SCI lecture 1 Flashcards
What is the most common distribution of SCI
Incomplete tetraplegia (partial paralysis of arms and legs)
What is the highest level of SCI where the UE is fully innervated
T1 (the level of injury refers to the last working level)
Why might spinal cord injury patients have cognitive deficits
Due to associated injuries (TBI and LOC)
Most SCI deaths are due to what
respiratory disease
Note: but the rates of cardiovascular disease, infection, and suicide are also higher than normal population
What is the most common kind of SCI in the cervical spine
hyperext
What is the most common cause of SCI in the thoracic spine
flexion-rotation injury
FRT vs mFRT
The modified functional reach test allows sitting
Why might the FES and ABC scale not be helpful to SCI patients
Because they may not walk and those scales ask about how worried you are about falls while walking
What is the instrument that assesses safety of transfers and risk of overuse injuries
Transfer assessment instrument
What signals the end of spinal shock’
when does it typically resolve
return of anal and bladder reflexes
begins to resolve in 24 hours, lasts a few weeks
Why might SCI patients have a hard time regulating temp
Unable to sweat, shiver, or have goosebumps below level of injury
A SCI patient who has a lesion above or at ___________ might have bowel and bladder affected
S2 S3 S4
UMN injury leads to what kind of B&B problems
Reflexive/neurogenic
they need a supossitory program and need to use digital stimulation to empty
LMN injury leads to what kind of B&B problems
flaccid
must manage fluids, diet, may need to manually evacuate
(make sure these patients are not constipated)
Which gender has fertility impacted by SCI
UMN vs LMN
male
UMN: arousal cant occur but can be manually stimulated
LMN: won’t become erect no matter what
How often to reposition SCI patients in bed in the hospital?
every 2-4 hours (Even at night they need to have an alarm to wakeup and turn)
how often to reposition patients in WC
every 30 minutes for 2 minutes
What are the most common areas of pressure injuries in supine patients
heel and sacrum
What are the most common areas of pressure injuries in WC patients
sacrum, trochanter, ischium
Where can contractures form in a SCI patient?
below level of lesion
What do you need in a SCI patient to prevent osteoporosis
Weightbearing and muscles pulling on bone
What has to happen on a cardiopulm basis before we can assess if a patient will need a power chair
They must be able to sit up without passing out
What is the first thing we do with a SCI patients when we see them and want to improve their upright tolerance
tilt the head of their bed upwards
do not get them up or have them seated EOB
what can we do to assist patients with venous return for up right tolerance
compression for LE, abdominal binder
autonomic dysreflexia can occur in SCI patients above what level?
T5/T6
What do patients who have autonomic dysreflexia need to carry on them
a card behind their wallet explaining their condition for EMS
What is do we need to do for patients with autonomic dysreflexia
check for irritants
create orthostatic hypotension
call 911
T or F: Higher level spinal cord injuries have more difficulty adjusting than lower level injuries
F, age is the primary factor of ability to adjust
older people have harder time adjusting
When will we see a patient with Gardner-wells tongs
When theyre awaiting surgery
provides traction and decompresses cervical spine
Can you make a minor adjustment for a patient with a halo vest?
No!
also side note: these allow for early out of bed activities, eliminates all motion of cervical spine
What kind of cervical braces can be removed briefly for hygiene
Sternal Occipital mandicular immobilizer
Philidelphia collar
What kind of neck stabilizing brace is least restrictive
Philadelphia collar
What kind of brace is made to minimize thoraco-lumbar movement
body jacket
what is a less restrictive thoracolumbar brace?
Taylor-knight brace
what is the LEAST restrictive thoracolumbar brace
Jewett
mainly restricts flexion
What do we need to teach our patients who might have a chest-tube
Glossopharyngeal breathing
to be able to breathe and stay calm incase chest tube comes out
What movements do we want to avoid for SCI patients who complain of neck pain with cervical injuries
Avoid shoulder flexion and abduction
What movements do we want to avoid for patients with SCI at the lumbar who complain of back pain
SLR
no hip flexion over 90 degrees for lumbar injuries
What technique do we want to use to turn SCI in bed
log roll
Can SCI patients do longsitting?
No, avoid longsitting until atleast 90 degrees of passive unilateral SLR attained on both sides
Whats the most important thing to emphasize for SCI patients early
The patient’s responsibility for their own car e
General program progression for SCI in PT
Beside treatment
Upright tolerance
Mat activity
Transfer
WC skills
Power building and conditioning
Advanced WC skills
Gait
Pain management
What was the main difference of people who have a SCI and have shoulder pain vs those without shoulder pain
The time they’ve lived with their injury
more time= more chance of shoulder pain
What levels are considered a high tetraplegic?
C1-C4
What is the main goal for instructions of care for patients with high level tetra
Instruction needs to be good enough that someone who’s never done the task before can safely assist
A patient on greater than _______ of oxygen on a vent can’t leave the room
2L
