SCI Flashcards
At which spinal cord levels (and below) is estim going to be ineffective?
L1/L2 and below
T/F using estim for a peripheral nerve injury is an ineffective treatment.
True
The spinal cord has 2 enlargements: ________ and ________.
Cervical and lumbosacral enlargements
The spinal cord terminates at the _______________.
conus medullaris
What does the DCML pathway mediate (3)?
Proprioception
Vibration
discriminative touch
What does the spinothalamic tract mediate (3)?
Pain
Temperature
Non-discriminate touch
Which gender is at a higher risk of SCI?
Male
What age group is at a higher risk of SCI?
16-30
What underlying bone disorders are risk factors for SCI?
Osteoporosis
Rheumatoid arthritis
70% of SCI are caused by ________ and _________.
accidents and falls
___% of SCI are traumatic and ___% are non-traumatic.
95%; 5%
What is the most common motion that leads to an SCI?
Flexion
Identify three ways to classify an SCI:
Level of injury
Degree of impairment (complete or incomplete)
Syndromes associated with injury
Define paraplegic
Loss of lower extremities
Define tetraplegic
Loss of all 4 extremities (quadriplegic)
How is the level of the injury classified?
The most caudal level of the spinal cord with normal function bilaterally.
Define a complete SCI
No sensory or motor function in the lowest sacral segments S4-S5.
Therefore no voluntary control over the sphincter and no anal sensation.
Asia impairment scale: A
Complete. No sensory or motor function preserved in sacral segments S4-5
Asia impairment scale: B
Incomplete. Sensory but not motor preserved below the neurological level and includes sacral segments S4-5.
Asia impairment scale: C
Incomplete. Motor function preserved below neurological level, and more than half of key muscles below the level have a muscle grade less than 3.
Asia impairment scale: D
Incomplete. Motor function is preserved below neurological level, and at least half of key muscles below level have a muscle grade greater than or equal to 3.
Asia impairment scale: E
Normal. Sensory and motor function is normal
What is the period immediately following an SCI termed?
Spinal shock
During spinal shock what happens to reflex activity?
Absence of all reflex activity.
What are the 3 phases of spinal shock?
Loss or weakening of reflexes
return of some reflexes
Hyperreflexia
One of the first indicators that spinal shock is resolving is the presence of a positive ____________ reflex.
bulbocavernosus
T/F tetraplegia and paraplegia can be either complete or incomplete.
True
Describe the consequences of Brown-Sequard syndrome
Ipsilateral weakness and loss of position and vibration.
Contralateral loss of pain and temperature.
Describe the consequences of cord syndrome
Below injury level, motor paralysis and loss of pain and temperature sensation.
Proprioception, touch, and vibratory sensation preserved.
Describe the consequences of cord syndrome
Loss of proprioception, two-point discrimination, graphesthesia, stereognosis.
Normal motor, pain and light touch function.
Describe the consequences of central cord syndrome
Early loss of pain and temperature. Upper extremities and cervical tracts affected.
Lumbar and sacral preserved.
What is the most common cause of Brown-Sequard?
Penetration trauma (i.e. knife)
Based on the following symptoms, identify the syndrome:
Bowel/bladder incontinence
Low back pain
Radicular pain down the legs
Lower extremity paralysis
Diminished reflexes
Cauda Equina syndrome
Autonomic dysreflexia typically occurs in lesions above ___.
T6
T/F autonomic dysreflexia subsides over time.
True
Identify some symptoms of autonomic dysreflexia (5):
HTN
dizziness
headache
bradycardia
sweating
If you suspect a patient has autonomic dysreflexia, what’s the first thing to do?
Put them in a seated position. DO NOT place them in supine.
Describe the type of pain: Acute pain that subsides with healing.
Traumatic pain
Describe the type of pain: Caused by damage to the nerve roots.
Nerve root pain
Describe the type of pain: Phantom pains below the level of the lesion.
Spinal cord dysesthesia
aka neuropathic pain
Describe the type of pain: Pain above the level of the lesion.
Musculoskeletal pain
List three treatment considerations for orthostatic hypotension:
Slow progression to vertical position
Monitor vital signs
Use compression stockings and abdominal binders
It’s common for SCI patients to have on-going LOW/HIGH BP levels
Low
Define maceration
Skin that becomes wet. Impairs blood flow.
i.e. band aid after shower
There is an increased risk of _______ and death due to pressure sore infections going untreated.
Sepsis
Three treatments for pressure ulcers:
Bed rest (stay off wound)
Alternating pressure mattress
Wound clinic attendance
Weight shifting should be performed every ___ - ___ minutes in sitting for ___ minutes.
15-20; 1 minute
Describe an abdominal binder and what it helps with.
Goes from below ribs to top of pelvis.
Assists with BP
Assists with inspiration
When worried about skin integrity, what motion should be avoided?
Shearing. Lift over slide
How often should patients change position in bed?
every 2 hours
Why are splints used?
to prevent contractures
Optimal ROM for SCI patient: Lumbar spine
mild extensor tightness
Optimal ROM for SCI patient: Shoulder extension
Greater than normal
Optimal ROM for SCI patient: Wrist
90 degrees of extension
Optimal ROM for SCI patient: fingers
Mild tightness of the long finger flexors.
Optimal ROM for SCI patient: hamstrings
SLR 110-120 degrees
Optimal ROM for SCI patient: Ankle DF
0 degrees if non-ambulatory
