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Conditions neuro > SCI > Flashcards

SCI Flashcards

1
Q

What is the most common cause for SCI?

A

Trauma due to Motor Vehicle accidents

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2
Q

What are some other common causes for SCI other than MVA?

A
  • Violence like GSW or stab wounds
  • Falls (22%)
  • Sports accidents (8%)
  • Driving (2%)

-Spinal tumors, ALS, MS, etc

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3
Q

Define quadriplegia

A

any degree of paralysis of the 4 limbs and trunk muscular

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4
Q

Define paraplegia

A

Paralysis of lower extremities with some trunk involvement depending on the level (waist down)

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5
Q

Define spinal shock

A
  • 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
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6
Q

What happens after spinal shock subsides? Above Lesion? Below Lesion

A
  • 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
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7
Q

Define complete SCI

A

Total paralysis and loss of sensation below the level of lesion

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8
Q

Define incomplete SCI

A

some degree of preservation

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9
Q

Describe the Brown-Sequard Syndrome

A
  • 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
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10
Q

Describe central cord syndrome

A
  • 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
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11
Q

Describe Anterior Cord Syndrome

A
  • 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)
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12
Q

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?

A

Skin breakdown

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13
Q

Describe the decreased vital capacity complication of SCI

A
  • cervical & thoracic lesions
  • limited chest expansion, lack of O2
  • increased risk of pneumonia, respiratory infection
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14
Q

What SCI complication is marked by disuse of long bones, at risk for fractures (especially femur & tibia), decrease of calcium?

A

Osteoporosis

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15
Q

Describe orthostatic hypotension

A
  • 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

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16
Q

What is autonomic dysreflexia?

A
  • 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
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17
Q

What are some interventions for autonomic dysreflexia complications?

A
  • upright position and take BP
  • loosen clothing
  • check catheter tubing/ drain bladder
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18
Q

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?

A

Reflex Sweating

19
Q

How do deep venous thrombosis occur?

A
  • 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
20
Q

Describe spasticity complication

A
  • very common in SCI

- an involuntary contraction when communication cannot go down below lesion

21
Q

What are C1-3 expected functional level?

A
  • 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
22
Q

What muscles are still innervated with a C1-3 level injury? What are possible movements?

A

Muscles:

  • Sternocleidomastoid
  • Cervical paraspinal
  • neck accessories

Movements:

  • Head & eye movement
  • Neck flexion & extension
  • Head rotation
23
Q

C1-C3 interventions

A
  • vent dependent

- similar to C4

24
Q 
What SC level has the following muscles innervated?
Muscles:
-Sternocleidomastoid
-Cervical paraspinal
-neck accessories
-upper trap
-diaphragm
A

C4

possible movements with these muscles:

  • neck flexion, extension, & rotation
  • scapular elevation
  • inspiration!!!!! they can breathe!
25
Q

What are C4 expected functional level?

A
  • 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
26
Q

List some C4 intervention strategies

A
  • 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

27
Q

What additional muscles are innervated at C5 and what additional movements are possible?

A
  • deltoid, biceps brachialis, brachioradialis, serratus anterior (partial), rhomboids
  • shoulder flexion, extension, abduction
  • elbow flexion and supination
  • scapular adduction and abd
28
Q

What are C5 expected functional level?

A
  • 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
29
Q

What are some C5 interventions?

A
  • MAS
  • deltoid aide/overhead sling
  • dorsal long opponens splint
  • AT & DME
  • Weight shifting, positioning (watch elbows)
  • Quad cough- breathing
30
Q

C6 additional muscles innervated

A
  • clavicular pectoralis
  • extensor carpi readialis, longus, brevis
  • serratus anterior
  • latisimus
31
Q

C6 movement possible

A
  • scap protration
  • shoulder horizontal adduction
  • weak pronation
  • wrist extension
32
Q

C6 expected functional level

A
  • 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
33
Q

What is tenodesis?

& At what level is it used as an intervention?

A
  • flexion at wrist will have extension of fingers
  • extension at wrist will have flexion of fingers
  • C6
34
Q

What are additional muscles are innervated at C7-8?

A

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
35
Q

C7-8 movements possible

A
  • elbow extension
  • ulnar wrist extension
  • wrist flexion
  • finger flexion, extension, abduction
36
Q

C7-8 expected functional outcomes

A
  • 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
37
Q

At what level do you have a good, healthy cough ability?

What muscles are innervated at this level?

A

T10-L1

intercostals, external obliques, rectus abdominus

38
Q

T or F

At T1 intrinsics are complete.

A

True

39
Q

What muscle innervations at T1-9?

A
  • intrinsics of hand & thumb
  • lumbricals
  • internal & external intercostals
  • erector spinae
  • upper abs
40
Q

Possible T1-9 movements

A
  • UE’s movement

- limited upper trunk

41
Q

T1-9 expected functional outcomes

A
  • independent with all ADLs
  • independent with mobility
  • may require 3 hrs a day for homemaking
42
Q

Expected functional outcomes at T10-L1

A

independent but may require up to 2 hrs a day for homemaking

43
Q

Muscle innervated at L2-S5

A
  • abdominals/trunk
  • some hip flexors, extensors, abduct, add
  • some knee flexors, extensors
  • ankle doriflexion, plantarflexion

Conditions neuro (11 decks)

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