PT and Medical Management of SCI and GBS Flashcards
1
Q
spinal cord ends at…
A
L1-2
2
Q
sacral cord segments (cauda equina) are level with what vertebra
A
T12-L1
3
Q
hyperextension injuries are common in this region and cause damage to what structures
A
common in c-spine
anterior ligaments and disc
4
Q
hyperflexion injuries could cause damage to what structure
A
- if posterior ligament is intact, wedging of vertebral body occurs
- if ligament is torn, may cause subluxation
5
Q
_____ compression can cause burst fractures
A
axial
*bone fragments may be pushed into cord
6
Q
this mechanism of injury can cause dislocation with or without fracture
A
flexion with rotation
7
Q
types of severity of SC damage (5)
A
1 - concussion
2 - contusion
3 - laceration
4 - compression
5 - complete transection
8
Q
all types of damage except _____ can lead to complete SCI
A
concussion
9
Q
what could cause laceration of the spinal cord
A
- bony fragments being driven into the foramen
- cord stretched to point of tearing
10
Q
what could cause compression of SC
A
- displacement of vertebrae
- disc herniation
- swelling
- displacement of bone fragment
11
Q
T or F: a concussion of the SC is temporary and transient
A
T
12
Q
what are some non-traumatic causes of SCI
A
- SC stroke (atherosclerosis, cardiac arrest, AAA)
- SC tumor
- spinal cord syrinx
- transverse myelitis
13
Q
transverse myelitis
A
inflammation of spinal cord
14
Q
syringomyelia
A
fluid filled cyst in spinal cord
15
Q
decompression sickness happens when…
A
coming up too fast when diving
16
Q
what is step 1 of emergency management of SCI?
A
immobilization and stabilization
17
Q
ideally, all pts with SCI would be transported to where
A
a level 1 trauma center
18
Q
what are 3 types of medications given in emergency management of SCI and why
A
1 - corticosteroids: to manage inflammatory response
2 - anticoagulants: to manage blood clots
3 - vasopressors and fluids: manage orthostatic hypotension from neurogenic shock
19
Q
Stable SCI - what is it, how is it treated
A
- vertebral column will not displace by normal movement
- treated with bracing
20
Q
unstable SCI - what is it, how is it treated
A
- significant risk of displacement and further damage to neural tissue
- need to reduce fx and stabilize
21
Q
for pt’s with stable SCI, what do you need prior to mobilizing pt
A
upright x-ray to make sure the brace is doing its job
22
Q
where do you brace
A
above and below the injured segment
23
Q
single most common level of SCI
A
C5
24
Q
what are some indications for surgical management of SCI?
A
- compression of cord
- unstable vertebral body
- penetrating wound
- bony fragments in spinal cord
- stabilize the spine
*goal is to remove pressure from cord to preserve function and provide stability
25
what should a halo ring always have on the front of the vest
a wrench to allow for CPR
26
precautions for Halo ring
none specifically because halo prevents all the movements you shouldn't do
27
cervical precautions
no bending, lifting, turning, unilateral shoulder flexion above 90 degrees
28
spinal precautions
no bending, lifting, or twisting
29
how should UE resistive exercises be completed during the first 6 weeks post-op spine surgery
symmetrically to prevent rotational forces
30
T or F: you can use a pillow under the head with a c-collar
F: use a folded towel to fill space between bed and pt's head with increasing cervical or thoracic flexion
31
______ shock only occurs when there is direct injury to the spinal cord while _____ shock can occur with any insult to the nervous system
spinal
neurogenic
32
spinal shock
muscle flaccidity, paresis, loss of sensation, areflexia
33
spinal shock typically lasts...
24-48 hours
34
neurogenic shock
autonomic dysfunction - sudden loss of sympathetic control
35
classic triad for neurogenic shock
1 - hypotension
2 - bradycardia
3 - hypothermia
36
neurogenic shock occurs within ___ minutes of spinal cord injury level ______ or above. It can last up to ______ weeks
30 minues
T5/6
6 weeks
37
what is the leading cause of death in people with SCI
cardiovascular/pulmonary disease
38
where is the sympathetic nervous system in the spinal cord
T1-L2
39
where is the parasympathetic nervous system in the spinal cord
pelvic splanchnic nerves (S2-4)
40
if you have an injury at the _____ level or above you have lost descending sympathetic control to more than half of the body
T6
41
Heart and lungs sympathetic levels
T1-T5
42
With SCI, you get peripheral ______ below the level of the lesion
vasodilation
43
T or F: people with SCI have reduced exercise tolerance. Why or why not?
T: they cannot increase their HR because of impaired sympathetic NS
44
T or F: the left ventricle can atrophy with SCI autonomic dysfunction
T
45
orthostatic hypotension is a drop in systolic BP of at least ____ mmHg or diastolic of at least _____ mmHg when changing position
20
10
46
what is the physiology behind orthostatic hypotension
it is a failure of the NS to respond pooling of blood in the extremities
*in SCI, this is due to lack of sympathetic NS
47
What equipment can help treat orthostatic hypotension
- tilt in space wheelchair, tilt table
- gradually increase tilt by 5-10 degrees taking BP every 5 minutes and stopping if orthostatic
- *can also use ace wraps, venodyne boots, abdominal binders, and compression socks to help increase BP
48
why is it important to make sure LE ACE wraps are not too tight in higher level spinal injuries
it can become a noxious stimuli which in T6 and above can cause autonomic dysreflexia
49
normal BP for cervical level SCI
90/60
50
Pts with SCI experience hypothermia due to _____. they can also experience hyperthermia because why?
hypo = peripheral vasodilation and absence of shivering
hyper = no sweating below lesion
51
autonomic dysreflexia
LARGE sympathetic response
MEDICAL EMERGENCY
52
autonomic dysreflexia is common in SCI level _______ and above
T6
53
What is autonomic dysreflexia triggered by
noxious stimuli below the SCI lesion
*often related to bladder
*could be too tight clothing, wraps, or abdominal binder, pressure sores, or fecal impaction
54
You are working in acute care and your pt with a C5 SCI starts complaining of a sudden, severe headache. His face is flush and profusely sweating. His UE and LE are dry and pale. What is likely happening and what do you do?
autonomic dysreflexia
raise the HOB to sit them upright, notify nurse, and take vitals. check for any possible noxious stimuli
55
symptoms of autonomic dysreflexia
- hypertension
- bradycardia
- headache
- profuse sweating above level of injury
- dry and pale skin below level of injury
56
cardiac output =
heart rate x stroke volume
57
mechanism behind autonomic dysreflexia
- noxious sensory input excites sympathetic system
- descending parasympathetic signals cannot be transmitted below level of injury
- increase in peripheral vascular resistance is greater than compensating parasympathetic response which is limited to levels above lesion
58
autonomic constriction causes what with blood vessels and BP
vasoconstriction
hypertension
59
if the face is pale, raise the ______. if the face is red, raise the ______
tail
head
60
what innervates the diaphragm
phrenic nerve (C3-5)
61
why do people with SCI often get lung infections
to effectively cough, you need your abdominals therefore people with SCIs cannot clear secretions
62
T or F: people with high cervical SCIs have reduced inspiratory and expiratory ability
T
63
what innervates the intercostal muscles
T1-11
64
what innervates the abdominal muscles
T6-L1
65
cervical lesions lead to what kind of respiration? what does it look like
- paradoxical
- the chest and abdomen move in opposite directions instead of the same
66
what does an abdominal binder do
- optimizes respiratory function - increases vital capacity
- increases total lung capacity
- helps manage orthostatic hypotension
67
T or F: you can wear an abdominal binder in supine
F
68
where should an abdominal binder be situated
top = below floating ribs
bottom = ASIS
69
what can you do to help a pt with SCI cough
- abdominal thrust (basically the heimlich)
- lateral/costophrenic assist (hands on lateral costals - pressure inward and downward through expiration)
70
what does the angle of a tilt chair need to be to provide adequate pressure relief
25-65
71
pressure relief every _____ minutes for ______ minutes when sitting
20
2
72
reposition every ____ hours in bed
2
73
heterotopic ossification
bone growth in or near a joint after SCI and TBI
74
T or F: heterotopic ossification is always below the level of the lesion
T
75
T or F: there is a known etiology for heterotopic ossification
F
76
heterotopic ossification is commonly found in what joints
hips, knees, elbows
77
how to diagnose heterotopic ossification
- asymmetrical ROM
- x-ray won't show it right away
- bone scan (detects early)
78
in SCI, make sure to always complete hip flexion in a...
straight plane
79
gold standard to diagnose DVT
ultrasound
80
T or F: Homan's sign is good to perform
F: NO, use Well's instead
81
signs of pulmonary embolism
- sudden SON
- hypoxemia
- pressure/pain in chest
- panic
- hypotension
- tachycardia
-arrhythmia
*MEDICAL EMERGENCY
82
nociceptive pain vs neuropathic pain
nociceptive = dull, aching, cramping (MSK, visceral)
neuropathic = burning, electric, shooting (PNS< CNS)
83
complex regional pain syndrome is _____ pain
neuropathic
84
signs/symptoms of CRPS
STAMP
- sensory: allodynia, hypo/hyperalgesia, hypo/hyperesthesia
- tropic: skin, hair, nail changes
- autonomic: swelling, edema, sweating
- motor: weakness, contractures, atrophy
- pain
85
bariatric pts with spinal cord injuries may need what kind of wheelchair and why
a power chair because larger manual WC are harder to propel due to biomechanics
86
T or F: a pt with both a SCI and TBI is more likely to need ventilator support
T
87
spasticity usually develops within the first ____ months of injury due to spinal shock
3
88
spasticity develops because below the level of injury the spinal reflexes are still intact, but lack ___ from the cortex
inhibition
89
spasticity is velocity ______ while contractures are velocity ________
dependent
independent
90
spasticity develops _____ while contractures develop ________
acutely
chronically
91
T or F: with contractures ROM varies based on position or other factors
F: but spasticity can
92
T or F: spasticity is always bad
F it can help with transfers, grip, B&B training, postural control, prevent DVTs, and/or helps maintains good muscle mass
93
T or F: noxious stimuli can trigger spasticity
T: (infection, sores, movement, stretch, UTI, tight clothing)
94
what are a few ways to manage spasticity in PT
- skin checks below level of injury
- ROM, stretching pt, caregiver ed
- supported standing
- positioning
- bracing
95
what are some advantages to a baclofen pump to treat spasticity? disadvantages?
- advantages: effective, no systemic side effects, consistent treatment, allows for reduced oral meds
- disadvantages: increased infection risk, surgery, limited battery life, minimal effect on UE, may compromise walking
96
what is a neurosurgery that can help manage spasticity? what about ortho surgeries?
neuro = selective dorsal root rhizotomy
ortho = tendon lengthening, tendon transfer
97
in normal bladder function, the _____ nervous system controls bladder filling and the _______ nervous system controls bladder emptying
sympathetic
parasympathetic
98
in an injury is above T12 skeletal level, is the B&B reflexive or areflexive
reflexive - UMN
- B&B can fill and empty reflexively but pts have poor control of it
- incontinence common
99
if an injury is below T12 skeletal level is the B&B reflexive or areflexive
areflexive - LMN
- cannot empty bladder or remove stool - self catheter
100
T or F: when treating pts with GBS, anticipate a full recovery
T
101
What is one of the most important things to monitor for when working with pts who have GBS
- fatigue... if you overwork these pts the symptoms can get worse
- start light, take rest breaks and reduce activity if function declines or pt reports increased fatigue
102
what might pts with GBS benefit from wearing during mobility
a cervical collar to help with control of the head
103
duration/intensity for aerobic exercise in pts with GBS
- 15-20 minutes a session
- mod intensity: 45-60% HR max or RPE 13
104
what are some symptoms of overwork in GBS
- DOMS
- decreased max isometric force produced that gradually recovers
- muscle belly tenderness
- increase in serum creatine kinase (check labs)
105
where do most pt d/c to after SCI or GBS
home
106
how fast do you need to be able to walk/roll to safely across the street
1.06 m/s
107
you have to be able to lift ______ of your body weight to perform a successful pop-over transfer without shearing
2/3
