Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OTA 200 - Phys Rehab Conditions > SCI > Flashcards

SCI Flashcards

1
Q

Types of Paralysis

A

Tetraplegia/Quadriplegia: Caused by cervical injury; 4 limbs and trunk affected; may have partial UE function depending on level of injury.

Paraplegia: Thoracic/lumbar/sacral injury; paralysis of LEs with involvement of trunk, legs, feet, toes depending on level of injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Complete vs. Incomplete SCI

A

Determined by client’s voluntary motor control/sensation in anal area (S4-5). (ASIA Scale shows degree of complete/incomplete.)

Complete: No sensory function at S4-5.

  • ASIA A: no sensory function
  • ZPP (zone of partial preservation): has some strength/sensation below level of injury in a ASIA A

Incomplete: Some degree of voluntary motor control/sensation at S4-5.

  • ASIA B: sensory incomplete; sensation, but no motor control below level.
  • ASIA C: motor incomplete; some motor function and > 1/2 of key muscles grade <3.
  • ASIA D: motor incomplete: same as C but muscle grade 3 or more.
  • ASIA E: normal sensation and motor control.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Orthostatic Hypotension

A

Decreased blood pressure (20 mm Hg or more systolic). Common in acute phase of rehab when pt moves from supine to upright or changes position quickly. Allow pt to adjust slowly to upright sitting. Immediately recline pt and elevate legs.

Remember: BP Low = Recline (get low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Autonomic Dysreflexia

A

Abnormal response to problem in body below level of SCI. Medical emergency! Often in level T6 or above. Autonomic nervous system reflex to stimulus such as full bladder/bowel, kidney stone, constipation, infection, pressure sore, ingrown toenail, thermal/pain stimuli, deep vein thrombosis, or broken bone. Increased blood pressure (20 to 40 mm Hg or higher than normal BP); remedy by sitting pt upright.

Symptoms: immediate pounding headache, anxiety, perspiration, flushing, goose bumps above level, nasal congestion, bradycardia.

Remember: BP High = Sit Upright (get high)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to prevent pressure injuries

A
  • Skin checks
  • Relieve pressure
  • Routine repositioning
  • Keep dry
  • Good nutrition/hydration
  • Properly fitting clothing/shoes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Surgical Managements of SCI

A

Open reduction with internal fixation and spinal fusion used to decompress SC and achieve stability/normal bone alignment.

Surgery not always necessary; immobilization may allow for healing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Medical Managements of SCI

A
  • Axial Traction on neck
  • Specialized beds
  • Cervical collar
  • Halo vest
  • Thoracic brace
  • Body jacket
  • Steroid use in first 24-48 hr. not definitive (still being studied)
  • Emerging: Cooling measures (hypothermia); Pharmacologic Neuroprotective Agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Intervention for SCI

A
  • Upright sitting tolerance program
  • Prevent movement of spine/neck
  • Stabilization and decompression are initial goals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neurogenic Bladder

A

Inability to empty bladder, incontinence, frequent urination, UTI
• Spastic/Reflex Bladder = T12 or higher; no control when it empties
• Flaccid Bladder = T12 to L1; inability to detect when full

Both come with risk of overstretching/rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Neurogenic Bowel

A

Bowel incontinence; constipation; impaction.
• Reflex/Upper Motor Neuron Bowel = Above T12; anal sphincter closed but opens on reflex when rectum full (use digital rectal stimulation and stimulant meds to manage)
• Areflectic Bowel = Lesions in lumbar/sacral; reduced reflex control of sphincter; prone to accidents (manage with digital stimulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OT Goals in Acute Phase vs. Inpatient Rehab

A

Acute Care: Intensive care unit; pt most fragile. GOALS: preserve joint integrity/mobility when positioning and early mobilization; restore function through self-care training; initiate education and training of family/caregivers; coordinate care, including prep for next level.

Inpatient Rehab: Once pt medically stable; time spent depends on many factors (at least 3 hr/day, 5-6 days/wk). GOALS: introduce importance of self-mgmt (incl proactivity, self-monitoring, prob solving, communicating, organization, stress mgmt); collaborate with pt in setting realistic/attainable goals; educate on transportation, emergency prep, community resources, nutrition, bladder/bowel mgmt, skin care; autonomic dysreflexia, pain mgmt, sexuality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List Clinical Syndromes of SCI

A

1) Central Cord Syndrome
2) Brown-Séquard Syndrome
3) Anterior Spinal Cord Syndrome
4) Conus Medullaris Syndrome
5) Cauda Equina Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Central Cord Syndrome

A

Most common incomplete SCI; when more damage to center of cord than periphery. Often result of cervical hyperextension such as falls or older adults with arthritic changes that caused narrowing of spinal canal.

Symptoms: paralysis greater in hands/arms than trunk/LEs; Bladder dysfunction; sensory loss below level; painful sensations (tingling, burning, dull aching).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brown-Séquard Syndrome (Lateral Damage)

A

When only one side of cord is damaged; stabbing or GSW; Below level has motor paralysis/loss of proprioception on ipsilateral side; Loss of pain/temp/touch on contralateral side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anterior Spinal Cord Syndrome

A

From injury that damages anterior spinal artery or anterior aspect of cord. Paralysis and loss of pain/temp/touch. Proprioception is preserved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Conus Medullaris Syndrome

A

Injury of sacral cord (conus) and lumbar nerve roots within neural canal, resulting in areflexic bladder, bowel and LEs.

17
Q

Cauda Equina Syndrome

A

Peripheral nerve injuries rather than spinal cord. Usually with fractures below L2; results in flaccid-type paralysis. Peripheral nerves can regenerate (rate of 1-2 mm/day), so this has better prognosis. Patterns of sensory/motor deficits highly variable and asymmetric.

18
Q

ASIA Scale

A

American Spinal Injury Association’s (ASIA’s) Impairment Scale: Neurological exam performed by trained medical professional. Tests key muscles and sensory points.

A – (Worst) This is considered a complete SCI. No sensory or motor function is preserved (including your sacral segments S4-S5).

B – Your sensory function — but not motor function — is preserved below the neurological level (including the sacral segments S4-S5).

C – This is an incomplete spinal cord injury in which your motor function is preserved below the neurological level, or you meet grade B criteria and have some motor function.

D – You meet the criteria defined by grade C by having preserved motor function as well as at least half of your muscle functions having a grade of three or higher.

E – (Mildest) Your motor function and sensory scores are normal. You may have suffered a spinal cord injury, but you will not experience paralysis and loss of sensations. However, there may be neurological or muscular changes or deficits.

19
Q

What must be treated after SCI

A

May be:
• cardiovascular symptoms (due to shock)
• blood profusion imbalances
• respiratory symptoms (ventilator needs in higher level SCI)
• work on sitting up, using remaining muscles
• pulmonary embolisms/DVT (blood clot) risk––prevent with use blood thinners or IVC Filter (inferior vena cava; like a strainer/dissolver; blocks clot from going to heart).
• Elimination issues (bowel/bladder schedule needs, catheter needs, maintenance of catheter; bowel schedule (enema/suppository use)

20
Q

C1-C3 Level SCI

A

(Christopher Reeve)
• Ventilator needed (with generator!)
• Only movements: head/neck
• Total Assistance required!
• Full electric hospital bed (Trendelenburg adjustable and side rails)
• Pressure relief mattress
• Total assisted transfers (lift?)
• Power wheelchair (chin/head/breath control)
• Pressure relief!!
• Electronic assistance/tech (voice activation, mouth sticks, head pointer)

21
Q

C4 Level SCI

A

(Catch a breath! Diaphragm works)
• NOT ventilator dependent
• Shoulder elevation only addtl movement
• Total assistance needed

22
Q

C5 Level SCI

A

(Winnie the Pooh eating honey w/hand)
• Can flex/extend elbow
• Universal cuff needed (no wrist/hand movement)
• Innerv to biceps
• Some ADLs/eating ability with adaptive devices
• Bathing/transfers need assistance
• Use of wrist cock up splint
• Long opponens splint
• Mobile arm support (and to improve position)
• Power Wheelchair with arm drive control
• Might drive vehicle in specialized van with lift and training
• At home, lightweight rigid or folding frame wheelchair (level, non-carpet surface)
• Pressure relief cushions!
• Bathing: total assist (padded tub tsfr bench to avoid ulcers)
• Same bed as C1-C4
• Mech lift still useful for tsfr

23
Q

C6 Level SCI

A

(Snow White: Take a bite!)
• Tenodesis Grasp ability (promote functional grasp)
• Wrist extension
• Splint can be used to sustain ability to grasp: Wrist-Driven Flexor Hinge Splint
• Full electric hosp bed or full to king size standard bed
• Transfer independently with transfer board! (Remember: Snow White downgrades to plain bed with dwarves)
• Indep grooming with AE (remember: Snow White is pretty bc she can groom!)
• Dressing: Looped zipper pulls, palmar cuff buttonhook, front opening bra/
• Velcro closure, ditch underwear, Velcro/elastic shoelaces
• Bathing: built up handles, bath mitts, long handled brushes
• Can do own skin inspection with long handled mirror, and can move self to alleviate pressure
• Power wheelchair with arm drive control, or manual lightweight rigid/folding frame with modified rims (same as C5)
• Do home evaluation when returning home for safety/accessibility

24
Q

C7 Level SCI

A 
(Ariel: push up and lift)
• Triceps innervated
• Independent with AE— ADLs and transfers
• Limited grasp
• Shoulder/elbows have full strength
• Depression transfer ability
25
Q

C8 Level SCI

A

(8th Grade Graduation: more independence going into HS!)
• Greater hand function/fine motor
• Indep with ADLs and transfers (SBA)
• Participate in most leisure activities

26
Q

Characters to remember SCI Levels:

A 
C1-C3 = Superman (Christopher Reeve)
C4 = Catch a breath! (diaphragm works!)
C5 = Winnie the Pooh (eating with hand)
C6 = Snow White (taking a bite; tenodesis)
C7 = Ariel (push up and lift!)
C8 = 8th Grade (more independence)
27
Q

Common mechanisms of SCI

A
  • Car accidents
  • Hyperextension injury
  • Compression injury (as in diving**- most common)
  • Force put on back during flexion/rotation (as in sports)
28
Q

Spinal Shock

A

Temporary loss or depression of all or most spinal reflex activity below level of injury within first few days. Symptoms may include:
• Altered body temp
• Skin color/moisture changes
• Abnormal perspiration
• Increased BP and slowed heartrate
• Irregularities in musculoskeletal system
• Altered sensory response
• Unusual urinary bladder/GI functions (overflow and incontinence)
• Irregular vasomotor response
• Depressed genital reflexes

29
Q

Areas affected by SCI

A
  • Cardiovascular symptoms (due to shock)
  • Blood profusion imbalances
  • Respiratory symptoms (ventilator needs in higher level SCIs)
  • Pulmonary embolism/DVT (clot) risk
  • Elimination issues (catheter needs, etc.)

OTA 200 - Phys Rehab Conditions (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions