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Phys Dis 1 > SCI > Flashcards

SCI Flashcards

1
Q

Descibe the levels of Spinal Cord injury.

A

Quadriplegia (Tetraplegia)

  • Involvement of all 4 limbs

Paraplegia

  • Involvement of LEs and trunk (depending on level)

Level of SCI

  • Complete
    • Designated by the region of injury and the last fully functioning neurologic segment in that region
    • Example: C5= fifth segment of the cervical region is last level of full function

Partial

  • Incomplete lesion results in partial function and partial preservation of the sensory or motor pathways below the level of the lesion
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2
Q

What is Spinal Shock?

A

Spinal Shock

  • Occurs within 24 hrs, Lasts 4 to 6 weeks
    • No reflexes below level of injury
      • Deep tendon reflexes decrease
      • Sympathetic function decrease
        • Constriction of blood flow, low blood pressure, decreased heart rate, no perspiration below level of injury
    • Bowel/ Bladder= atonic
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3
Q

What is spasticity?

A

Spasticity

  • Follows Spinal Shock
  • Develops because the monosynaptic reflex arc is intact but separated by the higher inhibitory influences
    • Effects Deep Motor Reflex, Bowel/bladder, Sympathetic function
    • Spinal reflex activity: mass muscle spasms below level of injury
      • Effects LE muscle/abdominals

Bladder infections

  • Catheters/Delayed or incomplete elimination
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4
Q

What are the secondary symptoms?

A

Decubitus ulcers

respiratory infections

osteoporosis

orthostatic hypotension

automonic dysreflexia

spasiticity

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5
Q

what are Decubitus ulcers?

A

Decubitus ulcers

  • Kinetic bed, weight shifts, sensory education, proper transfers (no shearing), proper positioning, frequent repositioning, proper w/c cushions
  • Stages
    • Red
    • Blanches when pressed
    • No blanching when pressed
  • Skin (tip of a cone)
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6
Q

What are respirtory infections and what can be done?

A

Respiratory infections

  • Strengthening of SCM and diaphram
  • Manual assisted cough, deep breathing exercises,
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7
Q

What are osteoporosis and orthostatic hypotension?

A

Osteoporosis

  • Disuse of long bones

Orthostatic Hypotension

  • Decreased BP when changing position
    • Pooling of blood due to lack of muscle tone (LE and Abs)
  • Sx: Dizziness, nausea, LOC with transitions from supine to sit
  • Treatment
    • Adjusting position
      • Recline patient: Tip back chair
    • Tilt table
    • Abdominal binder
    • Compression garments
    • Medication
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8
Q

What is hyperreflexia?

A

Autonomic Dysreflexia (hyperreflexia)

  • Occurs with SCI at or above T6
  • Reflex action of the ANS to a stimulus (distended bladder, bladder infection, fecal mass, viceral distention, pain)
  • Sx: Immediate pounding headache, anxiety, blurred vision perspiration, flushing, chills, nasal conjestion, paroxysmal hypertension and brachycardia
  • MEDICAL EMERGENCY (Can lead to stroke – seek medical attention)
    • Sit patient upright, remove restrictive clothing /abdominal binders/compression stocking to decrease blood pressure
    • Drain bladder/check for obstruction in urine bag
    • Monitor blood pressure
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9
Q

Autonomic dysreflexia?

A
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10
Q

What is spasticity?

A

Spasticity

  • Gradually increase the first 6 months
  • Plateau after first year
    • Moderate spasticity
      • Maintains muscle mass, increases circulation, can assist with bed mobility/transfers
      • Sudden increase in spasticity can alert pt to a medical problem
        • Bladder infection, fever, decubitus ulcer
    • Severe treated with meds, botox, nerve blocks
  • Decreased thermo regulation
  • Difficulty swallowing
  • Deep Vein Thrombosis (DVT)
  • Heterotrophic Ossification
    • Bone develops in abnormal anatomic locations
    • Sx: warm, swollen, decreased ROM
    • May limit hip ROM, lead to pelvic assymetry, scoliosis, skin breakdown
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11
Q

Describe the levels C1-C5 muscles function and limitations of injury.

A
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12
Q

Describe C6-C8 level of injury

A
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13
Q

Describe T1-S5 level of injury

A
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14
Q

What are the key muscles of function for C1-S5?

A

Key Muscle Function

C1-3: Head and Neck

C4: Diaphram

C5:Elbow flexors, Deltoids

C6:Wrist extensors

C7:Elbow extensor

C8:Finger flexion

T1-T8: Chest muscles

T9-12:Abdominal muscles

L1-5:Leg muscles

L2: Hip flexors

L3:Knee extensors

S1-5: Bowel, bladder, and sexual function

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15
Q

Describe C1-C4

A

C1-3

Require Assist with almost all ADLs

Vent Dependent

Electronic Assistive Devices

  • Mouth stick, voice activation

Sip and Puff Controls

Animal Assisted Therapy

C4

ADLs: Same as above

Can wean from vent

Increased head/neck control

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16
Q

Describe C5-C6

A

C5 (biceps/delts)

With use of wrist support and universal cuff can perform feeding and grooming tasks

Use a power w/c with hand controls or manual with rim projections

Require Assist with LE dressing, transfers, bladder/bowel care

Electronic Assistive Devices : phone, computers, lights, TV

Driving an adaptive van may be possible

C6 (Wrist extensors)

Feeding, grooming, bathing, bed mobility with

Adaptive Equipment and Tenodesis

I with UE dressing, LE with Assist

Bowel/Bladder with Assist

Can transfer using slide board (some become I, others require A)

  • Bed to chair

Maunual w/c with rim projections/enhancement

Can drive using hand controls, custom lift and other adaptations

IADLs – phone, turn pages, write/type with assistive devices

17
Q

Describe C7-C8

A

C7(triceps)

Can live Independently

Independent with feeding, UE dressing, bed mobility, transfers (may need A with uneven surfaces)

Use Assistive Devices for LE dressing, grooming, bathing, bowel care

IADLs :Independent with or without Assistive devices

Manual wheelchair (may need Assist with curbs)

Can drive using adaptive vehicle with hand controls

C8(Finger flexion)

Independent withmost ADL/IADLS

Manual wheel chair

Drive using adapted van /hand controls

18
Q

Descibe T1-T12

A

Thoracic Paraplegia ( T1-12)

Independent with all Self Care including bowel/bladder

Can perform light housekeeping/meal prep

Independent with all wheelchair mobility

Advanced w/c training: curbs, ramps, wheelies, uneven surfaces

Can transfer from floor to chair

Drive with hand controls

19
Q

Describe what will be in an assessment chart.

A

Assessment

Comprehensive

Chart

  • PMHx- pass medical history
  • PLOF- Prior level of function
  • All secondary dx
  • PRECAUTIONS
  • Medications
  • Discharge destination
  • Motor function-manual muscle test
  • Sensation
  • ADL
  • COPM or similar
  • Pain
  • Cognition
  • Perception
20
Q

What are the treatment objectives for SCI?

A

Treatment Objectives

  • Maintain or Increase joint /soft tissue integrity
    • ROM, Orthotics, positioning, patient education
  • Increase Strength of all innervated/partially innervated muscles
  • Increase Endurance
  • Maximize Independence in ALL areas of occupation
  • Assist with Psychosocial adjustment
  • Assess Adaptive equipment needs
  • Home Adaptations: safety, accessibility recommendations
  • Patient/Caregiver Education
21
Q

What is the acute intervention phase?

A

Intervention: Acute Phase

  • Body Positioning
    • Prevent decubitus/contractures
  • Environmental Controls
  • Orthotics/Hand Splinting
    • Ex: C5 (no hand/wrist)
      • Splint : maintain wrist neutral/extension and thumb web
      • C6 (wrist extensors)
        • Splint: wrist extension/ or short opponens: digits flex naturally: train for tenodesis
  • Appropriate ROM/Strengthening
  • Muscle Re-ed
  • ADLs
    • Feeding, hygiene
    • U-Cuff for feeding
  • Pt/Caregiver Education
22
Q

What Orthotics are used for what SCI?

A

Orthotics

  • Palmar splints (C1-4)
  • Futuro (dorsal) wrist splints (C5)
  • Tenodesis (wrist driven or externally powered) (C6)
  • Short opponens (C6)
  • Thumb web space (All)
23
Q

What is intervention at the Rehab/ active phase?

A

Intervention: Active/ Rehab Phase

Sitting tolerance

Pressure relief training

A/PROM and Strengthening

  • Proximal Stability
  • Wrist extension: tenodesis
  • Triceps: pressure relief/transfers
  • Prevent elbow contractures (full extension essential for mobility)
  • Allow finger flexion tightness for functional tenodesis

Adaptive Equipment: Balance with Functional Independence

ADLs: feeding, hygene, bathing, bowel/bladder care, Dressing, Transfers, Commincation, tenodesis splints

Wheelchair Seating:Proper cushions

Psychological Support

Pressure Relief

  • Every 15 minutes
  • 1-2 minutes a side
  • Work up tolerance

Prevention of Pressure Sores

  • Cushion
  • Pressure relief
  • Skin care and hygiene
  • Transfers
  • Nutrition
24
Q

What happens at the discharge phase?

A

Discharge Phase

  • Home adaptation
  • Community re-entry
  • Mobility
    • Driving Evals
    • Transportation
  • Assertiveness training
  • Home health or outpatient therapy
  • Leisure
  • Return to work/school
  • DME- durable medical equipment
  • Follow-up care-tendon transplants, etc.

Phys Dis 1 (6 decks)

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