SCI Flashcards
What is the most common cause for SCI?
Trauma due to Motor Vehicle accidents
What are some other common causes for SCI other than MVA?
- Violence like GSW or stab wounds
- Falls (22%)
- Sports accidents (8%)
- Driving (2%)
-Spinal tumors, ALS, MS, etc
Define quadriplegia
any degree of paralysis of the 4 limbs and trunk muscular
Define paraplegia
Paralysis of lower extremities with some trunk involvement depending on the level (waist down)
Define spinal shock
- May last 24 hours to 6 weeks
- state of diminished excitability; flaccid muscles below lesion
- Period of areflexia (without any reflex)
- Deep Tendon reflexes decreased
What happens after spinal shock subsides? Above Lesion? Below Lesion
- Area above lesion begins to work
- -No reflex at level of lesion, no motor, no sensation
- Below lesions start of reflex arc activity
- increase spasticity below lesion
- deep tendon reflex becomes hyperactive
Define complete SCI
Total paralysis and loss of sensation below the level of lesion
Define incomplete SCI
some degree of preservation
Describe the Brown-Sequard Syndrome
- one side of the spinal cord is damaged (freq result of GSW or stab)
- ipsilateral loss of motor function below level of injury
- ipsilateral reduction of deep touch & proprioception
- contralateral loss of pain, temp, and touch
- -Major challenge: extremities with the greatest strength have the poorest sensation
Describe central cord syndrome
- more central structures are damaged
- common causes: hyperextension of neck with narrowing of spinal canal
- arms and hands more impaired
- more prevalent in the aged
Describe Anterior Cord Syndrome
- injury to the anterior spinal artery or the anterior aspect of the cord
- paralysis & loss of pain, temp, touch
- loss of reflex motor activity and ability to sense position and vibration
- Proprioception is preserved (protective sensation)
What complication of SCI is marked by sensory loss on skin receptors, pressure causes loss of bloody supply, common areas affected: sacrum, trochanters, heels, elbows?
Skin breakdown
Describe the decreased vital capacity complication of SCI
- cervical & thoracic lesions
- limited chest expansion, lack of O2
- increased risk of pneumonia, respiratory infection
What SCI complication is marked by disuse of long bones, at risk for fractures (especially femur & tibia), decrease of calcium?
Osteoporosis
Describe orthostatic hypotension
- Lack of muscle strength or tone in abdomen & LE’s
- Blood pools in legs ad abdomens
- results: decreased BP
- occurs:when moved from supine to sit position
-patient must be reclined quickly
What is autonomic dysreflexia?
- injuries above T4 to T6 level
- Rapid increase in BP caused by reflex action of the ANS in response to some stimulus
- Common factors: bladder distention, fecal mass, thermal/pain stimuli, catheter irritation, clothing wrinkle, pressure sore
What are some interventions for autonomic dysreflexia complications?
- upright position and take BP
- loosen clothing
- check catheter tubing/ drain bladder
What complication is common in T10 and above injuries and may be trigged by spasticity, and occurs anytime of the day but usually at night time?
Reflex Sweating
How do deep venous thrombosis occur?
- due to blood clots due to immobility that get loose and travel
- more prone in the first 6 months post injury
- must monitor LE for swelling and redness and temp change
Describe spasticity complication
- very common in SCI
- an involuntary contraction when communication cannot go down below lesion
What are C1-3 expected functional level?
- ADLs: total assist
- Respiration: dependent on ventilator
- W/C: (I) with power
- Bowel & Bladder: total assist
- Homemaking: Total assist
- Education: Min A, independent using AT
- work: up to independent using AT
What muscles are still innervated with a C1-3 level injury? What are possible movements?
Muscles:
- Sternocleidomastoid
- Cervical paraspinal
- neck accessories
Movements:
- Head & eye movement
- Neck flexion & extension
- Head rotation
C1-C3 interventions
- vent dependent
- similar to C4
What SC level has the following muscles innervated? Muscles: -Sternocleidomastoid -Cervical paraspinal -neck accessories -upper trap -diaphragm
C4
possible movements with these muscles:
- neck flexion, extension, & rotation
- scapular elevation
- inspiration!!!!! they can breathe!
What are C4 expected functional level?
- respiration: (I) but low endurance
- ADLs: total assist
- W/C: (I) with power
- Bowel & Bladder: total assist
- homemaking: total assist
- Education: Min A, independent using AT
- Work: up to independent using AT
List some C4 intervention strategies
- use AT to allow them to make decisions
- low tech mouth-sticks
- communication- directing car
- education
- W/C control: stick, head array
- Tilt, recline
important to remember that all DME & AE should be padded to avoid pressure sores etc
What additional muscles are innervated at C5 and what additional movements are possible?
- deltoid, biceps brachialis, brachioradialis, serratus anterior (partial), rhomboids
- shoulder flexion, extension, abduction
- elbow flexion and supination
- scapular adduction and abd
What are C5 expected functional level?
- Respiratory: (I) but low endurance
- Self-feeding: I after set up
- Dressing: LE total A, UE Min A
- Grooming: min to total
- Bathing/ toilet: total
- W/C: (I) with power, some manuel
- Bowel & Bladder: total assist
- homemaking: total assist
- Driving: I with AE
What are some C5 interventions?
- MAS
- deltoid aide/overhead sling
- dorsal long opponens splint
- AT & DME
- Weight shifting, positioning (watch elbows)
- Quad cough- breathing
C6 additional muscles innervated
- clavicular pectoralis
- extensor carpi readialis, longus, brevis
- serratus anterior
- latisimus
C6 movement possible
- scap protration
- shoulder horizontal adduction
- weak pronation
- wrist extension
C6 expected functional level
- Respiratory: still limited
- bowel & bladder: Min A, to total assist
- bathing: I with UB, LB up to total
- self feeding: I after set up
- Dressing: I UB, SBA to total A LB
- Grooming: (I)
- W/C: I in power or manuel
- Driving: I
What is tenodesis?
& At what level is it used as an intervention?
- flexion at wrist will have extension of fingers
- extension at wrist will have flexion of fingers
- C6
What are additional muscles are innervated at C7-8?
C7
- latis dorsi
- sternal pect
- triceps
- pronator quad
- ext carpi ulnaris
- flex carpi radialis
- extensor cummuntis
C8 (Some intrinsics)
- FDP & FDS
- Flexor/extensor/abductor pollicis
- partial lumbricals
C7-8 movements possible
- elbow extension
- ulnar wrist extension
- wrist flexion
- finger flexion, extension, abduction
C7-8 expected functional outcomes
- bowel: some to total assist
- bladder: independent to moderate
- dressing: I UB, up to I with LB
- Bathing: up to independent
- personal care: up to 6 hrs a day
- homemaking assistance: 2 hours a day
At what level do you have a good, healthy cough ability?
What muscles are innervated at this level?
T10-L1
intercostals, external obliques, rectus abdominus
T or F
At T1 intrinsics are complete.
True
What muscle innervations at T1-9?
- intrinsics of hand & thumb
- lumbricals
- internal & external intercostals
- erector spinae
- upper abs
Possible T1-9 movements
- UE’s movement
- limited upper trunk
T1-9 expected functional outcomes
- independent with all ADLs
- independent with mobility
- may require 3 hrs a day for homemaking
Expected functional outcomes at T10-L1
independent but may require up to 2 hrs a day for homemaking
Muscle innervated at L2-S5
- abdominals/trunk
- some hip flexors, extensors, abduct, add
- some knee flexors, extensors
- ankle doriflexion, plantarflexion
