SCI Flashcards
Order of most common to least in extent of injury/neurological levels
- Incomplete tetraplegia (40.8%)
- Complete paraplegia (21.6%)
- Incomplete paraplegia (21.4%)
- Complete tetraplegia (15.8%)
associated injuries with SCI
-fractures
-LOC (28%)
-pneumothorax/hemothorax
-TBI (11.5%)
main cause of death in SCI
LUNG (pneumonia, respiratory system disease) =21%
*lung is also number 1 place to metastasize in SCI
Top 5 causes of death in order for SCI
- Pneumonia and respiratory system disease (21.6%)
- Cardiovascular system (18.51%)
- Infective/parasitic (11.9%)
- Unintentional injuries, suicide, homicide (10.1%)
- Cancer (10.0%)
The life expectancy for a 20 year old with SCI tetraplegia if ASIA A, B, C
if tetra and vent dependent?
20 years less
vent: 42 years less
Life expectancy for a 20 year old with SCI paraplegia (ASIA A, B, C)
what about ASIA D?
14 years less
D: 6 years less
The SCIM (SC independence measure) is better than FIM. Why?
More responsive to change
-respiration/sphincter management most often different
-self care least often different
SCIM 3 subscales
- self care
- respiration/sphincter management
- mobility
What can we use instead of FES or ABC for SCI population (falls)
SCI Falls Concern Scale (SCI-FCS)
*modified from FES
*also tested with adults with MS, Fear of falling didnt change even though function improved after fall risk intervention
____ is related to fear of falling in SCI (according to SCI-FCS)
poor sitting balance
The TAI (transfer assessment instrument) tests function and safety of transfer in what 3 phases?
- WC set up
- body set up
- flight
includes assistive technology
assesses risk of injury and overuse
UMN reflexive/neurogenic bowel:
___ reflex center
___bowel program
intact reflex center
suppository insertion, then digital stimulation for reflexive emptying of poop
LMN flaccid/areflexive bowel
___ reflex center
intact ___
bowel program?
non intact reflex center
intact abs
manage diet, fluids, may need manual evacuation of poop
UMN – neurogenic (reflexive) bladder program
-unable to empty
-varies, usually intermitt catheterization, fluid monitoring
LMN – flaccid (areflexive) bladder program
empties, incontinence
time voids, monitor fluids
2 big hotspots of SCI pressure sores during initial hospitalization
sacrum (37.4%)
heel: 15.9%
distribution of SCI grade 3/4 pressure injuries after 2 years
- ischium (30.9%
- trochanter 26.5%
- sacrum 17.6%
start vertical tolerance training by
dangling at edge of bed?
NO BC OTHN
major cardiopulm complications of SCI
- OTHN
- decreased vital capacity
- atelectasis
- pneumonia
- DVT
- Autonomic Dysreflexia (above T5/6)
symptoms of autonomic dysreflexia
HTN
pounding HA
sweaty, red, nasal obstruction
Patients with SCI have ___ higher
mortality risk for cardiovascular disease!
Decreased
peripheral
muscle mass
Decrease
venous return
Decreased
stroke volume/
cardiac output
228%
__% of chronic SCI have diabetes
50%
most common psych complication for SCI
anxiety, depression
suicide rates are 5-10% higher
predictors of favorable psych outcomes after SCI
age
personality
NOT LEVEL OF INJURY
cervical stabilization: ____ are used while waiting for surgery
gardner wells tongs
What are halo vests?
provide traction, eliminates c-spine movement, allows for early out of bed activity
*do not adjust even if patient asks
Sternal occipital mandibular immobilizer (SOMI)
Metal and leather frame with straps to minimize movement
Can be removed briefly for hygiene when patient is in bed
can also use a Minerva brace
what is the least restrictive collar?
philadelphia collar
*semirigid foam
*can be removed for hygiene in bed
similar: MIAMI J
least restrictive thoracolumbar brace
Less: Taylor-Knight brace
Metal and leather frame contacting sternum, pelvis, and can have clavicle/scapula extensions to control flexion and extension
LEAST: jewett hyperextension brace for resisting FLEXION
for patients early in SCI, what shoulder motions to avoid for cervical injuries + c/o neck pain
shoulder flex and ABD
complaint of back pain for early lumbar SCI injury: avoid stretching
hammies: SLR
Avoid long-sitting position until at least ____ passive unilateral SLR attained on both sides.
90 degrees
general program progression
- Bedside treatment
- Upright tolerance
- Mat activities
- Transfers
- Basic WC skills
- Power building & conditioning ex
- Advanced WC skills
- Gait
- Pain management
- driving
- vocational rehab
- psych/counseling
- home and work eval, recs,
SCI OVERUSE INJURIES
__% have degen changes in shoulder
__% have CTS
75% shoulder
40% CTS
*shoulder pain: only difference of with/without pain was time since injury –> its coming for most patients
If __ mm are intact and present, may use these on their WC for basic ADLs and act as deltoid assist
biceps
mobile arm supports
