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
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
26
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
27
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
28
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
29
What are some C5 interventions?
- MAS - deltoid aide/overhead sling - dorsal long opponens splint - AT & DME - Weight shifting, positioning (watch elbows) - Quad cough- breathing
30
C6 additional muscles innervated
- clavicular pectoralis - extensor carpi readialis, longus, brevis - serratus anterior - latisimus
31
C6 movement possible
- scap protration - shoulder horizontal adduction - weak pronation - wrist extension
32
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
33
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
34
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
35
C7-8 movements possible
- elbow extension - ulnar wrist extension - wrist flexion - finger flexion, extension, abduction
36
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
37
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
38
T or F | At T1 intrinsics are complete.
True
39
What muscle innervations at T1-9?
- intrinsics of hand & thumb - lumbricals - internal & external intercostals - erector spinae - upper abs
40
Possible T1-9 movements
- UE's movement | - limited upper trunk
41
T1-9 expected functional outcomes
- independent with all ADLs - independent with mobility - may require 3 hrs a day for homemaking
42
Expected functional outcomes at T10-L1
independent but may require up to 2 hrs a day for homemaking
43
Muscle innervated at L2-S5
- abdominals/trunk - some hip flexors, extensors, abduct, add - some knee flexors, extensors - ankle doriflexion, plantarflexion