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Neuro 1 > SCI > Flashcards

SCI Flashcards

1
Q

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

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

A

MVA

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2
Q

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

A

true

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3
Q

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

A

the spinal cord level is higher than the vertebral body

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4
Q

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

A

T10 and T11

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5
Q

Which vertebral section is the most vulnerable?

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

A

Cervical

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6
Q

A majority of injuries occur at which level?

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

A

Cervical

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7
Q

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

A

stenosis and hyperextension

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8
Q

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

A

stenosis and hyperextension

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9
Q

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

A

flexion injury with wedge fx

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10
Q

Flexion/rotation injury often occurs in combination with

A

lateral flexion and shearing

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11
Q

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

A

vertical compression

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12
Q

Extension injury is a distraction on the _ side

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

A

anterior

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13
Q

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

A

true

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14
Q

What are potential associated injuries with SCI?

A 
Fractures
Pneumothorax or hemothorax 
TBI
Internal injuries to organs
Brachial plexus injury
PNI
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15
Q

Ascending tracts carry _ info from _ to _

A

Sensory

From periphery to CNS – brainstem/brain/cerebellum

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16
Q

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

A

Motor

CNS into tissues

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17
Q

What is the center of the spinal cord?

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

A

Cervical

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18
Q

Central cord syndrome shows more losses in _ region

A

cervical region

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19
Q

C1-C4 is testing the

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

A

sensory level

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20
Q

Testing the biceps and brachialis will test which nerve root?

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

A

C5

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21
Q

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

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

A

C6

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22
Q

Testing the triceps will test which nerve root?

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

A

C7

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23
Q

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

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

A

C8

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24
Q

Testing the abductor digiti minimi will assess which nerve root?

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

A

T1

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25
Q

If you are assessing the iliopsoas, which nerve root are you assessing?

a. L1
b. L2
c. L3
d. L4

A

L2

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26
Q

Testing the quadriceps will identify which nerve root?

a. L1
b. L2
c. L3
d. L4

A

L3

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27
Q

Testing the tibilias anterior will identify which nerve root?

a. L2
b. L3
c. L4
d. L5

A

L4

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28
Q

Testing the extensor hallucis longus will identify which nerve root?

a. L3
b. L4
c. L5
d. L6

A

L5

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29
Q

Testing the gastrocnemius, soleus will identify which nerve root?

a. L5
b. S1
c. S2
d. S3

A

S1

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30
Q

Explain the somatotopic organization of the spinal cord

A

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

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31
Q

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

A

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

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32
Q

Incomplete SCI will have

A

sensory function or motor function in sacral plexus

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33
Q

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

A

ASIA A

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34
Q

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

A

ASIA B

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35
Q

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

A

ASIA C

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36
Q

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

A

ASIA D

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37
Q

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

A

ASIA E

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38
Q

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

A

Brown-Sequard

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39
Q

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

A

true

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40
Q

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

A

yes typically

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41
Q

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

A

proprioception, vibratory sense, deep touch, discrimination

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42
Q

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

A

pain, temperature, crude touch

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43
Q

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

A

Anterior Cord

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44
Q

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

A

sensory and very little or no motor

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45
Q

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

A

Central Cord

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46
Q

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

A

sensory and motor on both sides

UE significant effect

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47
Q

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

A

Posterior cord

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48
Q

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

A

both motor and sensory function

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49
Q

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

A

true

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50
Q

What syndrome is damage to the sacral cord and lumbar nerve roots?

a. cauda equina
b. posterior cord
c. conus medularis
d. central cord

A

conus medularis

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51
Q

What is lost with Conus Medularis?

A

flaccid paralysis

bowel and bladder loss of function

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52
Q

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

A

Cauda Equina

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53
Q

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

A

true

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54
Q

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

A

false

greater recovery proximal less in distal

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55
Q

What is seen in function with spinal shock?

A

areflexia
no sensation
no motor function
no automatic control

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56
Q

When does spinal shock typically begin to resolve?

A

48-72 hours

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57
Q

Impaired breathing and coughing is a

(primary or secondary) effect

A

primary

58
Q

Spasticity is a (primary or secondary) effect

A

primary

59
Q

Heterotropic ossification is a (primary or secondary) effect

A

primary

60
Q

Voluntary motor paralysis is a (primary or secondary) effect

A

primary

61
Q

Sensory impairment is a (primary or secondary) effect

A

primary

62
Q

Autonomic dysfunction is a (primary or secondary) effect

A

primary

63
Q

What are the secondary effects of impaired breathing and coughing?

A

atelectasis
pneumonia
respiratory insufficiency

64
Q

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

A

GPB

65
Q

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

A

chest stretches

air shift

66
Q

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

A

diaphragm strengthening, strengthening of accessory muscles and GPB

67
Q

for decreased cough force, patients can

A

place hands across abdomen and press in to assist cough

68
Q

What is paradoxical breathing?

A

the diaphragm moves in the opposite direction it should during inhalation

69
Q

List the possible breathing and coughing secondary effects

A 
decreased chest expansion
decreased VC
decreased cough force
paradoxical breathing 
decreased diaphragm excursion upright
70
Q

What are early signs of heterotrophic ossification?

A

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

71
Q

What are the goals of PT with heterotrophic ossification?

A

maintain ROM and AVOID vigorous stretching inflammation

72
Q

What are options for treating spasticity

A 
stretching 
ice
strengthening/facilitation of antagonists 
positioning 
tone reducing techniques
73
Q

What are the secondary effects of sensory impairment?

A

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

74
Q

How should sensory impairment be managed?

A

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

75
Q

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

A

every 30 minutes for sitting

every 2 hours for supine

76
Q

Autonomic dysfunction is

A

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

77
Q

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

A

false

78
Q

Virchow’s triad is

A

alterations in normal blood flow
injuries to vascular endothelium
hypercoagulability

79
Q

What are risk factors for deep vein thrombosis?

A

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

80
Q

Deep vein thrombosis is more common in

a. hemiplegia
b. paraplegic
c. tetraplegia

A

tetraplegia

81
Q

Onset of DVT is usually within

a. 2 days
b. 5 days
c. 2 weeks
d. 8 weeks

A

2 weeks

82
Q

How can DVT be prevented?

A

pneumatic compression devices
anticoagulants
compression stockings

83
Q

What are the symptoms of DVT?

A

red, warm, swollen

84
Q

How is DVT treated?

A

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

85
Q

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

A

autonomic dysreflexia

86
Q

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

A

false

87
Q

With autonomic dysreflexia it is important to NOT

A

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

88
Q

Early rehab after SCI includes

A

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

89
Q

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

A

inpatient

90
Q

What setting works on advanced transfers, gait and is 2-3/week?

a. inpatient
b. outpatient

A

outpatient

91
Q

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

A

clonus

92
Q

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

A

flexor spasm

93
Q

A reaction of clonus is seen when there is

A

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

94
Q

A positive reaction of flexor spasm is seen when

A

the leg withdrawls and pulls away

95
Q

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

A

extensors spasms

96
Q

A positive reaction of extensor spasms is

A

a contraction of extensor muscles and a quick fall if spasticity

97
Q

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

A

C1-C4

98
Q

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

A

C5

99
Q

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

A

C6

100
Q 
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
A

C7-C8

101
Q

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

A

T1-T9

102
Q

At what level is ambulation possible in the home?

a. T1-T9
b. T10-L4
c. L3
d. L1-L2

A

L1-L2

103
Q

At what level would you expect ambulation potential for limited community ambulation?

a. T10-L4
b. L2
c. L3
d. L4

A

L3

104
Q

At what level would you expect ambulation potential for community ambulation?

a. L1
b. L2
c. L3
d. L4

A

L4

105
Q

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

A

Ground reaction AFOs, AFOs, or KAFOs

106
Q

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

A

AFOs and forearm crutches

107
Q

What level is independent community ambulation common?

a. L3
b. L4
c. L5
d. L5, S1, S2

A

L5, S1, S2

108
Q

Passive ROM should be performed for

A

all joints not innervated

109
Q

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

A

False DONT stretch finger flexors

110
Q

What HS length should be attained in a complete SCI?

a. 90-100
b. 100-120
c. 110-120
d. 105-110

A

110-120

111
Q

What is key with stretching the HS?

A

dont bend the back

112
Q

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

A

True

113
Q

What MMT level is needed to strengthen?

a. 0/5
b. 1/5
c. 2/5
d. 3/5

A

1/5

114
Q

What treatments can be done for spasticity?

A

medication, surgery, stretching, ice

115
Q

What are 3 components of floor to wheelchair transfers?

A

hands and knees, crawling, kneeling

116
Q

What are 3 components for ambulation from floor to standing?

A

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

117
Q

FEF can be used to improve

A

Cardiovascular fitness, muscle mass, skin protection, maintain ROM

118
Q

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

A

Peripheral

119
Q

if peripheral nerves are intact then _ is still present

A

reflexes

120
Q

Brown Sequard is caused by what MOI?

A

penetrating
burst
flexion with rotation

121
Q

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

A

false

will likely have a high level of function

122
Q

What information do the dorsal columns carry?

A

proprioception
vibration sense
deep touch
discriminative touch

123
Q

What information does the anterolateral tract carry?

A

pain
temperature
crude touch

124
Q

What information does the lateral corticospinal tract carry?

A

voluntary motor control

125
Q

Consider what 2 things for prognosis of SCI?

A

level of injury

rate of return

126
Q

What carry info to and from the brain?

gray or white matter?

A

white matter

127
Q

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

A

gray matter

128
Q

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

A

false

129
Q

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

A

dislocation of vertebral bodies and severe spinal damage

130
Q

flexion/rotation MOI can have _ _ dislocation

A

unilateral facet dislocation

131
Q

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

A

bony fragments

132
Q

What tracts are lost with Brown Sequard syndrome?

A

dorsal column - ipsilateral
lateral corticospinal - ipsilateral
anterolateral - contralateral

133
Q

What tracts are lost with Anterior Cord Syndrome?

A

anterolateral and lateral corticospinal - bilateral

134
Q

What tracts are lost with Posterior Cord Syndrome?

A

dorsal column - bilateral

posterior lateral corticospinal - ipsilateral

135
Q

What is the goal with ventilation?

A

max ventilatory ability

prevent pulmonary complications

136
Q

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

A

abdominal binder

137
Q

DVT is more common in UE or LE

A

LE

138
Q

For spasticity management, strengthen the (antagonist/agonist)

A

antagonist

139
Q

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

A

sympathetic response

below lesion

140
Q

What is the primary goal of ROM?

A

to prevent contractures

141
Q

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

A

hyperextension with osteophytes

extension without osteophytes

142
Q

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

A

true

Neuro 1 (7 decks)

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