SCI Flashcards
total absence of sensation in dermatomes below level of lesion
complete lesions
sensory loss related to damage within specific spinal tracts
incomplete lesions
C5 controls which myotome
elbow flexors
C6 controls which myotome
wrist extensors
C7 controls which myotome
elbow extensors
C8 controls which myotome
finger flexors
NEUROLOGIC level of injury is the lowest level on the spinal cord where key muscles test at least / and sensation intact for this level dermatome
3/5
FUNCTIONAL level lowest segment which strength of key muscles graded at / or higher and sensation intact
3+/5
A lesion to the centrally located structures of region, that produces sacral sparing and greater weakness in the upper limbs than in the lower limbs. Typically seen in older adults
central cord syndrome
Hemisection of the cord which produces ipsilateral (same-sided) proprioceptive and motor loss and contralateral (other side) loss of pain and temperature
Brown-Sequard syndrome
Rare, results from compression by tumor or infarction of the posterior spinal artery. Proprioception, stereognosis, two-point discrimination, and vibration sense are lost below the lesion.
posterior cord syndrome
A lesion that produces variable loss of motor function and of sensitivity to pin and temperature, while preserving proprioception, touch and vibration.
anterior cord syndrome
Injury of the sacral cord (conus) and lumbar nerve roots within the neural canal that usually results in nonreflexive bladder, bowel and lower limbs. Sacral segments may occasionally show preserved reflexes (bulbocavernosus and micturition reflexes).
conus medullaris syndrome
Injury to the lumbosacral nerve roots within the neural canal resulting in nonreflexive bladder, bowel and lower limbs.
cauda equina syndrome
what movement is possible if you have a C1-C3 SCI
neck flexion
neck extension
neck rotation
what movement is possible if you have a C4 SCI
neck flexion neck extension neck rotation scapular elevation inspiration
what movement is possible if you have a C5 SCI
Shoulder flexion Shoulder abduction Shoulder extension Elbow flexion Supination Scapular adduction & abduction
what movement is possible if you have a C6 SCI
Scapular protraction
Horizontal adduction (some)
Forearm supination
Radial wrist extension
what movement is possible if you have C7-C8 SCI
Elbow extension Ulnar wrist extension Wrist flexion Finger flexion & extension Thumb flexion, extension, & abduction
what movement is possible if you have a T1-T4 SCI
Upper extremity
Limited trunk stability
Increasing lung capacity
what movement is possible if you have T10-L1 SCI
trunk stability
what movement is possible if you have L2-S5 SCI
trunk stability
partial to full control of LE
A L2 SCI is classified as motor function in what muscle
ilipsoas
A L3 SCI is classified as motor function in what muscle
quadriceps femori
A L4 SCI is classified as motor function in what muscle
tibialis anterior
A L5 SCI is classified as motor function in what muscle
Extensor hallucis longus
What education should you provide a patient with a SCI
Levels & Outcomes
Positioning to manage tone
Body mechanics to minimize injury (both to pt and family)
Use of adaptive equipment for independence
Sensory awareness
Handling architectural barriers (what does their home look like)
Managing complications (AD, OH)
Sexual counseling
determines the L3 level of lesion
knee extensors
determines the C6 level of lesion
wrist extensors
determines the T1 level of lesion
small finger abductors
determines the L2 level of lesion
hip flexors
determines the C7 level of lesion
elbow extensors
determines the L4 level of lesion
ankle dorsiflexors
determines the C8 level of lesion
finger flexors
determines the S1 level of lesion
ankle plantar flexors
determines the C5 level of lesion
elbow flexors
determines the L5 level of lesion
long toe extensors
determines the C3 level of lesion
diaphragm
what type of stimulus do you test with for a SCI patient
strong
If a patient has a known complete lesion, should you test multiple sensory modalities
no
If a patient has unknown or incomplete lesions, should you test multiple sensory modalities
yes
When does sensory recovery typically happen
within the 1st year
complete loss of neurological function that results in diminished reflex activity below level of injury. Lasts 1 day-6 weeks.
spinal shock
what are symptoms of spinal shock in the affected area
Decreased sensation Decreased deep tendon reflex Decreased blood pressure Flaccid muscle function Frequent loss of bowel & bladder control
what is involved with acute management of SCI
♣ Positioning/Deformity Control
♣ Skin integrity
♣ Initial ADL skills
♣ Education but action is primary feature
♣ Start upright tolerance
♣ Building blocks * think about what are the skills you will need them to have in order to complete ADL’s*
♣ Strengthening/ROM- this also helps to start acclimating them to their body
what is involved with inpatient rehabilitation
♣ Upright tolerance ♣ Deformity control ♣ Skin issues become more directive ♣ ADL’s ♣ Strengthening/ROM ♣ Learning body in space skills ♣ Teach them their head controls body movements ♣ Functional mobility ♣ Spinal shock resolves ♣ Education
what is involved with outpatient/home health
Finishing what you started ROM/Strengthening Body in space ADL skills at higher level Functional mobility skills Community access Training family
what are the prognosis factors for a SCI
Type of injury Motivation Socioeconomic background Education Family support Acceptance of disability Problem solving abilities
what are the symptoms of OH
♣ Dizziness ♣ Loss of consciousness ♣ Nausea ♣ Pallor ♣ Sudden weakness
what is the treatment of OH
♣ If sitting in chair tilt chair backwards
♣ If sitting EOB lie patient back down
♣ Coming to upright position slowly can help decrease incidents of orthostatic hypotension
prevention of OH
Ace wraps
abdominal binder
gradual increases in sitting tolerance
treatment of autonomic dysreflexia
Elevate to sitting position
♣ Take blood pressure in both arms – remember systolic BP can be in 90 – 110 mmHg range normally
♣ Check for blockage/kinks in bladder & bowel system
♣ Check for areas of restriction – tight clothing
♣ Relieve urinary pressure
♣ Seek medical attention
risk factors of DVT
immobilization, post-op, age>40, cardiac disease, limb trauma, coagulation d/o, obesity, advanced neoplasm (abnormal growth), pregnancy
clinical signs of DVT
Pain
Swelling
Superficial venous distention
Fever
treatment of DVT
blood thinners – Coumadin, heparin
compression (more as a prevention—ie TED hose)
bed rest
