SCI in children Flashcards
1
Q
Non-traumatic causes of SCI
A
- Intramedullary tumors
- Transverse myelitis
- Epidural abcess
- Arteriovenous malformation
- MS
- SC infarction
- Developmental disorder orthopedic conditions”
2
Q
What are the common injury levels in MVA SCI?
A
- < 4y/o high cervical lesion
- 5-8 y/o lap belt injury at thoracolumbar junction
- Teens in cervical level”
3
Q
Survival rates in pediatric SCI
A
- 50-83% in long term survival rate
- More frequent recovery of neurologic function”
4
Q
Characteristics in juvenile spine
A
- Ligaments and joints have more stretch
- Anteriorly wedges vertebral bodies allow forward slip
- Uncinate processes are absent in <10 y/o”
5
Q
What type of SCI is more common in 0-9 y/o?
A
- Spinal cord injury without orthopedic radiographic abnormality
- Traumatic myelopathy
- Spinal cord ischemia
- Most are complete or near complete injury”
6
Q
What is “seatbelt syndrome”?
A
- Compression injury of ant. vertebral body and distraction injury to posterior vertebral elements
- Organ injury common with this”
7
Q
Complications of pediatric SCI
A
- Scoliosis
- Risk of hip dislocation
- Bladder does not reach adult capacity if injured < 10 y/o
- Self injurious behavior
- Pathological fx
- Immobilization hypercalcemia
- Low potassium
- Lower U/E strength makes transfers difficult
- DVTs rare except in 14-19 y/o
8
Q
What is immobilization hypercalcemia?
A
- First 12-18 months after SCI, 40% bone mineral density lost, excreted in urine
- Too much for the kidneys to excrete”
9
Q
Symptoms of immobilization hypercalcemia
A
- Lethargy
- Nausea
- Mood alteration
- Anorexia”
10
Q
Treatment for immobilization hypercalcemia
A
- Hydration to eliminate excess calcium
- Meds to prevent/treat kidney stones
- Weightbearing
11
Q
Symptoms of pathological fx
A
- Redness
- Heat
- Swelling
- Exacerbation of AD
- Osteopenia greatest @ hip
12
Q
What can hip dislocation/subluxation lead to?
A
- Pelvic obliquity
- Greater risk of skin breakdown
- Exacerbated neuromuscular scoliosis”
13
Q
Common contractures in pediatric SCI
A
- Hip flexors
- Hamstrings
- Adductors
- Ankle PF
- Pseudo hip flexion contracture - IT band tightness”
14
Q
What levels have complete diaphragm paralysis?
A
- C1-3 or down to C4
- Diminished vital capacity”
15
Q
Causes of skin breakdown in pediatric SCI
A
- Not usually from pressure
- Shear and moving across w/c tire
- Disregard of insensate body parts - dragging them”
16
Q
PT intervention for pediatric SCI
A
- Routine sessions in safe play space
- Strengthening
- Balance
- Reaching
- Rolling
- Sitting
- Transfers
- Mobility
- Paraparesis - crawling, kneeling, standing, gait”
17
Q
Prevention of pediatric SCI
A
- Car safety - infants in rear facing carseat; toddlers in booster seats; rear seats until 13 y/o; seatbelt across pelvis and clavicle
- Sports physical exams - screening x-rays
- Water safety - feet first”
