Review: Pediatric SCI & TBI

Question 1

Causes of TBI

Answer 1

Falls, abuse, MVA, sports injuries

Question 2

Pediatric Rancho Scale

Answer 2

Level V-No Response
Level IV-Generalized Response
Level III-Localized Response
Level II-Responsive to Environment
Level I-Oriented to Self & Surroundings

Question 3

Side effects

Answer 3

• Heterotopic Ossification
• Spasticity
• Autonomic Dysreflexia

Question 4

What are the top 3 most common places for heterotopic ossification to occur?

Answer 4

1. Hip
2. Knee
3. Shoulder

Question 5

Modified Ashworth Scale

Answer 5

0 = No increase in tone
1 = Slight increase
1+ = Slight increase throughout less than ½ of the ROM
2 = Marked increase; full ROM available
3 = Considerable increase; passive movement is difficult
4 = Affected part is rigid

Question 6

Coma Stimulation Program:

Answer 6

Appropriate in Low-Cognitive Level (Auditory, Visual, Olfactory, Tactile, Vestibular)

Question 7

How do you monitor the patient, to see if they are tolerating coma stimulation well?

Answer 7

Check HR, BP, grimacing, diaphoresis, and increased tone

Question 8

How many stimulus do you give at one time during a coma stimulation program?

Answer 8

One

Question 9

Midcognitive-level Physical Therapy:

Answer 9

Structured Activity

• Structured activity and environment
• Managing Agitation and Confusion

Question 10

Higher-Cognitive-Level Physical Therapy:

Answer 10

Reintegration

- School and community level adaptations/interactions

Question 11

How is the mechanism of injury in a pediatric SCI patient different than an adult patient?

Answer 11

• Ligamentous laxity can contribute to injuries at C3 & above
• Ring apophysis can separate into spinal canal & mimic a herniated disc
• SCIWORA is common in the pediatric population: up to 34% of all SCIs qualify as this.

Question 12

What is a ring apophysis?

Answer 12

• growth plate of a vertebra

- part of vertebra that grows the most and is very mobile.

Question 13

What is a SCIWORA?

Answer 13

SCI without radiographic abnormality

can present like cauda equina or herniated disc but has not abnormal radiographic findings

Question 14

ASIA Impairment Scale:

Answer 14

A = Complete
B = Incomplete
C = Incomplete; muscle grade  3 in majority of muscles below the neurologic level.

Question 15

Therapy interventions for SCI:

Answer 15

• Skin Health
• Contracture Prevention
• Positioning
• Functional Expectations by level of involvement
• Community adaptations/integration

Question 16

Illness Risks Associated with SCI:

Answer 16

1. Autonomic Dysreflexia (SCI above T6)
2. Hip subluxation - Due to lack of cocontraction of muscles to hold femoral head in acetabulum
3. Scoliosis - Due to abnormal muscle pull and positioning
4. Renal Disease - Due to medications and immobility
5. Skin Integrity
6. Bone Density - Lack of weight bearing