S3_L2: Spinal Cord Injury Flashcards
Enumerate the major factors in predicting recovery early after a traumatic SCI.
- Initial NLI
- Initial motor strength
- Classification of neurologically complete or incomplete
ASIA Impairment scale examination is performed how many hours or days post-injury?
72 hours/ 3 days
Most UE recovery occurs during the first (1) ____ to ____ months, with the greatest rate of change during the first (2)_____ months.
- 6 to 9
- 3
TRUE OR FALSE: Prognosis for motor recovery is more favorable in those with sparing LT rather than PP sensation alone. Motor recovery in the UEs and LEs occurs concurrently rather than sequentially.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
NOTE: Pinprick sensation is more favourable.
TRUE OR FALSE: Functional and neurological recovery is even more favorable for patients with an initial motor incomplete injury. Individuals with incomplete paraplegia have the best prognosis for LE motor recovery and ambulation.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are TRUE
TRUE OR FALSE: The crossed adductor response to patellar tendon taps in the acute stage highly predicts functional motor recovery. It presents a problem in the Spinocerebellar Tract.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
Determine the EQUIPMENT used based on the level of lesion. You may choose 2 or more answers.
- Sip and puff WC with power recliner
- Manual WC with friction hand rims
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- A
- D
NOTE: #1 is specific to C3
Determine the EQUIPMENT used based on the level of lesion. You may choose 2 or more answers.
- AFO with 15 degree stop
- Forearm crutches or cane
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- H
- G/ H
Determine the EQUIPMENT used based on the level of lesion. You may choose 2 or more answers.
- Manual WC with projection hand rims or a wrist driven flexion hinge support
- Motorized WC with hand control
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- C
- B
The following are key muscles innervated or available with a C1-4 lesion, EXCEPT:
A. Cranial nerve innervation
B. Face muscles
C. Neck muscles
D. Diaphragm
E. None
E. None
Which of the following are key muscles innervated or available with a C5 lesion? Choose as many as necessary.
A. Brachioradialis
B. Rhomboid
C. Triceps
D. Supraspinatus
E. Pronator
A & B Only
The following are key muscles innervated or available with a C6 lesion, EXCEPT:
A. Infraspinatus
B. Extensor carpi radialis
C. Pronator teres
D. Teres minor
E. Pectoralis minor
E. Pectoralis minor
Which of the following are key muscles innervated or available with a C7 lesion? Choose as many as necessary.
A. Triceps
B. Flexor carpi radialis
C. Extensor carpi ulnaris
D. Extensor pollicis longus and brevis
E. Anconeus
A, B, & D
The following are key muscles innervated or available with a C8 lesion, EXCEPT:
A. Intrinsic finger flexor
B. Flexor pollicis longus and brevis
C. Flexor carpi ulnaris
D. Extrinsic finger flexors
E. None
E. None
Which of the following are key muscles innervated or available with a L1-3 lesion:
A. Sartorius
B. Rectus femoris
C. Quadratus lumborum
D. Iliopsoas
E. Gracilis
All (A-E)
The following are key muscles innervated or available with a L4-S1 lesion, EXCEPT:
A. Gastrocnemius
B. Extensor digitorum
C. Gluteus medius and maximus
D. All
E. None
E. None
TRUE OR FALSE: Scapular elevation is available at the with a NLI of C5. Elbow flexion and supination is available at the with a NLI of C5.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are TRUE
1st statement is true because C1-4 is unaffected, therefore scapular elevation is also present.
TRUE OR FALSE: Increased respiratory reserve happens when NLI reaches at the level of T1 and below. Knee flexion is available at the with a NLI of L3.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
Knee flexion starts at L5-S1.
What muscle groups are to be assessed for good prognosis?
Anti-gravity knee flexors & hip flexors & knee extensors p 1 yr
Absence of the (1)_____ or the (2)____ after the acute period (24 to 72 hours) suggests injury to the conus medullaris or CE.
- bulbocavernosus reflex (S3-4)
- anal reflex (S2-4)
_____ is an inflammatory disorder of the spinal cord, with a female-to-male ratio 4:1 that peaks in the second and fourth decades.
Transverse myelitis
TRUE OR FALSE: Pts c T6 level of lesion must be independent in ADLs. Pts c L1 must have complete level of independence
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
NOTE: complete level of independence is obtained at L4.
Transverse myelitis most commonly affects the ______ spine
thoracic
How often must a pt be turned to prevent pressure sores?
every 2 hours
NOTE: If pt is an ectomorph, it must be every hour.
TRUE OR FALSE: Once the patient’s motor level of injury, AIS, and prognosis for neurological recovery are determined at the onset of rehabilitation, short and long-term functional goals are formulated and a therapy prescription established.
True
The following are clinical signs and symptoms of AD, EXCEPT:
A. Flushing
B. Fever
C. Blurry vision
D. Diaphoresis
E. Nasal congestion
B. Fever
The following are clinical signs and symptoms of AD, EXCEPT:
A. Feeling of anxiety and apprehension
B. Malaise
C. Sudden onset pounding HA
D. Piloerection below the site of lesion
E. Sudden rise in BP
B. Malaise
What is the most common source/ cause of autonomic dysreflexia?
bladder problems
What action will be available once a pt goes from NLI C7 to NLI C8?
Finger flexion
Between 30% and 80% of patient with initially complete tetraplegia will recover ____ root level/s of function.
one
TRUE OR FALSE: Motor recovery can continue during the second year, especially for patients with initial 0/5 strength.
True
TRUE OR FALSE: The majority of motor recovery occurs within the first 3 months after injury. The early return of motor function suggests a better functional outcome.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
Majority recovers within the first 6 months
_____ is felt during light touch in SCI pts
Hypesthesia
Ambulation can be predicted using what sensation?
pin prick sensation
TRUE OR FALSE: Incomplete SCI is more favorable than complete SCI for motor recovery
True
CASE:
- 45 y/o complete injury C4 c early referral to rehabilitation
- 32 y/o with incomplete C6 c 2 yrs turnover/referral to Rehab
Determine which pt will have a faster recovery.
Case #1
TRUE OR FALSE: Older individuals have less favorable outcomes c neuro recovery, final ambulation, and bowel & bladder independence
True
Why is transverse myelitis is more common in females?
shorter urethra vs males
TRUE OR FALSE: The most important aspects of ACUTE REHABILITATION include bowel, bladder, and pulmonary management, Arteriovenous malformation, Urinary tract infection, GI prophylaxis, and proper positioning in bed with the proper turning frequency to prevent contractures and skin breakdown.
False
AVM and UTI is not included
Which body areas or structures are most commonly observed to have a long term complication for contracture development?
shoulder, elbow, hip flexors, and heel cords
NOTE: These can potentially serve as a source of pain and functional limitation.
What assistive device is the most commonly used for SCI pts?
Lofstrand crutches
this is given esp if they have strong UE mms
This is the second most common etiology for rehospitalization in chronic SCI
Pressure sores
Goals should reflect what is (1)____ and (2)_____ to the patient.
- important
- meaningful
What kind of AD will be given to pts c C4 level of NLI?
Motorized WC with chin control
highest level where pressure relief can be done particularly for head and neck and upper trunk
C4
Highest level in which Independent manual coughing and bed activity can be facilitated
C6
highest level where self rom can be done
C7
highest level where independence in all aspect of ADLs and bed activity and transfers w/o sliding board
T1
Why is pin prick sparing a more favorable outcome?
it has a close anatomical relationship: motor tracts (lateral corticospinal tract) to the sensory tracts carrying pain and temperature fibers
Ambulation can be predicted by having _____ in 50% or more of the dermatomes in the LE (L2-S1).
PP sensation sparing
TRUE OR FALSE: Up to 40% of patients initially classified as AIS B will improve to AIS C and up to 40% to AIS D.
True
TRUE OR FALSE: Approximately 60-80% of patients initially classified as AIS C will improve to AIS E.
False
It cannot just from two levels, it will only improve to AIS D first.
TRUE OR FALSE: Individuals with no LE motor control at 1 month may still show significant return by 1 year.
True
TRUE OR FALSE: UE motor recovery is approximately twice as great in incomplete tetraplegia as in complete tetraplegia, with the potential for varying degrees of LE motor recovery and functional ambulation. 80% of individuals with incomplete paraplegia regain antigravity hip flexors and knee extensors at 1 year.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are TRUE
TRUE OR FALSE: If an SCI pt is not referred to rehab within 1 month, SCI sx can progress and increase in number. Greater extent of cord signal abnormality on MRI, greater chance of having complete injury.
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
For the 1st statement, it must be 1yr.
Once the spine is stabilized by surgery or orthoses, therapy, and nursing will incorporate ROM that will help prevent (1)____ and (2)_____.
- contractures
- skin breakdown
Enumerate the 3 areas where pressure sores develop. Arrange them from the most common to least common.
- ischium
- heel
- trochanters
If a patient cannot actively flex the fingers to grasp a bottle owing to weakness or paralysis of finger flexor muscles, what strategy may be used by the PT to aid this?
selective tightening of finger flexors and use of wrist “tenodesis”
What kind of intervention scenario is usually being done in SCI patients?
compensate
TRUE OR FALSE: With complete lower-level lesions, there is lesser potential for independence in mobility tasks and ADL.
With incomplete lesions, there is lesser functional potential as compared to AIS A injuries
A. Both statements are TRUE
B. Both statements are FALSE
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are FALSE
AIS ____ injuries represent greater functional independence than that of AIS B or C injuries.
D
The following are factors that affect functional outcomes, EXCEPT:
A. Age
B. Gender
C. Body type
D. Psychosocial support
E. None
B. Gender
The following are factors that affect functional outcomes, EXCEPT:
A. Motor level
B. Preexisting health conditions
C. Secondary complications
D. Concomitant injury
E. None
E. None
What MD Dx may occur simultaneously with SCI?
TBI
What blood vessels or nerves are affected in AD?
splanchnic vessels (T5-L2)
TRUE OR FALSE: AD may manifest with no symptoms
True
The following are potential causes of AD, EXCEPT:
A. Constrictive clothing
B. Ingrown toenails
C. Detected pressure sores
D. Orgasm
E. Heterotrophic ossification
C. Detected pressure sores
It causes AD when undetected. When detected, specific measure are already implemented to counteract its development and its risk for AD.
Fill in the blanks: PT Management for AD
- _____ the Patient up
- Loosen _____
- Monitor _____
- ____, ____, & _____
- Evaluate for ______
- Check ____ & ____
- Sit
- constrictive clothing
- BP
- Pause, think, and look
- noxious stimuli
- bladder and bowel
How many % of lidocaine should you put in a catheter?
2
If a pt has a catheter and you were task to manage it, what should a PT do?
Gently irrigate 10-15% cc of normal saline
If a PT was tasked to manage the bowel of a pt with fecal impaction, what must the PT do?
- palve 2% Lidocaine into the rectum
- gently evacuate the rectum for stool
& disimpact the bowel
- Dependent
- Pectoral girdle stabilized for lifting objects
- Finger extension
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- A
- F
- D
- Persons with this level of injury will require almost total assistance for their bowel program
- Independent with short distances in home and possibly community
- Highest level where indep or modified indep transfer can be done with use of swivel bar
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- B
- G
- B
- Forearm pronation
- Ankle eversion
- Hip adduction
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- C
- H
- G
1.Shoulder abduction and flexion to ~90°
2. highest level where independence in all aspect of ADLs
3. Independent ambulation in home and community
A. C1-4
B. C5
C. C6
D. C7
E. C8
F. T1-12
G. L1-3
H. L4-S1
- B
- E
- H
What NLI level is (+) physiologic standing seen?
T1
What NLI level is (+) ambulation using hip hiking muscles with a 2pt or swing to gait pattern seen?
T12
What NLI level is the highest level where the pt can negotiate stairs with all levels on independence possible
T12
What NLI level is the highest type of gait drag to gait and (+) ambulation depending on thoracic level lesion but need full body brace?
T1
What AD will be given to a pt c T6 NLI?
Trunk brace with HKAFO
What AD will be given to a pt c C8 NLI?
Manual WC with standard hand rims
YES OR NO: Will lesion in the conus medullaris present with UMN sx?
No
YES OR NO: Will lesion in the conus medullaris present with bowel & bladder dysfunction?
Yes
YES OR NO: Will lesion in the conus medullaris present with a good prognosis?
Yes
TRUE OR FALSE: A persistent delayed plantar response indicates a poor prognosis for LE motor recovery and function (ambulation).
True
YES OR NO: If plantar response recovers within 6 months, will this become a good prognosticating factor?
Yes
What is the response of a (+) crossed adductor response on (L)?
R knee adducts when L knee is tapped on the patellar tendon
NOTE: It is a contralateral affectation
TRUE OR FALSE: Older individuals may have a less favorable outcome with neurological recovery, functional ambulation, and bowel and bladder independence than younger patients with similar severity of the injury, and they have more associated medical complications.
True
TRUE OR FALSE: An intramedullary hemorrhage is correlated with a more severe initial neurologic deficit
True
TRUE OR FALSE: The presence of cord edema lesser than 1 vertebral body segment is also a poor prognostic findings.
False
How is a non-traumatic SCI best diagnosed?
MRI
what muscles are recommended to be maintained in a lengthened state for SCI pts?
hamstrings and hip IRs
NOTE: these help maintain mobility in long sitting and ease of wearing socks
what muscles are recommended to be maintained in a shortened state for SCI pts?
finger flexors and back extensors
NOTE: these are for tenodesis effect and support in sitting and standing
complete spinal cord injury, those happening at and above (1)_____, are considered tetraplegia, while this happening at and below (2)____ are considered paraplegia.
- T5
- T6
