sci and tbi Flashcards
what level does the spinal cord end?
T12-L1 but everyone is different
will a pt with a lesion to conus medullaris have an UMN or LMN presentation?
both
will a pt with a lesion to the cauda equina have a LMN or UMN presentation?
LMN
choose correct responses: the corticospinal tract is (ascending/descending) and (sensory/motor).
descending, motor
choose correct responses: the spinothalamic tract is (ascending/descending) and (sensory/motor).
ascending, sensory
the anterior STT is responsible for what?
crude touch
the lateral STT is responsible for what?
pain and temp
pneumonic: LPT (licensed PT)
choose correct responses: the DCML tract is (ascending/descending) and (sensory/motor).
ascending, sensory
the DCML is responsible for what sensations?
Poor Val got GBS twice
proprioception
vibration
graphesthesia
stereognosis (object identifying bu touch)
barognosis (feel weight/pressure)
two point discrimination
fine touch, precise location
what tract is affected in posterior cord syndrome? what is the cause usually?
DCML, medical error/iatrogenic
what tracts are affected in anterior cord syndrome?
lat STT, ant STT, CST
sx almost always B/L
what causes anterior cord syndrome?
hyperflexion injury
brown sequad is also known as
hemi cord syndrome
if i had hemi cord syndrome on the L, all symptoms will be on the L except
pain and temp on the R will be impaired
Brown POT (pain and temp opposite side)
how can a central cord injury happen?
hyperextension
what will be affected if I have central cord syndrome with a small lesion?
pain and temp (lat STT crosses through lesion)
sx will be bilateral
what will be affected if I have central cord syndrome with a large lesion?
all tracks will be a little affected bilaterally
MUD-E
motor
UE
distal
extension injury
what is usually the MOI for brown-sequad?
GSW or stab
if you suspect conus medullaris or cauda equina syndrome, what should you do?
emergency! call 911 or refer immediately to go right to dr
cauda equina has a (unilateral/bilateral), (asymmetric/symmetric) motor and sensory presentation.
unilateral, asymmetric
cauda equina ends with an A, for Asymmetric
conus medullaris has bilateral and symmetric presentation
what is better? complete or incomplete SCI
incomplete
what does a complete SCI mean?
no sensory or motor function in the lowest sacral segments (S4 and S5)
are anterior, posterior, central cord syndromes and brown sequard incomplete or complete?
incomplete?
what is an incomplete SCI?
you have motor and sensory function below the neurological level including sensory and/or motor function at S4 and S5
C5 muscle group
elbow flexors
C6 muscle group
wrist extensors
C7 muscle group
triceps/elbow extensors
C8 muscle group
finger flexors
S1 muscle group
plantarflexors
L2 muscle group
hip flexors
L4 muscle group
dorsiflexors
L3 muscle group
knee extensors
what are the two steps to determine motor level of an SCI?
- lowest level at which strength is at least 3/5
- all levels above being 5/5
what are the two steps to determine sensory level of SCI?
- lowest level where you have 2’s
- all above levels being 2’s
what are the two steps to determine neurological level of SCI?
- find motor and sensory level
- pick the higher one (one on top)
what ASIA level is a complete SCI with no motor or sensory function at S4-S5?
ASIA-A
what ASIA level in an incomplete SCI and has sensory but no motor function below NLI and S4-S5?
ASIA-B (sensory incomplete)
when less than half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___
C
when at least half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___
D
ASIA B, C, and D are all (incomplete/complete)
incomplete, ASIA A is complete and ASIA E is normal
define ASIA E
motor and sensory function is normal
E is ME
autonomic dysreflexia happens at or above what spinal level?
T6
what causes AD?
noxious stimuli below the level of lesion
what happens to HR and BP with AD?
HR decreases, BP increases (20-30mmHg)
AD is more common with complete SCI. (T/F)
T
what to do if a pt has AD?
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)
what tract is intact with anterior cord syndrome?
DCML
what type of SCI has the best prognosis for walking?
central cord (walking SCI)
what are the functions of the lateral spinothalamic tract?
pain and temp sensation (LPT!)
list the ranges for the Glascow Coma Scale
3-8 severe
9-12 moderate
13-15 mild
L1 vertebral level corresponds to which spinal level
conus medullaris/cauda equina
innervation of the diaphragm?
phrenic nerve (C3, C4, C5 keep the diaphragm alive)
if a pt has a injury at C1-C2, what muscles are innervated and what will they need to breathe?
SCM, upper traps (accessory nerve, not spinal cord)
pt will need a phrenic stimulator and ventilator
If a pt has an injury at C3-C4, what will they use to breath?
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)
at C5-C8, how is the diaphragm working/how is the pt breathing?
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
what spinal level injury will pt have near normal level of respiratory function?
T11
if you have a lesion above S2 spinal level (T12-L1 vertebral level), what bladder issue will you have?
UMN/spastic/reflexive bladder
if you have a lesion below S2 spinal level, what bladder issue will you have?
LMN/areflexic/flaccid bladder
for a reflexive bladder, what is the appropriate treatment?
intermittent catheterization every 3-6 hours and suprapubic tapping
if a pt has a LMN/areflexic bladder, what is the appropriate treatment?
intermittent catheterization every 3-6 hours, valsalva or Crede’s maneuver (pressure on abdomen)
C1, C2, C3, and C4 are (independent/dependent) with ADLs and transfers
dependent
can someone with a C7 central cord syndrome walk?
yes
can someone with a C7 complete SCI walk?
no
are C7 SCIs able to use WC on even and uneven surfaces?
just even surfaces; C8 can use WC on both even and uneven surfaces
when doing a WC<>bed transfer, the WC should be angled ___-___ degrees from the bed/met edge
20-45
list the ranchos los amigos levels
remember RLA looks like R(response) C(confused) A (appropriate)
- no response
- generalized response
- localized response
- confused and agitated
- confused and inappropriate
- confused and appropriate
- automatic appropriate
- purposeful appropriate
is group therapy good for someone with RLA level IV?
no
should you cancel and agitated pt with a TBI?
no, that will reinforce behavior
instead distract them and give them options to give control
what RLA describes responding consistently to simple commands, able to socialize for a short period?
V
5 looks like S for simple and socialize
