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sci and tbi Flashcards

1
Q

what level does the spinal cord end?

A

T12-L1 but everyone is different

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2
Q

will a pt with a lesion to conus medullaris have an UMN or LMN presentation?

A

both

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3
Q

will a pt with a lesion to the cauda equina have a LMN or UMN presentation?

A

LMN

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4
Q

choose correct responses: the corticospinal tract is (ascending/descending) and (sensory/motor).

A

descending, motor

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5
Q

choose correct responses: the spinothalamic tract is (ascending/descending) and (sensory/motor).

A

ascending, sensory

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6
Q

the anterior STT is responsible for what?

A

crude touch

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7
Q

the lateral STT is responsible for what?

A

pain and temp

pneumonic: LPT (licensed PT)

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8
Q

choose correct responses: the DCML tract is (ascending/descending) and (sensory/motor).

A

ascending, sensory

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9
Q

the DCML is responsible for what sensations?

A

Poor Val got GBS twice

proprioception
vibration
graphesthesia
stereognosis (object identifying bu touch)
barognosis (feel weight/pressure)
two point discrimination

fine touch, precise location

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10
Q

what tract is affected in posterior cord syndrome? what is the cause usually?

A

DCML, medical error/iatrogenic

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11
Q

what tracts are affected in anterior cord syndrome?

A

lat STT, ant STT, CST

sx almost always B/L

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12
Q

what causes anterior cord syndrome?

A

hyperflexion injury

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13
Q

brown sequad is also known as

A

hemi cord syndrome

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14
Q

if i had hemi cord syndrome on the L, all symptoms will be on the L except

A

pain and temp on the R will be impaired

Brown POT (pain and temp opposite side)

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15
Q

how can a central cord injury happen?

A

hyperextension

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16
Q

what will be affected if I have central cord syndrome with a small lesion?

A

pain and temp (lat STT crosses through lesion)

sx will be bilateral

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17
Q

what will be affected if I have central cord syndrome with a large lesion?

A

all tracks will be a little affected bilaterally

MUD-E

motor
UE
distal
extension injury

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18
Q

what is usually the MOI for brown-sequad?

A

GSW or stab

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19
Q

if you suspect conus medullaris or cauda equina syndrome, what should you do?

A

emergency! call 911 or refer immediately to go right to dr

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20
Q

cauda equina has a (unilateral/bilateral), (asymmetric/symmetric) motor and sensory presentation.

A

unilateral, asymmetric

cauda equina ends with an A, for Asymmetric

conus medullaris has bilateral and symmetric presentation

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21
Q

what is better? complete or incomplete SCI

A

incomplete

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22
Q

what does a complete SCI mean?

A

no sensory or motor function in the lowest sacral segments (S4 and S5)

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23
Q

are anterior, posterior, central cord syndromes and brown sequard incomplete or complete?

A

incomplete?

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24
Q

what is an incomplete SCI?

A

you have motor and sensory function below the neurological level including sensory and/or motor function at S4 and S5

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25
Q

C5 muscle group

A

elbow flexors

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26
Q

C6 muscle group

A

wrist extensors

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27
Q

C7 muscle group

A

triceps/elbow extensors

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28
Q

C8 muscle group

A

finger flexors

29
Q

S1 muscle group

A

plantarflexors

30
Q

L2 muscle group

A

hip flexors

31
Q

L4 muscle group

A

dorsiflexors

32
Q

L3 muscle group

A

knee extensors

33
Q

what are the two steps to determine motor level of an SCI?

A
  1. lowest level at which strength is at least 3/5
  2. all levels above being 5/5
34
Q

what are the two steps to determine sensory level of SCI?

A
  1. lowest level where you have 2’s
  2. all above levels being 2’s
35
Q

what are the two steps to determine neurological level of SCI?

A
  1. find motor and sensory level
  2. pick the higher one (one on top)
36
Q

what ASIA level is a complete SCI with no motor or sensory function at S4-S5?

A

ASIA-A

37
Q

what ASIA level in an incomplete SCI and has sensory but no motor function below NLI and S4-S5?

A

ASIA-B (sensory incomplete)

38
Q

when less than half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___

A

C

39
Q

when at least half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___

A

D

40
Q

ASIA B, C, and D are all (incomplete/complete)

A

incomplete, ASIA A is complete and ASIA E is normal

41
Q

define ASIA E

A

motor and sensory function is normal

E is ME

42
Q

autonomic dysreflexia happens at or above what spinal level?

A

T6

43
Q

what causes AD?

A

noxious stimuli below the level of lesion

44
Q

what happens to HR and BP with AD?

A

HR decreases, BP increases (20-30mmHg)

45
Q

AD is more common with complete SCI. (T/F)

A

T

46
Q

what to do if a pt has AD?

A

sit them up
remove painful stim
loosen tight clothing and abdominal binder
check bladder distention, unclamp cath and drain it
monitor vitals throughout (if no change, call nursing/medial assistance)

47
Q

what tract is intact with anterior cord syndrome?

A

DCML

48
Q

what type of SCI has the best prognosis for walking?

A

central cord (walking SCI)

49
Q

what are the functions of the lateral spinothalamic tract?

A

pain and temp sensation (LPT!)

50
Q

list the ranges for the Glascow Coma Scale

A

3-8 severe
9-12 moderate
13-15 mild

51
Q

L1 vertebral level corresponds to which spinal level

A

conus medullaris/cauda equina

52
Q

innervation of the diaphragm?

A

phrenic nerve (C3, C4, C5 keep the diaphragm alive)

53
Q

if a pt has a injury at C1-C2, what muscles are innervated and what will they need to breathe?

A

SCM, upper traps (accessory nerve, not spinal cord)

pt will need a phrenic stimulator and ventilator

54
Q

If a pt has an injury at C3-C4, what will they use to breath?

A

diaphragm is partially intact so these patients still need a mechanical ventilator

if they want to temporarily breathe without the ventilator, they use glossopharyngeal breathing (swallowing/gulping the air)

55
Q

at C5-C8, how is the diaphragm working/how is the pt breathing?

A

diaphragm is working a lot better so they wont need a mechanical ventilator but they will have a weak cough

need abs to cough which get innervated at thoracic level

56
Q

what spinal level injury will pt have near normal level of respiratory function?

A

T11

57
Q

if you have a lesion above S2 spinal level (T12-L1 vertebral level), what bladder issue will you have?

A

UMN/spastic/reflexive bladder

58
Q

if you have a lesion below S2 spinal level, what bladder issue will you have?

A

LMN/areflexic/flaccid bladder

59
Q

for a reflexive bladder, what is the appropriate treatment?

A

intermittent catheterization every 3-6 hours and suprapubic tapping

60
Q

if a pt has a LMN/areflexic bladder, what is the appropriate treatment?

A

intermittent catheterization every 3-6 hours, valsalva or Crede’s maneuver (pressure on abdomen)

61
Q

C1, C2, C3, and C4 are (independent/dependent) with ADLs and transfers

A

dependent

62
Q

can someone with a C7 central cord syndrome walk?

A

yes

63
Q

can someone with a C7 complete SCI walk?

A

no

64
Q

are C7 SCIs able to use WC on even and uneven surfaces?

A

just even surfaces; C8 can use WC on both even and uneven surfaces

65
Q

when doing a WC<>bed transfer, the WC should be angled ___-___ degrees from the bed/met edge

A

20-45

66
Q

list the ranchos los amigos levels

A

remember RLA looks like R(response) C(confused) A (appropriate)

  1. no response
  2. generalized response
  3. localized response
  4. confused and agitated
  5. confused and inappropriate
  6. confused and appropriate
  7. automatic appropriate
  8. purposeful appropriate
67
Q

is group therapy good for someone with RLA level IV?

A

no

68
Q

should you cancel and agitated pt with a TBI?

A

no, that will reinforce behavior

instead distract them and give them options to give control

69
Q

what RLA describes responding consistently to simple commands, able to socialize for a short period?

A

V

5 looks like S for simple and socialize

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