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PTA - Neuro > PTA Neuro - SCI, MS > Flashcards

PTA Neuro - SCI, MS Flashcards

1
Q

What functional capability does a patient with injury at level C1 - C3 have?

A
  • require mechanical ventilation
  • full time attendants
  • totally dependent in all ADLs, transfers, pressure relief
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2
Q

What functional capability does a patient with injury at level C4 have?

A
  • diaphragm
  • upper trapezius
  • no upper extremity innervation
  • dependent in all ADLs and transfers
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3
Q

What key muscles and available movement does the C5 level injured patient have?

A
  • biceps
  • brachialis
  • brachioradialis
  • deltoid
  • infraspinatus
  • rhomboids
  • serratus anterior
  • supinator
  • teres minor
elbow flexion
supination
shoulder ER
shoulder ABduction to 90
shoulder Flexion to 90
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4
Q

What key muscles and available movement does the C6 level injured patient have?

A
  • extensor carpi radialis
  • latissimus dorsi
  • pec major (clavicular bit)
  • pronator teres (weak)
  • serratus anterior
  • teres major
  • shoulder flexion, extension, IR, ADduction
  • scapular ABduction, protraction, upward/lateral rotation
  • forearm pronation
  • wrist extension
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5
Q

What key muscles and available movement does the C7 level injured patient have?

A
  • triceps
  • flexor carpi radialis
  • latissimus
  • pronator teres
  • elbow extension
  • wrist flexion
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6
Q

What key muscles and available movement does the C8 level injured patient have?

A
  • flexor carpi ulnaris
  • extensor carpi ulnaris
  • hand intrinsics
  • finger flexors
  • can write
  • finger flexion
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7
Q

What key muscles and available movement does the T1 - T8 level injured patient have?

A
  • hand intrinsics
  • top half of intercostals
  • pec major (sternal portion)
  • upper abs from T7
  • manual wheelchair propulsion
  • improved trunk control and breathing capabilities
    (barely any abs)
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8
Q

What key muscles and available movement does the T9 - T11 level injured patient have?

A
  • upper and lower abdominal muscles
  • upper and lower intercostals (we have deduced this)
  • independent wheelchair mobility
  • able to initiate cough (because lower abs)
    (still no hip flexor)
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9
Q

At what spinal level are the Upper Abdominals active?

A

T7 - T9

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10
Q

At what spinal level are the Lower Abdominals active?

A

T9 - T12

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11
Q

What key muscles and available movement does the T12 - L2 level injured patient have?

A
  • quadratus lumborum

still no quads

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12
Q

What key muscles and available movement does the L1 - L3 level injured patient have?

A
  • iliopsoas
  • quadratus lumborum
  • rectus femoris
  • gracilis
  • sartorius
  • hip flexion
  • hip adduction
  • knee extension
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13
Q

What key muscles and available movement does the L4 - L5 level injured patient have?

A
  • all the quadriceps group
  • medial hamstrings (L5 - S1)
  • anterior tibialis (L5)
  • strong hip flexion
  • strong knee extension
  • knee flexion
  • ankle dorsiflexion
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14
Q

What key muscles and available movement does the S1 level injured patient have?

A
  • plantar flexors
  • gluteus maximus
  • gastrocnemius
  • peroneals (L5, S1)
  • flexor digitorum (L5, S1)
  • ankle plantarflexion
  • ankle eversion
  • toe flexion
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15
Q

What key muscles and available movement does the S2 level injured patient have?

A
  • anal sphincter
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16
Q

At what level spinal cord injury may the patient live independently?

A

C6

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17
Q

List non-traumatic causes of SCI

A
  • Infections (Transverse myelitis, abscess)
  • Spinal Tumors
  • Multiple Sclerosis, ALS
  • Vascular Problems
  • Vertebral Subluxations due to - RA or DJD; Spinal stenosis
  • Spina bifida, toxins
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18
Q

What is tetraplegia?

A

(was quadriplegia)

  • Partial/Complete Paralysis of Trunk and Four Extremities
  • results from Cervical Lesions
  • no trunk control
  • strictly UE strength
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19
Q

What is paraplegia?

A
  • Partial/Complete Paralysis of All or Part of Trunk and Both Lower Extremities
  • results from Thoracic or Lumbar Cord Lesions
  • T1 on down to L5
  • Cauda Equina Injury = L1 or Below
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20
Q

How is the level of spinal cord injury designated?

A

by the most inferior or distal spared nerve root segment

(ex. a C5-level has innervation at C5, but none from C6 and down)
- intact muscle function is at least 3/5 muscle strength per MMT

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21
Q

At what level is a Cauda Equina injury?

A

below L1

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22
Q

What determines a spinal cord injury to be classified as incomplete?

A

perianal sensation must be present (sacral sparing)

  • voluntary contral RECTAL SPHINCTER
  • MAY HAVE NORMAL BOWEL/BLADDER & SEXUAL FUNCTION
  • MAY FLEX GREAT TOE
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23
Q

What determines a spinal cord injury to be classified as complete?

A

sensory and motor function will be absent below the level of the injury

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24
Q

What are complete lesions normally due to?

A
  • severing of the spinal cord
  • severe compression
  • extensive vascular impairment
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25
Q

What are incomplete lesions normally due to?

A
  • cord contusion (bruising)
  • edema
  • partial transection (damaged) of cord
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26
Q

Name some traumatic causes of spinal cord injury

A
  • motor vehicle accidents
  • acts of violence
  • falls
  • sports
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27
Q

describe the Brown-Sequard Syndrome

A

Incomplete Lesion

  • Injury to one side (longitudinal half) of spinal cord
  • Due to Gunshot or Stab Wounds
  • Lose motor function, proprioception, tactile sensation & vibration on same side as injury (because fibers at corticospinal tract and dorsal columns do not cross at the spinal cord level)
  • Lose pain & temperature sensation on opposite side a few segments lower ( because Lateral Spinothalamic Tract ascends, then crosses)
  • prognosis for recovery is good - many become independent in ADLs and are continent
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28
Q

describe Anterior Cord Syndrome

A

Incomplete Lesion

  • in the anterior (or ventral) column
  • due to flexion injury to cervical spine by fracture-dislocation to cervical vertebra
  • or due to vascular problem
  • lose motor function, pain and temperature sensation below level of the lesion
  • keep sense of proprioception, kinesthesia, and vibration (because they are in posterior column)
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29
Q

describe Central Cord Syndrome

A

Incomplete Lesion

  • most common
  • in central cord
  • due to progressive stenosis or compression due to hyperextension injuries
  • UEs more severely involved than LEs (because cervical tracts are located more centrally)
  • usually can ambulate
  • B, B, and Sex may be spared
  • sensory deficits tend to be variable
  • three different tracts can be affected - spinothalamic, corticospinal, dorsal
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30
Q

describe Posterior Cord Syndrome

A

Incomplete Lesion

  • rare
  • aka Dorsal Column Syndrome
  • due to compression of posterior spinal artery by tumor or vascular infarct
  • deficits in proprioception and vibration
  • keep motor control, pain sensors and light touch (because they are anterior)
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31
Q

What is the Cauda Equina Injury?

A

(frequently) Incomplete LMN lesion
- due to fracture-dislocation below L1
- flaccidity, areflexia, loss of B&B function are most common clinical manifestations
- regeneration of peripheral nerve possible, depending on extent of damage

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32
Q

List the clinical manifestations of spinal cord injury:

A 
motor deficits
sensory loss
respiratory dysfunction
temperature control impairments
spasticity
B&B dysfunction
sexual dysfunction
33
Q

What is spinal shock?

A

The shock that occurs immediately post-injury and lasts several hours to weeks.
- usually resolves in 24 hours
It is a period of areflexia, flaccidity, loss of sensation.
- no reflexes below the injury

34
Q

What is motor deficit?

A

complete or partial paralysis

35
Q

What is sensory loss?

A

impaired or absent sensation below the lesion level

36
Q

How is temperature control impaired?

A

hypothalamus cannot control vasodilation/constriction

  • mostly in cervical lesions
  • no sweating or shivering below the lesion level (spotty in complete)
  • extra a lot of sweating (diaphoresis) above lesion
  • body temp greatly affected by external environment
37
Q

How is respiratory function impaired due to SCI?

A
  • innervation to diaphragm affected with C1-C3 lesion
  • muscles of inspriation and expiration affected with upper level lesions
  • susceptible to Pneumonia due to ineffective cough and decreased vital capacity
  • susceptible to PE
38
Q

Why does spasticity occur in SCI?

A

Missing CNS control over still-intact reflex arcs

  • clonus,hypertonicity, hyperactive stretch reflexes occur below injury level
  • usually plateaus in one year
  • moving too quickly sets it off
39
Q

How can spasticity be helpful with a person with SCI?

A
  • prevent atrophy
  • help maintain muscle bulk
  • assist maintenance of circulation
  • assist patient in performing functional activities (transfers, bed mobility, standing)
40
Q

How can spasticity be managed?

A
  • baclofen (oral or pump)
  • diazepam
  • clonidine
  • botox
  • slow, smooth, controlled movement
  • static stretching
  • weight bearing
  • cryotherapy
  • e-stim
41
Q

What is LMN bladder dysfunction?

A

flaccid bladder

  • don’t feel the urge
  • injury in cauda equina or conus medullaris
  • injury is above S2 and sacral reflex arc is not intact
  • use manual compression (crede maneuver) or catheter
  • bladder training - timed voiding
42
Q

What is UMN bladder dysfunction?

A

spastic bladder

  • bladder empties whether ready or not
  • injury is above S2 and sacral reflex arc is intact
  • bladder training - timed voiding
  • fluid intake control
  • intermittent cath
43
Q

What is the bowel dysfunction in SCI?

A

Reflex Bowel

  • in lesions at T11-12 and above
  • can use digital stimulation

Flaccid Bowel

  • at or below T12 on conus medullaris and cauda equina lesions
  • no digital
  • bowel program - high fiber diet, appropriate fluid intake, stool softener, suppositories
44
Q

What stimuli increase Spasticity?

A

changes in velocity

- spasticity is velocity dependent

45
Q

Flaccid Bladder is known by what other designations?

A
  • Autonomous
  • Nonreflex
  • LMN Lesion of Conus
  • Medullaris
  • LMN Lesion of Cauda Equina
46
Q

Spastic Bladder is known by what other designations?

A
  • Reflex
  • UMN
  • Neurogenic
47
Q

what are 3 kinds of catheter?

A
  • indwelling
  • external
  • suprapubic
48
Q

how does SCI affect sexual function in males?

A
  • erectile capactiy altered
    • greater in UMN lesion than LMN or incomplete lesion
  • ejacutaion ability alter
    • greater in incomplete lesions than complete lesions
  • fertility reduced
    • may use vibratory stimulation to collect higher quality semen for turkey baster
49
Q

how doe SCI affect sexual function in females?

A
  • fertility unimpaired
  • amenorrhea for 1-3 months post-injury, then resume normal
  • pregnancy can cause issues
    • affect respiratory function
    • can’t feel labor happening (C-section)
    • labor may cause Autonomic Dysreflexia
50
Q

what are some secondary complications to SCI?

A
  • respiratory complications
  • pressure ulcers
  • DVT
  • pain
  • osteoporosis
  • renal calculi
  • heterotopic ossification
  • postural hypotension
  • autonomic dysreflexia
51
Q

what are the most common sites for pressure ulcers?

A
  • sacrum

- ischial tuberosity

52
Q

how can pressure ulcers be prevented?

A

pressure relief

* every 30 minutes for 2 minutes

53
Q

what is the major cause of DVT that is secondary to SCI?

A

lack of mobility and active muscle contraction

- leads to stasis and hypercoagulability

54
Q

when is DVT most frequent when secondary to SCI?

A

within the first 2 months of the injury

- most likely to occur during the acute stage of recovery

55
Q

what is the prevention plan for DVT secondary to SCI?

A
  • prophylactic anti-coagulant drugs for 2-6 months post-injry
  • regular turning, PROM exercise, positioning of LEs
  • use of elastic support hose
56
Q

what is Thrombophlebitis?

A

the inflammation that results from the formation of the thrombus
- characteristic clinical features - swelling, redness, heat

57
Q

what kind of Pain is associated with SCI?

A
  • pain due to trauma
  • nerve root pain due to damage near the spinal cord
  • spinal cord dysesthesias
  • musculoskeletal pain
58
Q

what is dysesthesia?

A

condition in which an unpleasant sensation is produced by ordinary stimuli

  • touch sensation experienced as pain
  • burning, prickling, tingling, searing, or crawling sensations
59
Q

how is Pain due to SCI managed?

A

when due to trauma:

  • immobiliization
  • analgesics
  • TENS
60
Q

how is Nerve Root Pain due to SCI managed?

A

drugs

TENS

61
Q

how are Spinal Cord Dysesthias managed?

A

drug

  • Tegretol (used for seizures, nerve pain, bipolar disorder)
  • Dilantin (an anti-epileptic)
62
Q

what Musculoskeletal Pain due to SCI can be expected?

how can it be prevented?

A
  • pain due to overuse (such as in shoulders - which are now working for the arms and the legs)
  • regular ROM and positioning
63
Q

why does Ostoeporosis occur in the SCI patient?

what is a common fracture in the SCI patient?

A
  • because there is no weight bearing
  • no muscle pulling on the bone
  • a lack in the hormones
  • distal femur fracture
64
Q

what are Renal Calculi?

why do they develop?

A

Kidney Stones

  • resorption of bone due to Osteoporosis
  • hypercalciuria - calcium in the blood is deposited in the kidneys, leading to kidney stones
65
Q

how can Renal Calculi be prevented?

A
  • maintain good bladder drainage
  • follow a diet high in protein, vitamin-rich foods
  • restrict calcium intake
  • increase water intake
  • engage in mobility and standing as early as possible
66
Q

what is Heterotopic Ossification?

what causes it?

A
  • ectopic bone formation (osteogenesis)

may be due to

  • abnormal calcium metabolism
  • tissue hypoxia
  • local trauma
67
Q

where does Heterotopic Ossification occur in the SCI patient?

A
  • occurs in soft tissues below the lesion level
  • around joints
    • extraarticular
    • extracapsular
  • often Joint Ankylosis at the Hips
68
Q

how is Heterotopic Ossification treated?

A
  • use Diphosphates to inhibit bone growth
  • perform regular ROM exercises
  • possibly surgery

(NOTE: inconsistent evidence says that aggressive stretching may aggravate it)

69
Q

what are the signs and symptoms of Heterotopic Ossification?

A
  • decreased ROM
  • swelling
  • warmth
  • pain
70
Q

what is Postural Hypotension?
what causes it?
what are the symptoms?
how is it treated?

A
  • Low BP upon standing or sitting up
  • Lack of sympathetic vasoconstriction control
  • pallor, confusion, dizziness, fainting
  • move slowly; monitor vital signs; wear compression stockings & abdominal binder; employ drug therapy
71
Q

what is Autonomic Dysreflexia?

what can cause it?

A
  • an over-activity of the Autonomic Nervous System specific to SCI patients with lesion above T6
  • occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury
  • nerve impulses blocked by the lesion at the level of the injury
  • a reflex is activated to increase activity of the sympathetic portion of the ANS
  • overfull bladder
  • sat on a tack
  • genitals squished or tucked
  • clothing too tight
72
Q

what are the signs & symptoms of Autonomic Dysreflexia (AD)?

A
  • Hypertension; Bradycardia
  • Severe pounding headache; Profuse sweating
  • Increased spasticity; Restlessness
  • Vasoconstriction below lesion & vasodilation above lesion level.
  • Constricted pupils; Nasal congestion
  • Piloerection; Blurred vision
73
Q

what is the treatment for Autonomic Dysreflexia?

A

!! medical emergency !!
• Bring patient to sitting to lower BP.
• Check for bladder distension & assess drainage system
• Check for irritating stimuli, ie. tight clothing, straps, etc.
• Get medical/nursing assist if no relief
• Antihypertensive drugs may be needed
• Notify all health team members of episodes.

74
Q

what is the incidence of Multiple Sclerosis?

A
  • ~ 2.5 million people worldwide
  • 400,000 people in usa.
  • onset ages 20 – 50, peak at 20 - 30.
  • 2-3:1 women:men
  • primarily caucasians & northern or central european heritage
  • rare in africa, asia, s america
  • greater frequency farther from equator (decreased vitamin D)
  • solar radiation has protective effect
  • more common in europe, us, canada, new zealand & parts of australia.
75
Q

what is the etiology of MS?

A
  • unknown etiology
  • immune mediated process; exact antigen unknown
  • environmental- exposure to some environmental agent that occurs before puberty may predispose a person to develop MS later
  • infectious – many being investigated, but no definitive link yet (epstein-barr virus)
  • genetic - increased risk if primary relative has MS
76
Q

what are the pathological changes that occur with MS?

A
  • inflammation & breakdown of myelin in brain, spinal cord, & optic nerve > symptoms
  • demyelinated lesions scattered through CNS white matter
  • plaques of hard sclerotic scar tissue after myelin loss
  • neural transmission (saltatory conduction) impaired > nerves fatigue rapidly
  • new evidence- inflammation in gray matter very early in disease
  • may start in the cortex and spread to deep layers
  • common areas: optic nerve, subcortical white matter, corticospinal tracts, dorsal columns in sc, cerebellum
77
Q

what are the most common symptoms of MS?

A
  • Fatigue
  • Weakness
  • Spasticity – In 90% Of Cases, + Babinski And Clonus, Damage To Corticospinal Tracts And Motor Cortex
  • Gait, Balance, Coordination Problems
  • Cognitive Changes - 50% Of Patients,
  • Sensory Disturbances – Parasthesias (Pins & Needles) Or Proprioception Impairments
  • Depression; Other Affective Disorders
  • Bladder &/Or Bowel Dysfunction
  • Pain – In 55% Of Patients, Dysesthesia (Burning Or Aching), Lhermitte’s Sign (Electric Shock Like Feeling That Goes Down The Back And Extremities W/ Neck Flexion)
  • Visual Problems – Optic Neuritis > Blurred Vision, Scotoma (Dark Spot), Nystagmus (Eye Shakes), Diplopia (Dbl Vision)
  • Ataxia – (Due To Damage To Cerebellum) No Motor Movement (Not Due To Paralysis Or Paresis)
  • Intention And Postural Tremors
  • Dysarthria, Dysphagia
78
Q

what are 3 exacerbating factors of MS?

A
  • Heat – increased body temp of 2 degrees w/ activity or fever
  • Decreased overall health
  • Emotional or physical stress
79
Q

what is the prognosis of MS?

A
  • Normal life expectancy
  • better prognosis w/ earlier onset
  • relapsing remitting better prognosis than primary progressive

PTA - Neuro (6 decks)

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