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ACUTE CARE MODULE 2 > SCI > Flashcards

SCI Flashcards

1
Q

what are nontraumatic sources of SCI

A

RA, spina bifida, AVM, tumors, demyelination (MS), and infections (transverse myelitis)

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2
Q

how far down does the spinal cord travel

A

down to L2 vertebral level

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3
Q

where do spinal segments receive their vasculature

A

ASA and PSA from the VA

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4
Q

what does the SC dorsal column control

A

sensory ascending light touch and proprioception

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5
Q

how is the DCML organized

A

from medial to lateral

  1. fasciculus gracilis (S - L/T)
  2. fasciculus cuneatus (U/T to C)
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6
Q

what does the CST control

A

descending motor control

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7
Q

how is the CST organized

A

lateral column from deep to superficial C, T, L, S

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8
Q

how is the ALS controlled

A

anterolateral from deep to superficial C, T, L. S

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9
Q

what are the three components of SCI classification

A

vertebral level of lesion, tetra/paraplegia, and ASIA functional classification

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10
Q

how does ASIA determine the sensory level of injury

A

most caudal dermatome to have NORMAL senation for BOTH pinprick and light touch on BOTH sides

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11
Q

how does ASIA determine the motor level of injury

A

most caudal key muscle group (out of 10 myotomes) graded 3/5 or better with segments above 5/5

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12
Q

which segments are tested for ASIA sensation? motor?

A

sensation C2 - S4/5

motor: C5-T1 and L2-S1

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13
Q

what is the ASIA definition of complete?

A

absence of sensory and motor function at the lowest sacral level S4/5

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14
Q

what does ASIA definite as incomplete

A

sacral sparing

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15
Q

what is sacral sparing

A

voluntary external anal reflex OR light touch/pin prick at S4/5

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16
Q

what is the zone of partial preservation

A

segments below the neuro level of injury with some or both sensation and motor ONLY applying to complete injuries

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17
Q

what is the grading range for ASIA testing

A 
0 = absent
1 = altered
2 = normal
NT = not tested
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18
Q

define ASI-A

A

complete - no sensory or motor function preserved through S4/5

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19
Q

define ASI-B

A

sensory incomplete - sensory is preserved through S4/5 AND no motor more than three levels below level of injury on either side

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20
Q

define ASI-C

A

motor incomplete - motor function preserved below the level of injury AND more than half of mytomes below the level are graded 0-2

21
Q

define ASI-D

A

motor incomplete - motor function preserved below the level of injury AND more than half of the myotomes below the level are graded 3-5

22
Q

define ASI-E

A

normal - history of SCI, previously graded lower, but shows normalcy in all grades throughout

23
Q

T/F: ASIA A-E can all be graded as complete OR incomplete

A

false: only ASI-A is complete and ASI-B-E are incomplete

24
Q

what are four common incomplete syndromes

A

anterior cord, central cord, brown-sequard, and cauda equina

25
Q

T/F: surgical decompression for SCIs must be performed early for best outcomes

A

false/trick question: the jury is out on the best timing for surgical decompression whether it be early or delayed

26
Q

what are two PT considerations for cervical SCI

A

posterior approaches disrupt neck extensors and iliac bone grafts

27
Q

what are vascular and inflammatory consequences of SCI

A
  1. ischemia/hypoxia
  2. hemorrhage
  3. toxins/oxidative stress
  4. swelling
  5. apoptosis
28
Q

how does blood pressure relate to SCIs

A

SCI patients are vulnerable to systemic hypotension

29
Q

what is typical blood pressure management parameters for SCI patients

A

maintain MAP above 85-90 for 5-7 days via volume resuscitation and vasopressors

30
Q

what medication is typically administered for secondary effects of SCI

A

methylprednisolone (MPSS)

31
Q

what is spinal shock

A

period of areflexia immediately following SCI usually resolving within 24 hours

32
Q

what are the characteristics of spinal shock

A

areflexia, flaccidity, loss of bowel and bladder, autonomic dysreflexia

33
Q

what is the first and major sign of resolving spinal shock

A

positive bulbocavernosus reflex

34
Q

what do we expect with sympathetic trunk involvement in SCI patients

A

bradycardia, dilation of peripheral vasculature below lesion, decreased exercise tolerace, lower SV and CO

35
Q

how to you condition patients to upright

A

apply TED hose, ace wraps, and abdominal binding prior to beginning upright activities followed by slow accommodation to upright

36
Q

what causes orthostatic hypotension

A

imbalance between sympathetic and parasympathetic nervous systems, decrease in active muscle contraction, and prolonged bed rest

37
Q

in which SCI population do you expect to see AD

A

T6 and above injuries and more commonly in complete injuries

38
Q

what are the sxs of AD

A
  1. BP 20-30 mmHg above normal
  2. sweating
  3. headache
  4. flushed
  5. blurred vision
  6. tight chest and stuffy nose
39
Q

what typically triggers AD

A

bladder, bowel, skin, and sexual organ noxious stimulus

40
Q

what do you do if a patient experiences AD

A

sit up and lower the legs

41
Q

what is spastic hypertonia

A

a long term complication of SCI characterized by hypertonicity, hyperactive stretch reflex, spasticity, spasms, and clonus

42
Q

who gets spastic and flaccid bladders

A

spastic in UMN and flaccid in LMN

43
Q

how do you prevent pressure ulcers in bed? in a chair?

A

bed rolling every 2 hours and chair pressure relief every 15-20 min

44
Q

where can osteogenesis occur in SCI patients

A

soft tissues below the level of injury

45
Q

what are the early sxs of HO

A

swelling, decreased ROM, erythema, local warmth

46
Q

how do you manage HO

A

P/AAROM once signs of inflammation have subsided

47
Q

when does the most dramatic return of movement and function occur in SCI patients

A

first several months

48
Q

what happens to movement and function after the first few months of recovery

A

plateauing although not uncommon to see improvement

49
Q

what are the general goals of acute care SCI PT

A
  1. prevent joint contracture
  2. improve muscles and breathing
  3. acclimate to upright
  4. prevent secondary complications

ACUTE CARE MODULE 2 (9 decks)

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