Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuro III > Physical Effects, Complications and Effects of Aging > Flashcards

Physical Effects, Complications and Effects of Aging Flashcards

1
Q

What are the primary physical effects of a SCI?

A 
motor function
muscle tone
sensation
breathing/coughing
bowel and bladder
genital function
cardiovascular 
thermoregulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the hallmarks of a LMN?

A

flaccid paralysis

dennervated atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the hallmarks of UMN?

A 
paralysis
spasticity
increase DTR
clonus
Babinski
disuse atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is motor function affected by a SPI?

A

Combination of LMN and UMN d/t disruption of white and gray matter
Paralysis or paresis of voluntary musculature
Anterior horn cells and out are damaged (LMN)
Descending tracts are damaged (UMN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is muscle tone affected by a SPI?

A

flaccidity with spinal shock (everything shuts down)

may progress to spasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In what SPIs is spasticity more common?

A

cervical, thoracic and incomplete (ASIA B and C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In what SPIs is flaccid paralysis more frequent?

A

caudal lesions (cauda equina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is spasticity?

A

An increase to resistance to movement and is velocity dependent
Hyperactive stretch reflexes and clonus
Gradually increases after 6 months
Varies in level of severity
Can assist or interfere in functional activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is spasticity affected by?

A

positional changes, cutaneous stimuli, environmental temperature (cold), tight clothing, fecal impaction/catheter blockage, bladder/kidney stones, UTI, pressure ulcer, and emotional stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the drug therapies for spasticity?

A

diazepam/valium
baclofen
dantrolene
Significant side effects (lethargy) and are non specific so it will decrease tone everywhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the injected agents used for treating spasticity?

A

peripheral nerve block and intafecal catheter (usually more specific but invasive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the surgical options for treating spasticity?

A

Tendon releases

Sever nerves or nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the PT management for spasticity?

A

prolonged stretching
position out of the position that makes it worse
prolonged weight bearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is sensation affected with a SPI?

A

impairs body awareness (significant barrier)
makes patient vulnerable to trauma
usually improves overtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What lesions affect the muscles of respiration?

A

T12 and above will affect muscles but just because it is below T12 doesn’t mean there will be no respiratory problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the muscles of respirations and their innervations?

A 
SCM- CN XI, C2-3
Upper Trap- CN XI, C2-4
Diaphragm- C3-5
Scalenes- C3-8
Serratus Anterior- C5-7
Pec Minor- C6-T1
Intercostals T1-11
Abdominals T6-L1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Respiration function with a C1-2 neurological level?

A

Partial SCM and Upper traps
no diaphragm
will need to be on a ventilator
need assistance with forced exhalation or airway clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Respiration function with a C3 neurological level?

A

Full SCM, partial Upper Trap, scalenes and diaphragm
may be able to breathe I but will fatigue quickly
ventilator support acutely
need assistance with forced exhalation/airway clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Respiration function with a C4 neurological level?

A

Full Upper traps, partial diaphragm and scalenes
may be able to breathe I but ventilation in the beginning because diaphragm will flatten and will be compromised
need assistance with forced exhalation/airway clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Respiration function with a C5-8 neurological level?

A

Full diaphragm, partial to full scalenes, serratus anterior and pec minor (most accessory muscles)
breathes I better
need assistance with forced exhalation/airway clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Respiration function with a T1-5 neurological level?

A

Partial intercostals but no abdominals
breathes I
needs assistance with forced exhalation/airway clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Respiration function with a T6-12 neurological level?

A

Partial to full intercostals and abdominals
Could have some compromise with coughing
L1 and below respiratory muscles are intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the positional factors with respirational problems?

A

Supine will be easier because will increase pressure d/t increase abdominal area
Sitting is harder because abdominal contents lower and diaphragm could flatten and compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a paradoxical breathing pattern?

A

Upper chest depresses and lower distends in inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is sleep apnea and who does it affect?
Moments in sleep when a person ceases breathing increased incidence in SPI associated with obesity and males
26
What needs to be intact for normal bowel and bladder function?
Intact sacral cord | most SCI lead to loss of voluntary bowel and bladder control
27
What are the implications for loss of voluntary bowel and bladder control?
``` infection sepsis skin breakdown autonomic dysreflexia death ```
28
What is the storage phase in normal bladder function?
Sympathetic efferents relax detrusor muscle and contract bladder neck Somatic control- tonic contraction of external sphincter and pelvic floor muscles
29
What is the urination phase in normal bladder function?
Parasympathetic stimulation contracts detrusor muscle and relaxes bladder neck Somatic control relaxers external sphincter
30
What is areflexive bladder?
LMN at or below T12 lose parasympathetic stimulation bladder is flaccid and large volumes remain d/t lack of reflexive emptying overflow or dribbling incontinence
31
What is reflexive bladder?
UMN C/T-spine injuries S2-4 reflex arc intact descending (sympathetic) input lost bladder empties reflexively (parasympathetic control) because there is no voluntary control
32
What is detrusor-sphincter dyssynergia?
involuntary external sphincter contraction occurs at the same time as detrusor contraction (can't get urine out) high post void residuals can be present with reflexive bladder
33
What are the possible causes of detrusor-sphincter dyssynergia?
UTI sepsis autonomic dysreflexia renal damage
34
What are the bladder management goals?
complete bladder emptying at appropriate intervals low pressure voiding and storage of urine prevention of urinary incontinence
35
What is normal bowel function?
Intrinsic- control of smooth muscle in gut, internal sphincter Autonomic- sympathetic dampens peristalsis and parasympathetic excites peristalsis Somatic- external anal sphincter and pelvic floor (S2-4)
36
What is the intrinsic defecation reflex?
mediated by intrinsic system relaxes internal anal sphincter and peristalsis not strong enough to produce bowel movement alone
37
What is the parasympathetic defecation reflex?
relaxation of internal anal sphincter and intensification of peristalsis
38
What is areflexive bowel function?
Sacral reflex arc not intact can become impacted or incontinent manual evacuation techniques needed
39
What is reflexive bowel function?
Sacral reflex arc intact bowels function reflexively digital stimulation needed
40
How is genital function affected by SPI?
innervated from thoracolumbar and sacral region disrupts sexual response men are likely to be infertile
41
What are the early cardiovascular effects?
``` at or above T6 bradycardia bradyarrhythmia hypotension orthostatic hypotension ```
42
What are the lasting cardiovascular effects?
``` at or above T6 decrease exercise tolerance exercise-induced hypotension decrease venous return, stroke volume and CO autonomic dysreflexia ```
43
How can you manage postural hypotension?
common early on slow progression to vertical monitor BP compression hose or abdominal binder may help
44
How is thermoregulation affected by SPI?
tendency toward hyperthermia lose sympathetic control of sweat glands (no sweating below excessive sweating above) higher lesions are more problematic (can't go in hot tub)
45
What are some physical complications in SPI?
autonomic dysreflexia, pressure ulcers, contractures, HO, respiratory, osteoporosis/fractures, pain, GI, urinary tract, DVT/PE, and CV disease
46
What is autonomic dysreflexia?
pathological autonomic reflex produced by noxious stimuli below LOL usually in at or above T6 complete or incomplete lesion considered a medical emergency because it triggers excessive sympathetic response (could lead to CP failure, LOC, seizures, stroke, coma or death)
47
What are the symptoms are autonomic dysreflexia?
``` hypertension bradycardia HA (severe and pounding) usually first symptom increase sweating increase spasticity flushing above LOL nasal congestion/ constricted pupils goose bumps blurred vision anxiety ```
48
What are possible initiating stimuli of autonomic dysreflexia?
``` bladder distention bowel distention tight clothing/orthotics/straps pressure sores urinary stones bladder infection ```
49
What is the intervention for autonomic dysreflexia?
Sit pt up search for noxious stimuli and correct (question pt if needed) call for help or code monitor BP and keep head up document event usually removal of stimuli will fix problem
50
Pressure ulcers in SCI?
more vulnerable up to 85% will develop at least 1 serious medical complications can lead to osteomyelitis/infection/sepsis/death
51
What are the factors associated with pressure ulcers?
``` excessive pressure prolonged unrelieved pressure shearing or dragging exposure to moisture local or systematic temperature elevation skin collagen degradation compromised peripheral blood flow ```
52
What are the stages of a pressure ulcer?
1: non-blanchable erythema 2: partial thickness 3: full thickness skin loss 4: full thickness tissue loss
53
What is stage 1 of a pressure ulcer?
Non-blanchable erythema intact skin can keep from progressing harder to see on darker patients
54
What is stage 2 of a pressure ulcer?
partial thickness partial loss of dermis shallow open wound
55
What is stage 3 of a pressure ulcer?
full thickness skin loss | eaten through subcutaneous fat
56
What is stage 4 of a pressure ulcer?
full thickness tissue loss | eaten through muscle, tendon and down to bone
57
What are the most susceptible areas for pressure ulcers?
``` sacrum heel ischial tuberosity scapula malleolus occiput spinous process ```
58
What is the treatment of pressure ulcers?
prevent by turning patient every 2 hours or pressure relief every 10 mins if in sitting local wound care diet (protein for healing) surgical management is really progressed
59
What are the respiratory problems for SCI?
most common cause of death reduction in inspiratory/expiratory ability ineffective cough
60
What can respiratory problems in SCI lead to?
atelectasis pneumonia respiratory insufficiency
61
How can contractures occur in SPI?
inability to move and muscle imbalance spasticity habitual postures
62
What are some complications for contractures?
significantly affect function increase likelihood of skin breakdown higher the lesion the more debilitated by contractures
63
What are the common contracture sites?
shoulder flexion elbow flexion wrist flexion knee flexion
64
What is heterotopic ossification?
deposition of bone in soft tissue around peripheral joints (extra articular/ extracapsular) usually stronger than older bone almost always below level of lesion
65
What are the common sites of HO?
hip knee shoulder elbow
66
What are the signs and symptoms of HO?
1-6 months after SCI joint swelling/warmth joint p! if intact sensation decrease ROM
67
What must be differentiated from with HO?
thrombosis cellulitis infection hematoma
68
How do you diagnose HO?
plain film is most common bone scan for early detection and monitoring growth (best way but expensive) MRI/CT shows relationship to blood vessels, nerves and muscles
69
What is the drug treatment for HO?
Prophlactic (NSAIDS) prevention d/t inhibits osteogenic cells and suppresses prostaglandin-mediated response Bisphosphonates: inhibit CA phosphate precipitation (prevents progression)
70
What is the surgical management of HO?
lesions are removed but must be mature (12-18 months) or will return bone scan to determine metabolic activity
71
What is PT management of HO?
ROM (aggressive could restart process) strengthening post-op control of edema, and scar management
72
Osteoporosis in SCI?
rapid bone loss in the first few months 25% in hip and 50% in knee 2 yrs after more common with motor complete than incomplete UE in tetraplegia
73
What is the fracture risk in SCI?
2x more likely than able-bodied distal femur/proximal tibia most common associated with increase morbidity: non-union, delayed healing, pressure ulcers LOS is 7x longer than other health problems
74
What are the common causes of fractures in SCI?
fall from WC transfer from WC rolling over in bed (weakest in shearing/twisting)
75
What are the PT interventions for fractures?
WB exercise acute (dynamic, duration but not sustained) and chronic low magnitude vibration (delays bone loss) FES (acute and chronic but only bones muscle cross) bisphosphonates anabolic agents (parathyroid)
76
What are the sources of pain in SCI?
traumatic events (fx, ligaments, muscle, sx) nerve root dysesthesias (diffuse p) musculoskeletal (posture, overuse)
77
What are the effects on gastrointestinal in SPI?
``` 2-22% develop stress ulcers in stomach/duodenum paralytic ileus (gut shuts down) other: fecal impaction/ bowel obstruction, gallstones, hemorrhoids) ```
78
What are the urinary tract complications in SPI?
``` urinary retention kidney/bladder stones kidney failure septicemia increase risk of bladder cancer ```
79
What are the chances of DVT/PE in SCI?
highest incidence 72 hours to 2 weeks after SCI rare in chronic SCI consequence of decreased muscle function and mobility and hypercoagulability PE is leading cause of death in first year after SCI
80
What are the chances of cardiovascular disease in SCI?
higher than general population contributing factors: sedentary lifestyle, increased body fact, lipid abnormalities, altered glucose metabolism and diabetes
81
What is syringomyelia?
development of an abnormal cyst or cavity within spinal cord that compresses spinal cord and decreases neurological level unknown cause months to years after SCI
82
Where are the areas of occurrence of syringomyelia?
most common is lower c-spine (cerebrobulbia) brainstem (CN problem, dysarthria, nystagmus) lumbosacral segments (less common, B&B problems)
83
What is the treatment for syringomyelia?
drain cavity | place shunt
84
What are the effects of aging in SPI?
increase rick of pressure ulcers (decrease thickness, decrease blood supply, decrease movement) increase risk of respiratory complications increase incidence of sleep apnea urinary tract complications GI (slows down, constipation, hemhroid)
85
What are the neurological effects of aging in SPI?
overuse nerve entrapment decrease neurons brachial plexus
86
What are the endocrine effects of aging in SPI?
increase body fat distribution of fat changes increase obesity increase diabetes
87
What are the musculoskeletal effects of aging in SPI?
RTC tears overuse injuries shoulder impingements
88
What are the cardiovascular effects of aging in SPI?
increase risk for CV disease | quit smoking, lose weight, control cholesterol, and be active

Neuro III (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions