SCI Flashcards by Madelynn Kahl

What is the most common etiology from direct trauma for SCI?

a. Falls
b. Violent acts
c. MVA
d. Sports

MVA

How well did you know this?

Not at all

Perfectly

Males are more likely to suffer from spinal cord injury (true/false)

true

How well did you know this?

Not at all

Perfectly

What is the difference between the neurologic level vs the vertebral level?

the spinal cord level is higher than the vertebral body

How well did you know this?

Not at all

Perfectly

If a patient’s vertebral body is injured at T9, what level could have the potential for peripheral nerve injury?

a. T7 and T8
b. T8 and T9
c. T9 and T10
d. T10 and T11

T10 and T11

How well did you know this?

Not at all

Perfectly

Which vertebral section is the most vulnerable?

a. Cervical
b. Thoracic
c. Lumbar
d. Sacral

Cervical

How well did you know this?

Not at all

Perfectly

A majority of injuries occur at which level?

a. Cervical
b. Thoracic
c. Lumbar
d. Sacral

Cervical

How well did you know this?

Not at all

Perfectly

Which of the following is described: cord is compressed from osteophytes with damage to cord itself

a. Flexion injury with wedge fx
b. Stenosis and hyperextension
c. Flexion/rotation
d. Vertical compression

stenosis and hyperextension

How well did you know this?

Not at all

Perfectly

With whiplash it is most common to result in which type of injury?

a. Flexion injury with wedge fx
b. Stenosis and hyperextension
c. Flexion/rotation
d. Vertical compression

stenosis and hyperextension

How well did you know this?

Not at all

Perfectly

This type of injury occurs in a high-speed head on collision with rapid deceleration causing the head to flex forward forcefully

a. Flexion injury with wedge fx
b. Stenosis and hyperextension
c. Flexion/rotation
d. Vertical compression

flexion injury with wedge fx

How well did you know this?

Not at all

Perfectly

Flexion/rotation injury often occurs in combination with

lateral flexion and shearing

How well did you know this?

Not at all

Perfectly

This type of injury is when a vertical force presses down on head with enough force to break the vertebral body

a. Flexion injury with wedge fx
b. Stenosis and hyperextension
c. Flexion/rotation
d. Vertical compression

vertical compression

How well did you know this?

Not at all

Perfectly

Extension injury is a distraction on the _ side

a. Anterior
b. Posterior
c. Lateral
d. Medial

How well did you know this?

Not at all

Perfectly

Thoracic region is more stable because of articulation with ribs and additional musculature that supports the thoracic region (true/false)

true

How well did you know this?

Not at all

Perfectly

What are potential associated injuries with SCI?

Fractures
Pneumothorax or hemothorax 
TBI
Internal injuries to organs
Brachial plexus injury
PNI

How well did you know this?

Not at all

Perfectly

Ascending tracts carry _ info from _ to _

Sensory

From periphery to CNS – brainstem/brain/cerebellum

How well did you know this?

Not at all

Perfectly

Descending tracts carry _ info out of the _ and into _

Motor

CNS into tissues

How well did you know this?

Not at all

Perfectly

What is the center of the spinal cord?

a. Cervical
b. Thoracic
c. Lumbar
d. Sacral

Cervical

How well did you know this?

Not at all

Perfectly

Central cord syndrome shows more losses in _ region

cervical region

How well did you know this?

Not at all

Perfectly

C1-C4 is testing the

a. Sensory level
b. Neck sensation
c. Neck muscles
d. Scalenes

sensory level

How well did you know this?

Not at all

Perfectly

Testing the biceps and brachialis will test which nerve root?

a. C4
b. C5
c. C6
d. C7

How well did you know this?

Not at all

Perfectly

Testing the extensor carpi radialis longus and brevis will test which nerve root?

a. C4
b. C5
c. C6
d. C7

How well did you know this?

Not at all

Perfectly

Testing the triceps will test which nerve root?

a. C5
b. C6
c. C7
d. C8

How well did you know this?

Not at all

Perfectly

Testing the flexor digitorum profundus and middle finger will test which nerve root?

a. C5
b. C6
c. C7
d. C8

How well did you know this?

Not at all

Perfectly

Testing the abductor digiti minimi will assess which nerve root?

a. C6
b. C7
c. C8
d. T1

How well did you know this?

Not at all

Perfectly

If you are assessing the iliopsoas, which nerve root are you assessing? a. L1 b. L2 c. L3 d. L4

Testing the quadriceps will identify which nerve root? a. L1 b. L2 c. L3 d. L4

Testing the tibilias anterior will identify which nerve root? a. L2 b. L3 c. L4 d. L5

Testing the extensor hallucis longus will identify which nerve root? a. L3 b. L4 c. L5 d. L6

Testing the gastrocnemius, soleus will identify which nerve root? a. L5 b. S1 c. S2 d. S3

Explain the somatotopic organization of the spinal cord

cervical is more centered, then thoracic then lumbar as it goes out and down the body

A complete SCI will have sensory or motor function? peripheral nerve involvement? flaccid or spastic?

no sensation or motor function below the lesion flaccid paralysis/paresis at level of injury especially if PN roots involved spastic paralysis below level of injury

Incomplete SCI will have

sensory function or motor function in sacral plexus

What level ASIA scale is being described: Complete: no sensory or motor function is preserved in S4-S5? a. ASIA A b. ASIA B c. ASIA C d. ASIA D

ASIA A

What level ASIA scale is described as: incomplete: sensory function is preserved below the neurological level and includes S4-S5? a. ASIA A b. ASIA B c. ASIA C d. ASIA D

ASIA B

What level ASIA scale is described as incomplete: motor function is preserved below the neurological level. more than half the key muscles below the neurological level are <3/5 strength? a. ASIA A b. ASIA B c. ASIA C d. ASIA D

ASIA C

Which of the following ASIA level's is: incomplete: motor function is preserved below the neurological level. at least half of the key muscles below the neurological level are >or equal to 3/5 strength? a. ASIA A b. ASIA B c. ASIA C d. ASIA D

ASIA D

Which of the following ASIA scores is described as: normal, sensory and motor function is normal a. ASIA B b. ASIA C c. ASIA D d. ASIA E

ASIA E

Which of the following clinical syndromes is described as the hemisection of spinal cord caused by penetrating or burst or flexion with rotation a. Anterior cord b. Central cord c. Brown-Sequard d. Cauda equina

Brown-Sequard

It is common to see a mix of loss from the same side and opposite side with Brown-Sequard syndrome (true/false)

true

Are patients with Brown-Sequard able to ambulate and function?

yes typically

What will patients with Brown-Sequard lose on the same side?

proprioception, vibratory sense, deep touch, discrimination

What will patients with Brown-Sequard lose on the contralateral side?

pain, temperature, crude touch

Which of the following SCI syndromes is described as anterior being most damaged, dorsal column is preserved? a. Anterior cord b. Central cord c. Brown-Sequard d. Cauda equina

Anterior Cord

What is preserved with sensory and motor function of an Anterior cord syndrome? a. no sensory or motor b. only motor c. some sensory d. sensory and very little or no motor

sensory and very little or no motor

Which of the following syndromes is a compressive force as the cord is squeezed around it compresses with the most damage to the center causing hemorrhage and swelling? a. Anterior cord b. Central cord c. Brown-Sequard d. Cauda equina

Central Cord

What is affected with the sensory and motor function of Central Cord Syndrome? a. sensory on one side b. motor on one side c. sensory and motor on both sides d. full preservation of both

sensory and motor on both sides | UE significant effect

Which of the following syndromes is caused by trauma and common due to disease process? a. Anterior cord b. Central cord c. Brown-Sequard d. Posterior cord

Posterior cord

Which of the following is primarily lost with Posterior Cord Syndrome? a. motor function b. sensory function c. both motor and sensory function d. neither

both motor and sensory function

Posterior cord syndrome patients are unable to discriminate between sharp and dull touch (true/false)

true

What syndrome is damage to the sacral cord and lumbar nerve roots? a. cauda equina b. posterior cord c. conus medularis d. central cord

conus medularis

What is lost with Conus Medularis?

flaccid paralysis | bowel and bladder loss of function

Which of the following is an injury to lumbar and sacral roots, just peripheral nerves lower than the spinal cord? a. cauda equina b. posterior cord c. conus medularis d. central cord

Cauda Equina

Cauda Equina losses function of bowel and bladder function (true/false)

true

The greatest recovery for Cauda Equina is in distal muscles (true/false)

false | greater recovery proximal less in distal

What is seen in function with spinal shock?

areflexia no sensation no motor function no automatic control

When does spinal shock typically begin to resolve?

48-72 hours

Impaired breathing and coughing is a | (primary or secondary) effect

primary

Spasticity is a (primary or secondary) effect

primary

Heterotropic ossification is a (primary or secondary) effect

primary

Voluntary motor paralysis is a (primary or secondary) effect

primary

Sensory impairment is a (primary or secondary) effect

primary

Autonomic dysfunction is a (primary or secondary) effect

primary

What are the secondary effects of impaired breathing and coughing?

atelectasis pneumonia respiratory insufficiency

If patients have a problem with mechanical ventilation, they can be taught

GPB

What are two treatments that can be done for patients with decreased chest expansion?

chest stretches | air shift

For decreased VC, which of the following should the patient learn to do? a. air shift and strengthening accessory muscles b. diaphragm strengthening and accessory muscles c. chest stretch and strengthening d. diaphragm strengthening, strengthening of accessory muscles and GPB

diaphragm strengthening, strengthening of accessory muscles and GPB

for decreased cough force, patients can

place hands across abdomen and press in to assist cough

What is paradoxical breathing?

the diaphragm moves in the opposite direction it should during inhalation

List the possible breathing and coughing secondary effects

``` decreased chest expansion decreased VC decreased cough force paradoxical breathing decreased diaphragm excursion upright ```

What are early signs of heterotrophic ossification?

decreased hip IR and flexion hip flexion with a bias to external rotation night fevers and warmth swelling

What are the goals of PT with heterotrophic ossification?

maintain ROM and AVOID vigorous stretching inflammation

What are options for treating spasticity

``` stretching ice strengthening/facilitation of antagonists positioning tone reducing techniques ```

What are the secondary effects of sensory impairment?

skin and circulatory changes + sensory loss + lack of movement = pressure ulcers

How should sensory impairment be managed?

skin care education and inspection positioning in bed and W/C cushions and mattresses pressure relief

How often should there be pressure relief in sitting vs supine?

every 30 minutes for sitting | every 2 hours for supine

Autonomic dysfunction is

altered genital function impaired thermo-regulation bradycardia hypotension, orthostatic hypotension

Deep vein thrombosis is a primary effect (true/false)

false

Virchow's triad is

alterations in normal blood flow injuries to vascular endothelium hypercoagulability

What are risk factors for deep vein thrombosis?

Virchow's traid, fracture, old age, obesity, diabetes, arterial vascular disease, history of previous thrombosis

Deep vein thrombosis is more common in a. hemiplegia b. paraplegic c. tetraplegia

tetraplegia

Onset of DVT is usually within a. 2 days b. 5 days c. 2 weeks d. 8 weeks

2 weeks

How can DVT be prevented?

pneumatic compression devices anticoagulants compression stockings

What are the symptoms of DVT?

red, warm, swollen

How is DVT treated?

bed rest for 48-72 hours medical management vena cava filter placement

This term is defined as a reflex that occurs due to noxious stimulus below the level of the injury

autonomic dysreflexia

Autonomic dysreflexia occurs in areas they can perceive a stimulus (true/false)

false

With autonomic dysreflexia it is important to NOT

NOT put in dependent position, elevated BP can lead to vascular problems

Early rehab after SCI includes

interdisciplinary team approach prevention of secondary complications prepare for full rehab early mobilization

What setting of rehab is involved with an emphasis on improving function, ordering equipment, family training, patient education, home, and school or work evaluation? a. inpatient b. outpatient

inpatient

What setting works on advanced transfers, gait and is 2-3/week? a. inpatient b. outpatient

outpatient

Which SCATS test is described as the foot in full plantarflexion then pull into DF with force and maintain DF force? a. flexor spasms b. extensors spasms c. clonus

clonus

Which of the following is a noxious pin prick into the arch with enough to be noxious but not enough to break skin? a. flexor spasms b. extensors spasms c. clonus

flexor spasm

A reaction of clonus is seen when there is

a contraction of the gastroc and a repeat if there is clonus

A positive reaction of flexor spasm is seen when

the leg withdrawls and pulls away

Which of the following is when the therapist places the hip and knee at 90 degrees flexion then rapidly extend to the mat quickly? a. flexor spasms b. extensors spasms c. clonus

extensors spasms

A positive reaction of extensor spasms is

a contraction of extensor muscles and a quick fall if spasticity

Identify which level typically has these outcomes: bed mobility is dependent transfers are dependent, verbalizes care, hydraulic lift mod I in W/C mobility, UE and trunk supports skin care dependent and dep to mod I for pressure relief ROM and exercise: dependent but verbalizes cough max assist, vent a. C1-C4 b. C5 c. C6 d. C7-C8

C1-C4

Identify which given level bed mobility - max A to dependent, verbalizes, 4-way adj hospital beds, loops transfers - max A to dep, verbalizes, hydraulic lift; swival bar and loops, sliding boar W/c mobility: mod I, P/W/C UE/trunk sup skin scare - dependent verbalizes, dependent to mod I for pressure relief ROM and exercise - dependent verbalizes, min A UE, lt weights and airsplints driving - mod I, highly specialized van cough - assisted a. C1-C4 b. C5 c. C6 d. C7-C8

Identify the functional outcome level: sitting tolerance - 90 degrees, all day, W/C cushion bed mobility - min A to mod I, loops or E bed transfers - A to dep, verbalizes, sliding board, loops W/C mobility - mod I, P W/C skin care - A pressure relief - mod I ROM and exercise - min A, light weights, airsplints and loops driving - mod I, modified vehicle cough - A to self-A a. C1-C4 b. C5 c. C6 d. C7-C8

``` Identify the functional outcome level: sitting tolerance - 90 degrees, all day W/C cushion bed mobility - mod I, loops transfers - mod I to A, sliding board W/C mobility - mod I, W/C P or manual skin care - min A to mod I mirror, cushion pressure relief - mod I ROM and exercise - min A, light weights, loops driving - mod I, modified vehicle cough - A to self A a. C1-C4 b. C5 c. C6 d. C7-C8 ```

C7-C8

Identify the following functional outcome level: sitting tolerance - 90 deg, all day, W/C cushion bed mobility - I transfers - mod I to I, sliding board W/C mobility - I, manual W/C skin care - mod I, mirror, cushion pressure relief - I ROM and exercise - mod I, variety of equip driving - mod I, hand controls cough - self A to WF ambulation - standing mod I, frame/stander a. C6 b. C7-C8 c. T1-T9 d. T10-L4

T1-T9

At what level is ambulation possible in the home? a. T1-T9 b. T10-L4 c. L3 d. L1-L2

L1-L2

At what level would you expect ambulation potential for limited community ambulation? a. T10-L4 b. L2 c. L3 d. L4

At what level would you expect ambulation potential for community ambulation? a. L1 b. L2 c. L3 d. L4

What orthotics can be used for level L3 ambulatory? a. KAFO, crutches, walker b. GR AFO, AFO, KAFO c. AFO and forearm crutches d. AFO and cane

Ground reaction AFOs, AFOs, or KAFOs

What orthotics can be used for L4 ambulatory? a. KAFO, crutches, walker b. GR AFO, AFOs, KAFO c. AFOs and forearm crutches d. AFOs and canes

AFOs and forearm crutches

What level is independent community ambulation common? a. L3 b. L4 c. L5 d. L5, S1, S2

L5, S1, S2

Passive ROM should be performed for

all joints not innervated

It is important to stretch long finger flexors (True/false)

False DONT stretch finger flexors

What HS length should be attained in a complete SCI? a. 90-100 b. 100-120 c. 110-120 d. 105-110

110-120

What is key with stretching the HS?

dont bend the back

Strengthening can be performed on muscles that are less than a 3+ (True/false)

True

What MMT level is needed to strengthen? a. 0/5 b. 1/5 c. 2/5 d. 3/5

1/5

What treatments can be done for spasticity?

medication, surgery, stretching, ice

What are 3 components of floor to wheelchair transfers?

hands and knees, crawling, kneeling

What are 3 components for ambulation from floor to standing?

Half kneel, push-up into hands and feet, standing balance

FEF can be used to improve

Cardiovascular fitness, muscle mass, skin protection, maintain ROM

Does the peripheral or central nerve injury have more potential for recovery?

Peripheral

if peripheral nerves are intact then _ is still present

reflexes

Brown Sequard is caused by what MOI?

penetrating burst flexion with rotation

Brown Squard have a low level of function (true/false)

false | will likely have a high level of function

What information do the dorsal columns carry?

proprioception vibration sense deep touch discriminative touch

What information does the anterolateral tract carry?

pain temperature crude touch

What information does the lateral corticospinal tract carry?

voluntary motor control

Consider what 2 things for prognosis of SCI?

level of injury | rate of return

What carry info to and from the brain? | gray or white matter?

white matter

(gray/white) matter are synaptic junctions between the nerves at the specific spinal level

gray matter

areas of partial preservation with complete SCI will be functional (true/false)

false

If flexion injury with wedge fracture is severe, what can happen to the vertebral bodies?

dislocation of vertebral bodies and severe spinal damage

flexion/rotation MOI can have _ _ dislocation

unilateral facet dislocation

with a vertical compression or burst fracture, what can enter the spinal cord and compress?

bony fragments

What tracts are lost with Brown Sequard syndrome?

dorsal column - ipsilateral lateral corticospinal - ipsilateral anterolateral - contralateral

What tracts are lost with Anterior Cord Syndrome?

anterolateral and lateral corticospinal - bilateral

What tracts are lost with Posterior Cord Syndrome?

dorsal column - bilateral | posterior lateral corticospinal - ipsilateral

What is the goal with ventilation?

max ventilatory ability | prevent pulmonary complications

What is described as elastic support that stretches across abdomen for continuous support tight to compress and lift it back up

abdominal binder

DVT is more common in UE or LE

For spasticity management, strengthen the (antagonist/agonist)

antagonist

Autonomic dysreflexia starts with excessive (parasympathetic/sympathetic) response (below/above) lesion

sympathetic response | below lesion

What is the primary goal of ROM?

to prevent contractures

What is the difference between hyperextension and stenosis injury and extension injury?

hyperextension with osteophytes | extension without osteophytes

Muscles <3/5 are considered intact (true/false)

true