinsic defecation reflex- mediated by intrinsic system; relax of internal anal sphincter, peristalsis
parasympathetic defecation reflex- relax of internal anal sphincter, intensification of peristalsis

Question 26

Genital function

Answer 26

innervation from thoracolumbar and sacral region
disrupts sexual response
fertility unchanged in women, men likely infertile

Question 27

cardiovascular effects

Answer 27

lasting- decrease exercise tolerance, exercise hypotension, decrease venous return, SV and CO, autonomic dysreflexia

Question 28

Postural hypotension

Answer 28

common early on, slow progression to vertical, monitor BP, compression hose/ abdominal binder helps

Question 29

Thermoregulation

Answer 29

towards hyperthermia
lose sympathetic control of sweat glands- no sweat below LOL, excess sweat above LOL
varies with LOL- higher lesions more problematic

Question 30

Complications post SCI

Answer 30

autonomic dysreflexia, pressure ulcers, respiratory, contractures, HO, osteroporosis/fx, pan, GI, UTI, DVT/PE, CV disease