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NI2 > SCI > Flashcards

SCI Flashcards

2
Q

Which nerves can be affected in SCI?

A

Nerves

  • motor
  • sensory
  • autonomic
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3
Q

What are the implications for loss of autonomic NS function?

A

Implications

  • Blood pressure
  • Bladder/bowel
  • Sexual
  • Respiratory
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4
Q

UMN vs LMN lesions

A

Upper (above conus)

  • Spinal reflexes
  • Spastic paralysis

Lower (cauda equina)

  • Loss of SC mediated reflexes
  • Flaccid paralysis
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5
Q

What is the ASIA SCI level defined as?

A

Lowest intact neural segment

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6
Q

Motor impairment after SCI is due to:

A
  • Damaged ascending/descending tracts

- Poor spinal/cortical reorganisation

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7
Q

Physiotherapy Assessment in SCI?

A

Ax

  • Same as stroke except no dexterity training
  • Fitness
  • Activity Ax
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8
Q

What are the primary and secondary impairments in SCI?

A

Primary

  • strength
  • sensation
  • spasticity

Secondary

  • loss of muscle length
  • disuse weakness
  • cardiovascular deconditioning
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9
Q

What muscle innervations does a C6 Quad lack/is weak in?

A

No

  • Elbow extensors
  • Finger/thumb muscles
  • Trunk or below

Very weak

  • Elbow pronators
  • Wrist flexors
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10
Q

What is the optimal functional outcome for a C6 quad?

A

Optimal functional outcome

  • Totally independent at home alone
  • Lift body weight and transfer (shoulders in locked external rotation and elbows passively extended)
  • Manual wheelchair over level surfaces
  • Tenodesis grip
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11
Q

What does a T1-4 paraplegic lack in terms of muscular innervations?

A

? no abdominals and erector spinae above lesion level

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12
Q

Research on strength training below the level? (2)

A

Hicks et al 2011 (systematic review)
- Mod-high intensity exercise 2-3x/week
= increased strength in chronic SCI
= unsure about functional outcome

Kloosterman et al 2009 (systematic review)
- PRE for upper limb in partially paralysed mm
- 3-5x/week (20-45 mins) for 3-6m
= increased strength and function (T/Fs, w/c)

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13
Q

How much training? Research (1)

A

van Langevelde et al 2011

  • PT/OT/exercise
  • Average 8.9 sessions/week at 43 mins/session
  • Strength training and modified activity practice
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14
Q

Training function (sitting) in complete lesions (2)

A

Boswell-Ruys et al 2010

  • Chronic thoracic paraplegia
  • 1hr/3x wk/6wks
  • No improvements

Harvey et al 2011

  • Sub-acute thoracic paraplegia
  • Usual plus 30mins task specific 3x wk/6wks
  • All improved, no different
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15
Q

Training function in INcomplete lesions (2)

A

Harvey et al 2009 (systematic) = gait training to improve walking

Spooren et al 2009 (systematic) = repetitive motor task training improved UL and hand function

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16
Q

How can tendons be kept strong? (research)

A

Harvey et al 2010

- ES for keeping tendons strong before tendon transfer

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17
Q

Why is training function in SCI different to stroke?

A

Training new skills (whole, modified, part)

18
Q

How frequent is spasticity in SCI and how detrimental is it?

A
  • present in up to 80% of SCI Pts.

- more detrimental in incomplete lesion

19
Q

What is the leading cause of death in long term SCI?

A

CV disease

20
Q

Evidence for increasing ROM?

A

Positioning, splinting, casting, PROM and tilt table are not effective
(Rx for 30mins 3-5x/week for 4-12 weeks)

Ben and Harvey 2010

  • Self-administered hamstring stretches for 30mins, 5x wk/6wks
  • Average 10 deg improvement!
21
Q

Rx to maintain and increase ROM

A

ROM Rx

  • Assess accurately
  • Prevent (not reverse)
  • Target mm susceptible to shortening
22
Q

Essential components of lying to sitting in a C6 quad

A

Components

  1. Roll onto side
  2. Lift upper body off bed
  3. Support the upper trunk
  4. Hook top hand under leg
  5. Shuffle bottom elbow around the body
  6. Move into upright position
23
Q

Techniques to train rolling

A

Pre-swing phase

  • Small weight
  • Splints
  • Arms low and close to the body

Swing phase

  • Pillow behind trunk
  • Cross the ankles
  • Flex contralateral side knee
  • Begin 1/4 off supine
24
Q

Essential components of lying to sitting in a T4

A
  1. Rolling
  2. Walking on hands
  3. Lifting/pushing up trunk
  4. Hooking around leg and pushing to get into upright sitting
25
Q

Essential components of transfers for a C6

A
  1. Move to front of w/c (cushion, slide-sheet)
  2. Hook under legs to sit up
  3. Lift first leg onto bed (feet on raised stool, strap used to help lift leg)
  4. Lift the second leg onto bed
  5. Position the hands
  6. Lift and shift body onto the bed (slide board)
26
Q

Essential components of transfers for a T4

A
  1. Position feet on the floor
  2. Move to the front of w/c
  3. Position hands
  4. Lift and shift body onto bed (slideboard)
  5. Final sitting or lift legs onto bed (feet on stool, strap to help lift legs)
27
Q

Measures in SCI:

A

Measures

  • Impairment, activity limitations, participation limitations
  • Specific physio measures - 10m walk, TUG
  • ASIA classification
  • WISCI (walking index for SCI)
28
Q

Measures of overall mobility

A

Overall mobility

  • Functional Independence Measure (FIM)
  • Spinal Cord Independence Function (SCIM)
29
Q

Cardiovascular training considerations in SCI

A

CV considerations:

  • Medical clearance and supervision
  • Use BORG (HR is unreliable)
  • Task specific
30
Q

Gait training (who, considerations)

A

Who
- Thoracic paraplegia and incomplete lesions possibly

Consider

  • Musculoskeletal overuse
  • Orthotic requirements
  • Strength and fitness
31
Q

What are pressure areas?

A

Area of skin or underlying tissue that is dead or dying due to loss of blood flow to the area

32
Q

Risk factors for pressure sores

A

Risks

  • Limited mobility
  • Lack of sensation
  • Bladder and bowel accidents
  • Spasticity
33
Q

Strategies to prevent pressure sores

A

Strategies

  • Check skin regularly
  • Appropriate positioning and equipment
  • Pressure relief (cushions, moving chairs)
  • Care with T/Fs
  • Refer to specialist seating clinic
34
Q

What is autonomic dysreflexia?

A

Exaggerated reflex response of sympathetic NS to noxious stimuli
(E.g. pupil dilation, sweating, CV)

35
Q

What sort of noxious stimuli are common to cause autonomic dysreflexia?

A

Stimuli

  • Distended bladder/bowel
  • Pressure areas
  • Infections
  • Fractures
36
Q

How is autonomic dysreflexia treated?

A

Rx

  • Remove cause
  • Elevate head/lower feet
  • Meds
37
Q

What do social workers do?

A

Social workers:

  • Support/counsel
  • Information
  • Access to services
  • Advocacy
  • Discharge planning
38
Q

What do neuropsychs do?

A
  1. Capacity Ax (consent, D/C destination)
  2. Environmental safety
  3. Behaviour concerns
  4. Cognitive defect Ax
39
Q

What can nurse practioners do?

A

NP

  • Bladder and bowel management
  • Sexual function
  • Pressure care
  • Medication review

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