SCI

Question 1

Most/least common areas of injury

Answer 1

Cs: mc / ts: lc

Question 2

1 injury and 2 injury

Answer 2

1-injury 2-vasoconst, edema, ischema

Question 3

Methylprednisone

Answer 3

8 Hrs of injury; 24-48hrs

Question 4

Deep vein thrombosis

Answer 4

1st 12wks: 49-100%

Highest rate in 2wks

Question 5

Umn Injury

Answer 5

Signs below the injury

No atrophy, deep tendon reflexes increased, patho reflexes present, fasciculations absent

Question 6

Lmn injury

Answer 6

Signs at injury level, flaccid, atrophy, no deep tendon or patho reflexes, tremors present

Question 7

AD

Answer 7

Increase in bp, decrease in hr, goosebumps and diaphoresis is at the level above the injury

Question 8

Bradycardia

Answer 8

Occurs at T6 and above, similar to AD - common in cervical injuries

Question 9

Bladder innervation: P/S/S

Answer 9

P - pelvic nerve, S2-4
Symp - hypogastric nerve, T11-L2
Som - pudendal nerve, S1-S4

Question 10

Reflexive and areflexive bladder

Answer 10

R - S2-4 intact and bladder reflexively empties once it’s full
A - S2-4 compromised and bladder leaks, overflow continence

Question 11

Bowel innervation: P/S/S

Answer 11

P - pelvic nerve, S2-4, vagus nerve
Symp - hypogastric nerve, T11-L2, superior and inferior mesenteric
Som - pudendal nerve, S1-S4

Question 12

Reflexive and areflexive bowel

Answer 12

R - S2-4 intact and bowel reflexively empties once it’s full

A - S2-4 compromised, peristalsis intact due to intact sup/inf mesenteric but not enough for BM

Question 13

Thermoregulation

Answer 13

T1 to L1/L2

May be unable to sweat below the level of injury = hyperthermia

Question 14

ASIA A

ASIA B

Answer 14

A - intact
B - sensory but not motor below the neurological level (S4-5 sacral segments) AND no motor 3 levels below the motor level on either side

Question 15

ASIA C

ASIA D

Answer 15

C - motor incomplete, more then half muscles below neuro level graded <3
D - motor incomplete, more then half muscles below neuro level graded >3

Question 16

ZPP

Answer 16

Only determined for complete injuries

Question 17

Complete SCI motor recovery time frame

Answer 17

Most recover first 3 months (3-6 months)

- can continue up to 2 yrs if str >0/5

Question 18

Strength at 1 month with recovery at a year if 1-2/5 str

Answer 18

95% improve to 3/5

Question 19

Strength at 1 month with recovery at a year if first level 0/5

Answer 19

50% improve to 1/5; 25% improve to 3/5

Question 20

C1-C4 functional level

Answer 20

Transfers - Total A

Power WC with ind power tilt/recline

Question 21

C5 functional level

Answer 21

Transfers - Total A

Power WC with ind power tilt/recliners

Question 22

C6 functional level

Answer 22

Transfers - level: some assist to ind; unlevel: total A
Power WC with ind power tilt/recliners

*Manual WC ind within home but not community

Question 23

C7-8 functional level

Answer 23

Transfers - level: ind; unlevel: ind

Manual WC with ind in home and community; some assist with unlevel terrain

Question 24

T1-9 functional level

Answer 24

Manual wheelchair ind on home/community/unlevel terrains

Able to amb in // bars

Question 25

T10-L1

Answer 25

Manual wheelchair ind on home/community/unlevel terrains

T11-12: limited household
L1: household , possible limited community

Question 26

L2-S3 functional level

Answer 26

Manual wheelchair ind on home/community/unlevel terrains

L2: household, limited community
L3: household limited to ind community
L4 - ind with all

Question 27

Brown-Sequard

Answer 27

IPSI proprioception, vibratory sense, deep/disc touch, and voluntary motor control

CONTRA pain/temp, crude touch

**Most likely to have highest functional gain

Question 28

Ant Cord

Answer 28

Variable loss of motor function, pain, and temp with intact proprioception

Common with any spinal artery damage and hyperflexion injuries (teardrop/wedge)

**Most likely to have longest LOS

Question 29

Central Cord

Answer 29

UEs>LEs with sparing of sensation to sacral region

Common with hyper extension injuries

**Most likely to have worst FIM at admission

Question 30

Posterior Cord

Answer 30

Loss of proprioception, vibratory sense, and discriminative touch

Common with post spinal artery injury

Question 31

Cause Equina Syndrome

Answer 31

More LMS

Asymmetrical weakness with areflexive bladder

Question 32

Conus Medullaris Syndrome

Answer 32

Mix of UMS and LMS

Bilateral weakness with central s/s

Question 33

Endurance and resistance training recommendations

Answer 33

E - 20-60 minutes, 3-5x week, 60-80% VO2 peak

R - 3x 8-12 reps, 2x week at mod to high intensity

Question 34

Isokinetic strengthening can increase:

Answer 34

6MWT, BBS, and isometric strength

Question 35

Guidelines (4) for locomotor training

Answer 35

1. Maximize load through LEs
2. Optimize sensory curing but avoid inappropriate sensory input like bracing or facilitation of antagonist musculature
3. Promote normal kinematics
4. Correct posture with AD (walking stick)

Question 36

Protocol for managing shoulder pain with exercise:

Answer 36

Strengthening posterior shoulder musculature

Strengthening ERs of shoulder

Stretching anterior structures

Question 37

Electrical stimulation for management of spasticity (types and how long):

Answer 37

Reciprocal inhibition
Tetanic contraction of agonist
FES
TENs

**Benefits last 10 mins to 3 hrs

Question 38

Epidural spinal cord stimulation for 1.) mild/incomplete lesions and 2.) severe spasticity

Answer 38

1. ) Stim below the level of lesion

2. ) Stim of dors roots of upper lumbar cord segments