Physical Effects, Complications and Effects of Aging Flashcards
What are the primary physical effects of a SCI?
motor function muscle tone sensation breathing/coughing bowel and bladder genital function cardiovascular thermoregulation
What are the hallmarks of a LMN?
flaccid paralysis
dennervated atrophy
What are the hallmarks of UMN?
paralysis spasticity increase DTR clonus Babinski disuse atrophy
How is motor function affected by a SPI?
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 is muscle tone affected by a SPI?
flaccidity with spinal shock (everything shuts down)
may progress to spasticity
In what SPIs is spasticity more common?
cervical, thoracic and incomplete (ASIA B and C)
In what SPIs is flaccid paralysis more frequent?
caudal lesions (cauda equina)
What is spasticity?
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
What is spasticity affected by?
positional changes, cutaneous stimuli, environmental temperature (cold), tight clothing, fecal impaction/catheter blockage, bladder/kidney stones, UTI, pressure ulcer, and emotional stress
What are the drug therapies for spasticity?
diazepam/valium
baclofen
dantrolene
Significant side effects (lethargy) and are non specific so it will decrease tone everywhere
What are the injected agents used for treating spasticity?
peripheral nerve block and intafecal catheter (usually more specific but invasive)
What are the surgical options for treating spasticity?
Tendon releases
Sever nerves or nerve roots
What is the PT management for spasticity?
prolonged stretching
position out of the position that makes it worse
prolonged weight bearing
How is sensation affected with a SPI?
impairs body awareness (significant barrier)
makes patient vulnerable to trauma
usually improves overtime
What lesions affect the muscles of respiration?
T12 and above will affect muscles but just because it is below T12 doesn’t mean there will be no respiratory problems
What are the muscles of respirations and their innervations?
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
Respiration function with a C1-2 neurological level?
Partial SCM and Upper traps
no diaphragm
will need to be on a ventilator
need assistance with forced exhalation or airway clearance
Respiration function with a C3 neurological level?
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
Respiration function with a C4 neurological level?
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
Respiration function with a C5-8 neurological level?
Full diaphragm, partial to full scalenes, serratus anterior and pec minor (most accessory muscles)
breathes I better
need assistance with forced exhalation/airway clearance
Respiration function with a T1-5 neurological level?
Partial intercostals but no abdominals
breathes I
needs assistance with forced exhalation/airway clearance
Respiration function with a T6-12 neurological level?
Partial to full intercostals and abdominals
Could have some compromise with coughing
L1 and below respiratory muscles are intact
What are the positional factors with respirational problems?
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
What is a paradoxical breathing pattern?
Upper chest depresses and lower distends in inhalation
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
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
What are the implications for loss of voluntary bowel and bladder control?
infection sepsis skin breakdown autonomic dysreflexia death
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
What is the urination phase in normal bladder function?
Parasympathetic stimulation contracts detrusor muscle and relaxes bladder neck
Somatic control relaxers external sphincter
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
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
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
What are the possible causes of detrusor-sphincter dyssynergia?
UTI
sepsis
autonomic dysreflexia
renal damage
What are the bladder management goals?
complete bladder emptying at appropriate intervals
low pressure voiding and storage of urine
prevention of urinary incontinence
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)
