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NPTE > SCI > Flashcards

SCI Flashcards

1
Q

Flexion injuries occur most often at which spinal levels?
Extension injuries occur most often at which spinal levels?
What are some other mechanisms for spinal cord damage?

A

C5-C6
C4-C5
axial loading and rotatory injuries

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2
Q

SCI will have a primary area of damage and then a secondary area that can…

A

extend multiple segments beyond initial segment

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3
Q

Anterior cord syndrome

A

compression of anterior portion or spinal artery
caused by cervical flexion
loss of motor function and pain and temp below lesion due to damage of corticospinal and spinothalamic tracts

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4
Q

Brown-Sequard syndrome

A

caused by stab wound
paralysis and loss of vibratory and position sense on the same side as the lesion because of corticospinal and dorsal column tracts.
loss of pain and temp on opposite side from spinothalamic tract
pure brown-sequard is rare

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5
Q

Cauda Equina injuries are below what level?
They are…
it is considered what kind of injury?
Characteristics?

A

L1
incomplete
peripheral nerve injuries
flaccidity, areflexia, and impairment of bowel and bladder function.
Full recovery is not typical due to distance needed for axonal regneration

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6
Q

Central cord syndrome

A

due to cervical hyperextension damages spinothalamic, corticospinal and dorsal columns.
UE present with greater involvement and greater motor deficits

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7
Q

Posterior cord syndrome

A

relatively rare
caused by compression to posterior spinal artery
loss of proprioception, two-point discrimination and stereognosis.
Motor function is preserved

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8
Q

ASIA Scale:
A

A

complete
no sensory or motor preserved in sacral segments S4-S5

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9
Q

ASIA Scale:
B

A

sensory incomplete
sensory function preserved below neurological level including S4-S5 AND no motor function preserved more than 3 levels below on either side

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10
Q

ASIA Scale:
C

A

Motor incomplete
motor function preserved for voluntary anal contraction OR
pt meets sensory incomplete and has motor function more than 3 levels below motor level on either side.
Less than half the muscles below neurologic level have a grade greater than or equal to 3.

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11
Q

ASIA Scale:
D

A

Motor incomplete
C but with half or more of key muscles functions below having a muscle grade of greater than or equal to 3.

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12
Q

ASIA Scale:
E

A

normal

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13
Q

Motor level

A

most caudal key muscles that have muscle strength of 3 or more with the superior segment tested as normal 5.

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14
Q

Motor index scoring

A

testing each key muscle using 0-5 scaling totaling 25 points per extremity for total of 100

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15
Q

Sensory level

A

determined by most caudal dermatome with normal score of 2/2 for pinprick and light touch

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16
Q

Key muscles tested:
C5

A

elbow flexors (biceps, brachialis)

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17
Q

Key muscles tested:
C6

A

wrist extensors (extensor carpi radialis longus and brevis)

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18
Q

Key muscles tested:
C7

A

elbow extensors (triceps)

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19
Q

Key muscles tested:
C8

A

finger flexors (flexor digitorum profundus) to the middle finger

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20
Q

Key muscles tested:
T1

A

small finger abduction (abductor digiti minimi)

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21
Q

Key muscles tested:
L2

A

hip flexors (iliopsoas)

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22
Q

Key muscles tested:
L3

A

knee extensors (quads)

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23
Q

Key muscles tested:
L4

A

DF (anterior tib)

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24
Q

Key muscles tested:
L5

A

long toe extensors (extensor hallucis longus)

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25
Q

Key muscles tested:
S1

A

ankle plantar flexors (gastroc and soleus)

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26
Q

Sensory testing for light touch and pinprick

A

see photo

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27
Q

Complications with SCI

A

DVT
ectopic bone
orthostatic hypotension
pressure ulcers
spasticity

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28
Q

DVT prevention

A

prophylactic anticoagulant therapy
maintaining positioning schedule
ROM
proper positioning to avoid excessive venous stasis and use of elastic stockings

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29
Q

DVT is suspected then what

A

no active or passive movement
bed rest and anticoagulant therapy

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30
Q

Autonomic Dysreflexia

A

occurs in pts with SCI in T6 or above
sudden elevation in BP
caused by distended or full bladder, kink or blockage in catheter, bladder infections, pressure ulcers, extreme temp changes, tight clothing or ingrown toenail

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31
Q

Symptoms of Autonomic Dysreflexia

A

HBP, severe headache, blurred vision, stuffy nose, profuse sweating, goose bumps below level of lesion, vasodilation above level of injury.

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32
Q

How to treat Autonomic Dysreflexia

A

immediately check the catheter
lying the patient down is a contraindication
potentially check for bowel obstruction
pt should receive immediate medical intervention

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33
Q

Ectopic bone is aka

A

heterotrophic ossification

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34
Q

Ectopic bone typically occurs where?
Symptoms?

A

larger joints like knees and hips
edema, decreased ROM, increased temp of involved joint

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35
Q

Orthostatic hypotension is due to …
What is common during early stages of rehab?
Decrease of how much systolic BP and how much diastolic BP is considered orthostatic?

A

loss of sympathetic control of vasoconstriction in combo with absent or severely reduced muscle tone.
venous pooling
20 mmHg
10 mmHg

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36
Q

Pressure ulcers common areas

A

coccyx, sacrum, ischium, trochanter, elbows, buttocks, malleoli, scapulae, and prominent vertebrae

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37
Q

How often should they change positions to avoid pressure ulcers?
How often should weight shift?

A

2 hours
15-20 min

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38
Q

How can spasticity be enhanced?
Symptoms?

A

internal and external sources: stress, decubiti, UTI, bowl or bladder obstruction, temp changes or touch
increased tonic stretch reflexes and exaggerated DTRs

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39
Q

Bed Mobility levels of assist for High Tetraplegia (C1-C5)

A

dependent (C1-C4)
Moderate to max assist (C5)

40
Q

Bed Mobility levels of assist for mid-level tetra (C6)

A

minimal assist to mod I with equipment

41
Q

Bed mobility levels of assist for low tetra (C7-C8)

A

independent

42
Q

Bed mobility levels of assist for paraplegia

A

independent

43
Q

Transfers level of assist for high tetra (C1-C5)

A

dependent (C1-C4)
max A with level slide board transfer (C5)

44
Q

Transfers level of assist for mid-level tetra (C6)

A

min A to mod I for slide board transfers
dep with w/c loading
dep with floor transfers and uprighting w/c

45
Q

Transfers level of assist for low tetra (C7-C8)

A

mod I to I with level surface slide board
Mod A to Mod I with car transfer
Max to Mod A with floor transfers and uprighting w/c

46
Q

Transfer level of assist for paraplegia

A

Indep with level surface and car transfers
minA to I with floor transfers and uprighting w/c

47
Q

Weight shift level of assist for high tetra (C1-C5)

A

setup to Mod I with power recline
dep with manual

48
Q

Weight shift level of assist for mid-level tetra (C6)

A

Mod I with power recline
Min A to Mod I with manual

49
Q

Weight shift level of assist for low tetra (C7-C8)

A

Mod I with side to side, forward lean and depression

50
Q

Weight shift level of assist for paraplegia

A

Mod I for depression weight shift

51
Q

W/c management level of assist in high tetra (C1-C5)

A

dependent

52
Q

W/c management level of assist in mid-level tetra (C6)

A

some assistance

53
Q

W/c management level of assist in low tetra (C7-C8)

A

may require assistance with cushion adjustment, anti-tip levers, and w/c maintenance

54
Q

W/c management level of assist in paraplegia

A

independent

55
Q

w/c mobility level of assist in high tetra (C1-C5)

A

Sup/setup to Mod I on smooth, ramp and rough terrain in power w/c
Mod I with manual w/c on smooth surface (C5)
Max A to Dep with manual w/c in all other situations

56
Q

w/c mobility level of assist in mid-level tetra (C6)

A

Mod I in smooth, ramp and rough terrain in power w/c
dep to max A up/down curb with power w/c
Mod I on smooth surface in manual w/c
Mod to min A on ramps and rough terrain with manual w/c
max to mod A up/down curbs with manual w/c

57
Q

w/c mobility level of assist in low tetra (C7-C8)

A

Mod I on smooth, ramp and rough terrain with power w/c.
Dep to Max A up/down curb with power w/c.
Mod I on smooth surfaces and up/down ramps with manual w/c.
Min A to Mod I on rough terrain.
Mod to Min A up/down curbs with manual w/c.
Dep to Max A up/down steps with manual w/c

58
Q

w/c mobility level of assist in paraplegia

A

min A to Mod I up/down 6” curbs in manual w/c.
Mod I with descending steps with manual w/c.
Max to min A to ascend steps with manual w/c.

59
Q

Gait level of assist in paraplegia

A

exercise only with KAFO
household gait with KAFO
limited community gait with KAFO or AFO
functional community ambulation with or without orthoses

60
Q

ROM/positioning level of assist in high tetra (C1-C5)

A

dependent

61
Q

ROM/positioning level of assist in mid-level tetra (C6)

A

mod A to mod I with all

62
Q

ROM/positioning level of assist in low tetra (C7-C8)

A

Min A to mod I with all

63
Q

ROM/positioning level of assist in paraplegia

A

indepenent

64
Q

Feeding level of assist in high tetra (C1-C5)

A

dependent (C1-C4)
Min A with adaptive equipment in C5

65
Q

Feeding level of assist in mid-level tetra (C6)

A

Mod I with adaptive equipment

66
Q

Feeding level of assist in low tetra (C7-C8)

A

Mod I with adaptive equipment (C7)

67
Q

Feeding level of assist in paraplegia

A

independent

68
Q

Grooming level of assist in high level tetra (C1-C5)

A

dependent (C1-C4)
Min A with adaptive equipment for face, teeth, makeup/shaving (C5)
Max/mod A for assistance for hair grooming (C5)

69
Q

Grooming level of assist in mid-level tetra (C6)

A

mod I with adaptive equipment

70
Q

Grooming level of assist in low level tetra (C7-C8)

A

Mod I

71
Q

Grooming level of assist in paraplegia

A

Independent

72
Q

Dressing level of assist in High tetra (C1-C5)

A

dependent

73
Q

Dressing level of assist in mid-level tetra (C6)

A

Mod I for upper body in bed or w/c.
Min A with lower body dressing in bed.
Moderate A with lower body undressing in bed.

74
Q

Dressing level of assist in low tetra (C7-C8)

A

Mod I for upper/lower body dressing in bed.
Min A with lower body dressing/undressing in w/c (C7).
Mod I for upper/lower body dressing and undressing in w/c (C8).

75
Q

Dressing level of assist in paraplegia.

A

Mod I

76
Q

Bathing level of assist in high tetra (C1-C5)

A

dependent

77
Q

Bathing level of assist in mid-level tetra (C6)

A

Min A for upper body bathing and drying.
Mod A for lower body bathing and drying.
Use of shower or tub chair.

78
Q

Bathing level of assist for low tetra (C7-C8)

A

Mod I with all using shower or tub chair

79
Q

Bathing level of assist for paraplegia

A

Mod I with all on tub bench or tub bottom cushion

80
Q

Bowel/bladder problems level of assist for high tetra (C1-C5)

A

dependent

81
Q

Bowel/bladder problems level of assist for mid-level tetra (C6)

A

Bladder:
Min A for male in bed or w/c
Mod A for female in bed

Bowel:
Mod A with use of equipment

82
Q

Bowel/bladder problems level of assist for low tetra (C7-C8)

A

Bladder:
Mod I for male in bed or w/c
Mod I for female in be; Mod A for female in w/c.

Bowel:
Min A to mod I with use of equipment

83
Q

Bowe/bladder problems for paraplegia

A

Bladder:
Mod I for male and female

Bowel:
Mod I for male and female

84
Q

Head-hip relationships

A

when transferring, head to move in opposite direction of hips

85
Q

Myelotomy

A

severs certain tracts within spinal cord in order to decrease spasticity and improve function

86
Q

Neurectomy

A

removal of segment of a nerve in order to decrease spasticity and improve function

87
Q

Neurogenic nonreflexive bladder

A

bladder is flaccid as a result of cauda equina or conus medullaris lesion. sacral reflex arc in damaged

88
Q

Neurogenic reflexive bladder

A

empties reflexively for a patient with injury above T12. Sacral reflex arc remains intact

89
Q

Paradoxical breathing

A

abnormal breathing
common in tetraplegia
Inspiration: abdomen rises and chest pulled inward
Expiration: abdomen falls and chest expands

90
Q

Rhizotomy

A

resection of sensory component of a spinal nerve to decrease spasticity

91
Q

Spinal shock

A

occurs 30-60 minutes after trauma to spinal cord and can last several weeks. Presents with total flaccidity and loss of all reflexes below level.

92
Q

Tenodesis

A

tetra
do not possess control for grip but utilize the flexed fingers for grip

93
Q

Tenotomy

A

release of tendon

94
Q

Tetraplegia

A

cervical spine

95
Q

Paraplegia

A

thoracic, lumbar, sacral

96
Q

Gait training can be done in those with injury at ___ or lower.

A

T9

NPTE (54 decks)

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