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Neuro PT 2 > SCI > Flashcards

SCI Flashcards

1
Q

How is a level of SCI determined?

A

by the last intact mm group/dermatome

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2
Q

Key mm groups in SCIs

1) C1-4
2) C5
3) C6
4) C7
5) C8
6) T1

A

1) C1-4 diaphragm and sendory
2) C5 biceps
3) C6 wrist extension
4) C7 triceps
5) C8 finger flexors
6) T1 small finger adbductors

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3
Q

T2-L1= what kind of test

A

sensory level only

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4
Q

L2

A

hip flexors

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5
Q

L3

A

knee extensor

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6
Q

L4

A

ankle DFs

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7
Q

L5

A

long toe extensor

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8
Q

S1

A

ankle PFs

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9
Q

S2

A

sensory level again, + anal wink

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10
Q

level of injury: motor level

A

lowest key mm with a grade of at least 3/5 (provided all mm before it was 5/5)

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11
Q

level of injury: sensory level

A

lowest normal dermatome

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12
Q

ASIA grade A

A

complete, no motor or sensory fxn is preserved in the sacral segments S4-S5

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13
Q

ASIA grade B

A

sensory incomplete- sensory but no motor fxn is preserved below the neurological level. Sacral segments S4 and S5 are intact.

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14
Q

ASIA grade C

A

motor incomplete- motor fxn is preserved below the neurological level and mor than half of key mm fxns below the neuro level of Injury (NLI) have a mm grade less than 3/5.

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15
Q

ASIA grade D

A

motor incomplete- motor fxn is preserved below the NLI and at least half (so half or more)of key mm fxns below the NLI have a mm grade of >3/5, (3,4,5/5)

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16
Q

ASIA grade E

A

Normal- normal- used in follow up of pts with SCI who initially had deficits. A pt who never had an initial SCI doesn’t get an ASIA grade.

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17
Q

what is the most common SCI

A

incomplete tetra, then complete para, then incomplete para then complete tetra (rare)

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18
Q

anterior cord syndrome

A

still has: light touch, proprioception, deep pressure.

Missing: pain, motor fxn,

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19
Q

central cord syndrome

CCS

A

UE weakness > LE weakness, sacral sensory sparing

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20
Q

causes of central cord syndrome

A

hyperextension, hematoma or edema forming in the central aspect of the spinal cord (scorpion from ridiculousness)

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21
Q

what tracks are spared in a central cord syndrome bc they are laterally located?

A

LE and sacral tracts of the spinothalamic and corticospinal tracts

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22
Q

can a person with a complete SCI strengthen injuries

A

no…

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23
Q

what is tenodesis

A

the hooking/flexed position of the fingers that allows them to grasp,hold things, don’t discourage or stretch this out.

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24
Q

which pts usually need power chairs

A

C6 and above injuries

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25
Q

ppl with this level of injury MAY be able to use a manual chair… just have to weigh the energy expenditure with the benefits…

A

C7-T1

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26
Q

what are common sites for skin breakdown if ppl don’t get pressure relief

A

areas of bony prominences, problems when sitting and laying down

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27
Q

factors limiting activity tolerance in acute SCI

A 
upright BP tolerance
respiratory status (no abdominals to keep pressure/no intercostals)
endurance
pain
clearing secretions
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28
Q

autonomic dysreflexia

A

bc these pts have autonomic instability, any noxious stimuli makes the autonomic NS freak out and their HR and bp go through the roof. Can cause cerebral hemorrhage or heart failure.

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29
Q

what happens in the skin of ppl with injuries to T8 and above?

A

thinning of epithelial layer, changes to the collagen and hyperhidrosis

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30
Q

wound stages

I:

A

intact skin with non-blanchable redness of a localized area usually over a bony prominence

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31
Q

wound stages II:

A

superfuicial ulceration that extends into dermis

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32
Q

wound stage III:

A

an ulcer that extends into subcut. tissue but not into mm

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33
Q

wound stage IV:

A

deep ulceration that extends through mm tissue down to the underlying bony prominence

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34
Q

unstageable wound

A

full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough and or eschar in the wound bed

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35
Q

Deep tissue injury

A

purple or maroon localized ara of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear

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36
Q

is a rigid frame w/c or folding frame more energy efficient?

A

rigid frame- good for newbies

37
Q

whats the best cushion for pressure relief

A

custom pressure mapped cushion

38
Q

the higher the injury, the ________ it is to control BP and the _________ respiratory fxn

A

harder to control BP and the worse the resp. fxn

39
Q

what is good for helping to maintain abdominal pressure at first?

A

abdominal binders

40
Q

injury at C6-7= intact _________ but limited __________

A

intact diaphragm but limited intercostals

41
Q

inc. difficulty weaning off the ventillator and may need tracheostomy if…..

A

hx of smoking
pneumothorax
infection

42
Q

when does spasticity set in

A

after period of initial shock, will be flacid initially then may become spastic

43
Q

what is neurogenic bladder?

A

bladder will not empty with voluntary control

44
Q

hyporeflexive bladder

A

does not empty

45
Q

hyper-reflexive bladder

A

empties too often

46
Q

heterotrophic ossicifation

A

sudden limitation of ROM, bone begins to form in the mm tissue

47
Q

s&S of HO

A

red, warm, swollen, painful, loss of ROM

48
Q

management of HO

A

refer back to physician, medications needed, some ROM can be helpful but don’t be too aggressive

49
Q

what is the primary cause of autonomic dysreflexia for pts with injury at T6 or higher

A

bladder distention

50
Q

symptoms of autonomic dysreflexia

A 
headache
sweating
nasal congestion
sustained penile erection
hyperhidrosis above level of lesion
paresthesias
51
Q

causes of Auto. dysreflexia

A 
bowel or bladder
cutaneous lesions
fractures
intra-abdominal injury
body positioning
clothing/external irritants
52
Q

what is the single most common cause of AD

A

blocked urinary catheter

medical emergency

53
Q

what is neurogenic bowel

A

bowel will not empty with volitional control

54
Q

assistance for neurogenic bowel

A

suppositories
mini-enemas
digital stimulation
medications (stool softeners)

55
Q

if a patient is having loose stools, should stool softeners

A

no because there may still be a bolus blocking and only the loose stuff around it is coming out.

56
Q

who accounts for 80% of all SCIs

A

males

57
Q

whats the leading cause of SCI in ppl over the age of 60?

A

falls

58
Q

What are the 5 KU hospital spine precautions?

A

1) bed rest
2) do not elevate HOB
3) place in reverse trendelenburg at 30 degrees to avoid aspiration
4) log roll with 2 ppl
5) limit extremity movement to avoid spine movement

59
Q

how is the level of injury defined?

A

by the last intact muscle group (3/5, with the previous ones being 5/5) and dermatome, NOT BY SPINAL FRACTURE

60
Q

how much tilt do u need for pressure easing and then for true pressure relief?

A

35* for minimal drop in pressure, 65* of tilt for actual relief

61
Q

who is at highest risk of skin breakdown ?

A

fair skinned ppl with poor nutrition who have more mm atrophy and are overweight (moisture control issues)

62
Q

What is spinal shock?

A

all phenomena surrounding physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflex activity below the level of the injury.

63
Q

which nerve can provide a spinal cord-bypass pathway for vaginal-cervical sensation and can be activated to produce orgasm?

A

Vagus Nerve

64
Q

What are the three primary goals of acute SCI patients?

A

> prevention of secondary complications
upright tolerance
education

65
Q

whats a great way to prevent pneumonia and promote GI function with acute SCI patients

A

proper positioning and out of bed activities

66
Q

how do u prevent contractures and skin breakdown

A

positioning and teaching pressure relief strategies

67
Q

pay particular attention to what body part when avoiding contractures?

A

ankles- need to be able to place feet on foot rests

68
Q

What are the S&S of postural hypotension?

A

light headedness, low BP, yawning, passing out

69
Q

management of postural hypotension?

A 
increase pressure:
ace wraps
TED hose
reclining or cardiac chair
meds
abdominal binder
70
Q

how does a pressure sore begin?

A

redness that doesn’t go away in 20 min

71
Q

when is a DVT most likely to occur

A

in acute SCI during flaccidity phase

72
Q

S&S of DVT

A

warm, swollen, painful (if pt has sensation),

73
Q

management of DVT

A

IVC filter, SCDs, meds, mobility

74
Q

if face is red….

if face is pale…..

A

red raise the head

pale raise the tail

75
Q

What is syringomyelia

A

a progression of weakness proximal to the level of injury

76
Q

management of syringomyelia

A

surgery

77
Q

S&S of syringomyelia

A

change in level of function, unexplained decrease in motor function

78
Q

u should assume that anyone with a hx of SCI may have________ and therefore u should be cautious with ____________

A

ostoporosis, PROM

79
Q

proper wc positioning is key to prevention of what?

A

spinal deformities

80
Q

why are spinal deformities so dangerous ?

A

eventually may cause respiratory complications

81
Q

what is the regulation for ramps?

A

one foot of run for every inch of rise

82
Q

when talking about level of injury, what is the neurological level?

A

highest of the motor or sensory levels on either side

83
Q

how do u define “completeness” of injury?

A

presence or absence of rectal tone/sensation–>is there any motor or sensation below the level of injury?

84
Q

what is brown sequard syndrome?

A

hemisection of the cord

85
Q

S&S of brown sequard syndrome?

A

ipsilateral paralysis and loss of proprioception

contralateral loss of pain and temperatures

86
Q

what type of injury is a cauda equina injury?

A

LMN= flaccidity

87
Q

ppl with cauda equina injury have most probs with what?

A

bowel and bladder training

88
Q

does the evidence support high dose steroid administration for SCI pts?

A

no

Neuro PT 2 (12 decks)

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