SCI - Exam Flashcards
1
Q
SCI Injury Care
A
acute care stbailize thru respiratory ventilation
2
Q
SCI program - IRF
A
Be able to have control of bladder, motor function and psychosocial
3
Q
SCI care - outpatient rehab
A
day care
clinics
acute therapist
4
Q
SCI rehabilitation
A
INITIATE SCI REHAB EARLY
5
Q
SCI rehabilitation testing
A
motor and sensory testing with ASIA and recovery
6
Q
SCI rehab - functional training
A
positional, mobility, bed mobility, transfers and pressure relief
7
Q
SCI rehab - exercises
A
strengthening, endurance and trunk stability
8
Q
SCI rehab - musclar
A
lengthening and shortening of selective musculature (especially c6 injuries)
9
Q
SCI rehab - equipment
A
mobility training with W/C vs gait (environmental)
gait, W/C, transfers to car/bathroom/shower
10
Q
role of OTs
A
splinting
ADLs: shower chair, bench
adaptive equipment: helping with feeding
self care: dressing, feeding
11
Q
interdisciplinary approach
A
- rehab MD: lead
- physiologic funtion: cath/bowel/bladder - RN
- psychological: psychologist or counsel
- functional: OT and PT
- social: social work
- case manager: family needs, insurance, DME, environmental barriers to home
- Vocational rehab
- orthotis
12
Q
secondary collaborations
A
medical team: ileus/pneumonia/pressure ulcers/DVT
ortho: fx (29%) or spinal surgery
additional neuro: TBI/LOC (28%)
respiratory: weaning vent or pneumo
urologist: testing bladder functiona and evaluate kidney function
13
Q
spinal shock
A
result of spinal shock resolved within 48 hours w/ return of bulbocavernosus reflex = termination of shock
14
Q
bulbocavernosus reflex
A
tugging on foley cath with anal sphincter contraction
15
Q
sacral spraing
A
ability to have sensation @ s4-s5 (anal region)
16
Q
incomplete SCI
A
having motor and/or sensory function below neuro level + sensory and/or motor at s4-5
17
Q
complete SCI
A
loss of motor and sensation below the injury with no sacral sensation or motor activity
no sacral sparing
18
Q
zone of partial preservation
A
individual has motor and/or sensory function below neuro level BUT no sacral sparing
zone of partial preservation is the areas of intact below neuro level
19
Q
neurologic level of injury
A
lowest level of spinal cord with normal motor and sensory function bilaterally
20
Q
motor level
A
testing the strength of 10 key muscles bilaterally
tested via ASIA
21
Q
motor level dx
A
lowerst myotomes + muscle that has a grade of at least a 3
22
Q
sensory level
A
determined by testing the pt’s sensitivity to light touch and pinprick bilaterally
three point scale - normal, impaired, absent
23
Q
Grade B
ASIA
A
type: incomplete
def: sensory intact but not motor function
24
Q
Grade C
ASIA
A
Type: incomplete
Def: grade < 3
25
Grade D
| ASIA
Type: incomplete
def: muscle grade > 3
26
muscle testing
1. proper position -
2. stabilization of the limb
3. manual pressure - no more than one joint
4. palpation of muscles if lower than 3
27
perirectal sensation
complete absence of distal motor or sensory function
**indicates a complete SCI** and highly unlikelt that full recovery will happen
28
incomplete injuries rehab
possibility for return with increased function happening within a year
29
cauda equina syndrome
horse tail that is at the end of the spinal cord
medical emergency!!
30
cauda equina pathology
| w/ S/S
below L1
etiology: injury or infection
S/S: severe and stabbing pain that radiates along detmatomal patterns
- symptoms are likely unilateral or bilateral
- develops over time
- urinary distrubances
- impaired perianal sensation
31
complete transections
rare and almost always incomplete lesions
32
cauda equina injuries cause
saddle anesthesia
peripheral nerve injury
compression t12-l1
present with sciatica pain syndrome
33
conus medullaris
mix of UMN and LMN sundrome
t11-l2
34
cauda equina etiology
disc herniation - 45%
hematoma
tumor
35
cauda equina surgery treatment
decompression of neural strucutures
within 24 hours for the best outcome
36
outcome of cauda equina
48% - complete recovery after 24 hours decompression
18% - ongoing sciatica
8% - low back pain
years after surgery
51% - altered sensation
50% - urinary difficulties
37
conus medullaris etiology
spinal fx or spinal cord injury - primary factor
38
conus medullaris - S/S
abnormal sensation
weakness
urinary and bowel dysfunction
39
bladder management
renal insufficinecy, incontinence, UTIs being the most common
neurogenic bladder is the outcome of bladder function
bladder if flacid until after spinal shock is over
40
control of bladder
s2-s4
41
sympathetic control
thoracic
relaxes the bladder to let urine flow
42
parasympathetic control
L2-s4
controls the relaxation of the detrusor and urine is retained in the bladder
43
order of bladder muscle
bladder begins to fill
relays to pudental to contract external sphincter
stretch receptors send messages to pelvic n to sacral micturition and on the pontine M. center
44
full bladder order
full pontine m. center recieved messages to supress sacral reflex to:
1. relax external spincter
2. contract bladder and relax internal spinchter
3. urine output
45
SCI - bladder control
the ascending signal to the brainstem is impaired or lost fully
response is either hyper- or hypo- responsive
46
spastic bladder
there is a scaral rflex is overactive
= bladder contracts no matter the amount
47
flaccid bladder
when reflex response is blunted or fully gone
urine can't be expelled
48
goal of bladder management
remove urine and prevent high pressures within the bladder
49
level of spastic bladder
above t12 leaading involuntary contractions with incontinence
incomplete bladder emptying
50
level of flaccid bladder
t12 and below
leading to a full bladder - urine gets backed up thru the ureter to the kidney
may not be able to empty the bladder
51
indwelling catheter
high water consumption of about 15 glasses per day
should be maintained in order to reduce risk of bladder or kidney stones
52
foley
urethral cath that is held in place by partially inflated ballon - collected in a bag
53
suprapubic
surgically inserted tube through abdominal wall and into the bladder
often selected by females because it doesnt have a problem of urine leakage
54
clean intermittent catherization
technique of self catherization
55
primary muscles of inspiration
**diaphragm**
scalenes
56
accessory muscles of inspiration and expiration
SCM
intercostals
abdminal muscles
57
paralysis of respiratory system
paralysis of diaphragm because of:
- lesion of bulbospinal axons
- loss of phrenic motor neurons
- damage to prenic nerve
58
**ventilator neccesity**
if cough is absent = compelte SCI at C3 and above
NEEDS A VENT
59
**paralysis/paresis of intercostal and abdomonal muscles**
cough is weak especially with upper t-spine injures above t5
60
c3 and above
| respiratory
ventilator depedent
61
c4
| respiratory
vent depedent
possible to breath during day
ventilation with sleeping
frog breathing
62
c5
| respiratory
breath indepedently
- diaphram weakness
- no cough
- no intercostals
- poor lung volumes
- glossopharyngeal brething (using pressure to open glottis)
63
c6-8
| respiratory
independent breathing
people w/ lesions caudal **to c7 typically can augment inspiration and cough with accessory**
pec major and minor
64
t1-4
| respiratory
inspiratory capacity and forces expiration suppported by intercostal activty
**cough efficacy remains reduced** which is secondary to abdominal weakness
65
t5-12
| respiratory
progressive relative imprivement in muscle strength at descending lesion levels
minnimal disruption to autonomic dysfunction affecting CV system below T6
66
t12
| respiratory
respiratory function essentially comparable to that of normal person
67
greater respiratory capacity
typically occurs in supine because abdominal contect don't protrude
diaphragm mechanics are more effective
68
**abdominal binder**
use of a binder to compensate for abdominal laxity produces immediate improvement in respiratory function
- increased lung volume and coughing mechanics + upright position
69
factors that increases risk for CVD + SCI
obesity
glucose intolerance
vascular dysfunction
reduced PA
inflammation
other factors
70
t1
| cardiac function
not have any supraspinal sympathetic control
t1-4 will have partial preservation
71
below t5
| cardiac function
full supraspinal sympathetic control of heart and upper body vasculature
72
origin of sympathetic control of CV system
t1-4 spinal segments
73
pressure ulcers in SCI risk factors
nutrition is a major risk factor in ulcer development and healing gets hard
prolonged moisture in skin
smoking
74
nutrition for pressure ulcers
not enough protein after SCI
body catabolizes protein = resulting in poor collagen formation and loss of lean body mass
75
moisture on the skin for pressure ulcers
common sources are sweating where it's skin to skin and incontinence
urine and feces have high acidity so wash the exposed skin as quickly as possible before it becomes irritated
76
smoking for pressure ulcer
nicotine limits cutaneous blood flow and reduces tissue oxygenation
77
extrinsic tonal issues
flexor spams which is common in SCI
involved in flexor withdrawl mechanism
- loss of supraspinal info
- sensory trigger with no dampening
78
extrinsic tonal issues - sensory triggers
triggered by sensory information
- skin irritability
- joints (movements)
79
denervation of motor units
- gradual change in musles properties
- fibrosis
- atrophy
- **decrease in elastic properties (loss of ROM)**
- build up in connective tissue
- alterations in contractile properties towards hyperactive
80
SCI etiology
| examination
trauma:
- fx / TBI / internal injuries
medical:
- complications / medical rx
infections:
- process continues / complications
81
level of injury
| examination
cervical:
- CV
- Diaphragm / cough
- autonomic
thoracic
- autonomic (T6)
- diaphragm
lumbar
- ambulatory
82
relevant factors
| examination
- age
- sex
- fitness
- prior profession
- goals
- family support
- environment
- insurance
- cultural
83
impairments of SCI
muscles performance
sensory
spasticity
muscle length/ROM
pain
respiratory
posture
**reflex integrity**
**integumentary**
spasms
limited endurance/fatigue
84
function of SCI
gait
**W/C mobility **
**tranfers**
**bed mobility**
**bowel and bladder**
balance
self-care
home management
AD
**orthotics**
85
potential problems
cardiovascular
**autonomic dysreflexia**
integumentary
osteopenia
contractures
**heterotopic ossification**
**MSK injuries**
skeletal deformity
86
personal aspects of SCI
work reintegration
family
shopping
87
environmental aspects of SCI
recommendation for home, school, work
access to stairs and curbs
crossing the street
88
participant aspect of SCI
access to community
transportation
sports/leiusure
89
functional training
w/c transfer training (bed, toilet, bathtub/shower)
floor w/c transfers
curb and negotiating rough terrain
pressure relief
leg management on mat and w/c
skin checks
90
contractures
these develop secondary to long shortening of structures across and around the joint = limited ROM
initially create changes in muscles --> then involves to capsular and pericapsular changes
lack of active muscle function takes out normal reciprocal stretching
91
factors causing contactures
spasticity
w/c or bed positioning
abnormal skin tone
92
upper-limb pain in tetraplegia
| chronic pain associated with SCI
cause: transfers, head posture and overuse of w/c propulsion
cervical injury, pain in the neck/shoulder, "aching" pain
93
neuropathic pain below the level of injury
| chronic pain associated with SCI
cause: neuropathic pain
widespread pain, "burning" pain, pain in legs/feet, pain in thighs
94
severe, persistent pain
| chronic pan associated wtih SCI
cause: injury onset
high pain intensity, early onset of pain, short breaks in pain
95
Manual w/c
rigid = able to maneuver and can remove wheels
folding = transport (car and independent)
96
97
w/c for t-spine and low cervical
headrest
backrest
drive control
cushion
98
w/c cervical level
head rest
thoracic level back rest contour
forearm support
99
risk factors for skin breakdown
mass - weight loss or gain and loss of muscle mass
circulation - smoking and decreased circulation
external factors - extreme temps and moisture
100
high risk areas for SCI from prolonged positioning
shoulder blade
tailbone
sit bones
foot
back of the knee
heels
elbows
shoulder blades
back of the head
101
first signs of skin compromise
reddened, discolored or darkened area
may feel hard and warm to the touch
102
testing skin compromise
blanching test
- press on red, pink or darkened area with finger
- area should go white
- remove pressure and area should return to red, pink or darkened color within a few seconds = blood flow
- (+) = area stays white then impaired blood flow and damange
103
skin compromise
every pressure sore should be regarded as serious because of the possible damange below the skin surface
104
key areas for skin compromise
ischeal tuberosity
heels
greater tuberosity
scapula
sacrum (in supine)
105
stage 1
| pressure ulcers
skin not broken but red or discolored
redness or change in color does not fade within 10-30 mins after pressure is removed
106
stage 2
| pressure ulcers
epidermis or topmost layer of the skin is broken, creating a shallow open sore
107
stage 3
| pressure ulcer
extends to dermis and fat
108
stage 4
| pressure ulcer
extends to muscle and bone
109
seat cushions
ROHO or Jay cushions = allows the seat cushion to constantly adjust to a client's body movement
- made with air, foam, gel or hybrid
redistributes pressure to evenly displace across surface area of the skin
dissipates heat and moisture
110
gel
| W/C cushion
good pressure relief
shock absorption
heavier
difficult to transport
111
air
| W/C cushion
excellent pressure relief
lightweight
regular maintenance
difficulty to perform transfers
112
hybrid
| W/C cushions
gel support for pressure relief
form for thigh contour
decreases shear
113
Functional outcome measures
SCI function = SCI independence measure and FIM
Walking = walking index for SCI, 6MWT, 10MWT and TUG
W/C = functional eval, w/c skills test and w/c circuit
