SCI Flashcards
SCI : Statistics
Prevalence in 2014: 276,000
Age in 2010 : 42 (29 in the 70’s)
80% are mail
MVA, Falls, Violence, Sports, Uncertain
Hospital Stay : Acute
14-28 days
Hospital Stay : Rehab
2-4 months
92% are d/c to non-institutional residences
Spinal Shock
Period of swelling around S.C. (spinal cord) -> affects sensory & motor in/outputs
American Spinal Injury Association (ASIA) : Motor Level, C5
Elbow flexors
ASIA : C6
Wrist extensors
Decent elbow, hand function but limited trunk control.
ASIA : C7
Elbow extensors
Can do depression transfers
ASIA : C8
Finger flexors
Results in increased function
ASIA : T1
Finger abduction
Lession is at nipple area
ASIA : C4
Shoulder motion (i.e. shrug) No trunk control
ASIA : Sensory Level
Key sensory points along dermatome Light touch & pink prick 0-absent 1-impaired 2-normal
Sensory Testing
Acute: Usually tested every shift by a nurse or neurologist
Rehab: once stabilized decreased monitoring occurs
ASIA : T6
Sports chairs, low back w/c, increased trunk control
ASIA : L1
Pt. starts to walk more
Respiratory Impairment & SCI
A direct relationship exists between the level of cord injury and the degree of respiratory dysfunction
Leading cause of hospital re admissions & death
Respiratory : C1 or C2
vital capacity is only 5-10% of normal & cough is absent
Respiratory: C3-C6
vital capacity is 20% of normal, cough is weak/ineffective
Respiratory : T2-T4
vital capacity is 30-50% of normal, cough is weak
Respiratory : Lower level injures
Respiratory function improves
Respiratory : T11
respiratory dysfunction is minimal; vital capacity is essentially normal & cough is strong
Brown Sequard Syndrome
Damage to 1/2 cord (i.e. stab wound, incomplete injury)
Ipsilateral propioceptive & motor loss (R sided injury, No movement on R side)
Contralateral loss of pain & temp (R sided injury, no temp/pain on L)
Pt. positioning will be difficult
Increase pts visual skills & compensatory strategies
Central Cord Syndrome
Incomplete Injury
Cervical region
Damage to center part of cord (most often d/t tremor)
UE weakness > LE weakness
May be walking w. crutches or walker
Anterior Cord Syndrome
Variable motor & sensory loss
Intact propioception
Whiplash injuries
Cauda Equina Syndrome
Bowel & bladder issues
Sacral & Lumbar nerve/roots
Autonomic Dysreflexia
T6 & Above
Uncontrolled sympathetic activity flowing from SC below lesion level.
-bladder infection, over distended bladder/rectum
-sexual stim, abdominal pressure, pressure sores
Autonomic Dysreflexia : Sx
Severe, pounding headache
Sweating above lesion level
Stuffy nose, flushing, bradycardia
Autonomic Dysreflexia : Tx
Elevate head, eliminate offending stim
Positioning to prevent pressure sores
Skin checks, loosen clothing/constrictive devices
Check catheter for kink, monitor BP
Orthostatic Hypotension : Sx
Blood pressure drops dangerously low in response to upright positioning, light headedness, pallor
visual changes, T6 and above.
Seen during supine->sit
Orthostatic HTN : Tx
Recline pt. so head is below level of heart
Lift legs, tilt table, monitor Bp, call nurse & MD
Put pt. to bed with LE’s elevated above heart
Surgical stabilization : Cervical Spine
Philadelphia collar (23-24 hrs per day) SOMI Brace (sternal-occipital mandibular mobilizer) usually 6-8 weeks
Surgical Stabilization: Thoracolumbar Spine
Screws or rods
Surgical Stabilization : Transpedicular screws & Harrington Rod
May be impoloized or have limited rotation/lateral flexion
Nonsurgical Stabilization : Cervical Spine
HALO Traction : 4 pins inserted into skull
6-12 weeks
Pressure Relief
Increase risk for skin breakdown
Constant WS pressure relief schedule
Bladder & Bowel : Initial TX
During spinal shock both are flaccid
Prevention of bladder distention
Bowel impaction
Bladder & bowel reflexes return 1st marking the end of spinal shock
Bladder & Bowel : s/p Spinal Shock
UMN: Refleogenic, automatic, spastif Relex emptying of bladder/bowel Injuries above T2-L1 LMN: areflexogenic, atonic, flaccid Manual emptying of bladder/bowel Paraplegia lessions below L1
Bowel & Bladder & OT
Pt. ed on leg spreaders & mirrors
Limited hand function related to self-cathing, typically cant follow the streal techniques
OT: work on positioning, adaptive techniques & fine motor skills
Bladder Management
Controlled by S2-5 spinal segments
Complete lessions at & above S2 lose ability to void voluntarily
Indwelling catheter, intermittent catheterization
Bowel Management
Oral/suppository meds
Digital stim
Bladder Management & OT
Clothing management, body positioning
Set-up & cleanup of equipment
Disposal of urine
Cleanup or self
Other problems
Fatigue (d/t respiratory decline) - prioratize pt. routine DVT : calves & triceps Pain Heterotopic ossification Depressions
SCI General Functional Tests
Minnesota Upper extermity function test (UEFT) Purdue Prgboard Test Jebsen test of hand function 9 hole peg test Smith hand function eval Box & Block Test (BBT) Physical Capacities Eval of hand skills (PCE) Sollerman hand function test
Specifically designed for tetraplegic persons
Standardised object test (SOT) Vandenberge hand function test Grasp & Release Test (GRT) Capabilities of UE Instrument Thorson's function test
SCIM
Spinal cord independence measure
-in tetraplegic pt.’s, the FIM missed 22% of the functional changes dictated by the SCIM
Assessment & Tx
Occupation Hx (living Envt- accesability)
BAD & IADL
Trunk balance
A/PROM & Muscle strength (biomechanical approach)
Pain (Modalities)
Endurance
Make whatever muscles that can be used stronger b/c they will need to compensate for lost innervation
Assessment & Tx Continued
Hand function (pinch & grasp) (splinting0
Leisure
Communication
Bowel & Bladder
Mobility
Vocation, school, home & community access
