Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NM III > SCI- MED AND PT MANAGMENT > Flashcards

SCI- MED AND PT MANAGMENT Flashcards

1
Q

What is the most common way to obtain a traumatic SCI?

A

motor vehicle accident

central cord syndrome- common with older adult falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mean age of SCI?

A

43 YEARS

-group of older adults and younger

78% male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percent of SCI are in ppl > 60 years?

A

11.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common type of SCI?

A

incomplete tetraplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ISNCSCI testing (“ASIA Testing”)

A

COMPONENTS
-light touch sensation
-pin prick sensation
-anorectal exam —> allows us to determine incomplete or complete
-UE and LE motor testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Light touch sensory testing-ISNCSCI

A

Dermatomes- C2-S4/5

0- Absent - patient does not correctly and reliably report being touched

1- Impaired - feels touch but diff from face

2- Normal - feels touch and feels same as face

NT- not testable - Key sensory point unavailable or patient unable to distinguish
accurate testing on face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pin prick sensation- ISNCSCI

A

Dermatomes- C2-S4/5

0- Absent - patient does not correctly and reliably report being touched by either end of pin OR does not reliably distinguish between sharp and dull ends of the pin

1- Impaired - distinguishes between sharp and dull but reports intensity is different from face (greater or lesser)

2- Normal - distinguishes sharp or dull sensation correctly and describes it as same as their face

NT- not testable - Key sensory point unavailable or patient unable to distinguish
accurate testing on face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Upper extremity myotomes

A
  • C5: Elbow Flexors
  • C6: Wrist Extensors
  • C7: Elbow Extensors
  • C8: Finger Flexors
  • T1: 5th Finger Abductor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lower extremity myotomes

A
  • L2: Hip Flexors
  • L3: Knee Extensors
  • L4: Ankle Dorsiflexors
  • L5: Great Toe Extensors
  • S1: Ankle Plantar Flexors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is an upper and lower extremity motor exam typically performed per ISNCSCI?

A

often 72 hours after injury

-performed in supine (gravity eliminated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anorectal Exam

A

Deep Anal Pressure (DAP)

*May be the only evidence of an INCOMPLETE SCI

  • Insert gloved, lubricated finger into anus
  • The patient is asked to describe any sensory awareness
    including feeling of touch or pressure
  • Recorded as present or absent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Voluntary anal contraction- anorectal exam

A
  • After testing DAP, ask the patient to attempt to contract around your finger as though preventing a bowel movement
  • A circumferential tightening of the anal sphincter around your finger is positive
  • Pressure at the tip of your finger is the result of “bearing down” with the diaphragm or abdominals and is recorded as negative.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AIS A on INSCSCI

A

COMPLETE

  • No sensory or motor function is preserved in sacral segments S4-S5 –> no anal sensory or motor contraction
  • No anal sensory or motor contraction
  • Trick: NOOOON
    —> N: no voluntary anal contraction
    0- light touch R
    0-pin prick R
    0-light touch L
    0-pin prick L
    No- deep anal pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AIS B

A

INCOMPLETE

-sensory, but not motor function is preserved below the neurological level
-must include sacral segments S4-5

-NO NOOOON

B = Incomplete: Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AIS C

A

INCOMPLETE

  • Sensory or motor function is preserved in S4/5 segments
  • Must have either voluntary anal contraction OR
    Sacral sensation PLUS motor sparing of the
    motor function 3 levels below the motor level
  • More than half the muscles grades below the single neurologic level are <3.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain sparing with spinal cord injury:

A

C4 AIS A
–> patient can still have biceps control and wrist extensor control despite C4 level of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

AIS D

A

INCOMPLETE

  • Everything for AIS C
  • AND at least half of the muscle grades below the single neurologic level at >/= 3.

** muscles are stronger than AIS C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

AIS E

A

INCOMPLETE

  • Sensory and Motor function are normal
  • Persistent hyperreflexia does not negate
    this classification

-the patient had prior SCI-related deficits

*Individuals without a spinal cord injury do not receive an AIS Grade.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What factors have an impact on functional recovery following SCI?

A

age

timing of surgical decompression

penetrating injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the relationship between age and prognosis with SCI?

A

50-65 difficult to determine prognosis

under 50 - better prognosis

over 65- worse prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the rate of SCI recovery?

A

-most rapid in the first 3 months
-majority of recovery first 6-9 months
-late recovery up to 2-5 years
-most plateau 12-18 months

-early improvement–> greater recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of SCI has the lowest conversion rate to an incomplete?

A

High thoracic AIS A

-due to innate bony stability of the thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of SCI has the highest rate of conversion?

A

lumbar AIS A

-the highest rate of conversion likely due to cauda equina and possible peripheral nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

rate of conversion of SCI from greatest to least

A

lumbar>cervical>low thoracic> high thoracic

25
Q

AIS A characteristics:

A

CERVICAL
* Most (67-80%) cervical
complete regaining of motor function
at least one level at 1 month
* 90% of muscles with a 1 or 2
grade at initial testing recover to
greater than or equal to 3/5 by
one year
* Chance of LE recovery very low
if still motor/sensory complete at
1 month

THORACIC
-very low recovery in thoracic injuries T9 and above at one year
-more recovery possible in T10-T12

26
Q

AIS B Characteristics- motor complete, sensory incomplete

A
  • Individuals with sensory sparing in a COMBINATION of modalities with
    the greatest chance of recovery (light touch, pin prick, deep anal pressure)

-if pin prick spared> prognosis than light touch alone

-PP sparing in >50% of LE dermatomes (L2-S1) at 72 hours was predictive of ambulation

27
Q

AIS C and D characteristics- motor and sensory incomplete

A

-if only VAC is preserved (motor), functional recovery minimal at 1 year

-if VAC plus DAP+LT+PP at S4-5 spared–> 80% chance of recovery to functional recovery to AIS D

28
Q

Positive factors for SCI on imaging

A

T2 sagittal level

BASIC score: 5 factors from MRI correlated with the ISNCSCI exam and conversion rates

POSITIVE FACTORS:
-edema
-lesion spanning <3 levels
-BASIC score of 2

29
Q

Negative factors for SCI imaging

A

hemorrhage

lesion spanning > 3 levels

BASIC imaging score of 4

30
Q

What predictor is helpful for the prognosis of AIS B and C?

A

S1 pinprick sensation

31
Q

What is prevented by the ICU/ acute care team in a hospital for patients with SCI?

A

-respiratory
-skin breakdown
-autonomic function
-bowel and bladder complications
-shoulder pain
-joint contractures

32
Q

Characteristics of a UMN injury:

A

-CNS affected
-preserved reflexes- hyperreflexia
-spasticity
-neurogenic bowel and bladder–> spastic sphincters
-preserved reflexive penile erection

33
Q

LMN injury

A

-PNS affected
-loss of reflexes
-flaccidity
-flaccid bowel and bladder- flaccid sphincters
-no reflexive erection in males

34
Q

Common medical comorbidities in acute SCI

A

-pressure injury
-orthostatic hypotension
-autonomic dysreflexia
-deep vein thrombosis
-pulmonary embolism
-HO
-orthopedic injuries (cervical instability/fracture, vertebrae fracture (requires bracing))
-respiratory dysfunction
-sexual dysfunction
-neurogenic bowel/bladder

35
Q

Pressure ulcers and skin protection

A

Why are SCI patients more susceptible?
- Decreased vascular supply (even WITHOUT pressure)
- Impaired autonomic system
- Impaired temperature control

-early detection is VERY important
-can happen very fast
-push to see if blanching occurs- early in the process
-not blanching- more severe

SKIN PROTECTION:
-turn in bed every 2 hours
-weight shift in w/c every 20 min for 2 min
-recommended to turn at least once at night
-check sacrum, ischial, heels, shoulder blades, back of head

**make sure patients are not mobilized into chairs and left there for too long

36
Q

Review supine padding and side-lying padding examples on PPT

A

do it

37
Q

Why is it important to avoid cardiac chairs?

A

not enough padding

must be adequately padded if using and watch sacral pressure

38
Q

Characteristics of autonomic dysfunction (co-morbidity of SCI)

A

neurogenic shock
-orthostatic hypotension, loss of spinal reflexes in UMN injuries

cardio complications
-bradycardia, bradyarrhythmias, orthostatic hypotension, increased vasovagal reflex,
vasodilatation and stasis

temperature regulation
-reduced sensory input to thermoregulating centers and loss of sympathetic control of temp and sweat regulation below level of injury (LOI)

altered sweat secretion
-can be excessive, absent, or simply diminished
-reflex sweating- exclusively occurs below the LOI

39
Q

Orthostatic hypotension following SCI and treatment

A

-dec more than 20 mmHg systolic or more than 10 mmHg diastolic

CAUSES:
-↓vasoconstriction, ↓ venous return, Dehydration

PRESENTATION:
-Palor, diaphoresis, dizziness, nausea, light-headedness, blurry vision, “shortness of breath”, loss of consciousness

DIFF DX:
-vestibular dysfunction
-low oxygen saturation
-stress/anxiety

TREATMENT:
* Abdominal binder, medications
(Proamitine/midodrine, Florinef,
NaCL tablets), caffeine, Ace
wraps – Tubigrip/Dermafit
* Initial mobilization to a wheelchair.
* Caution: hospital bedside chairs or raising HOB -> sacral/ coccygeal pressure ulcers!
* Hydrate!! - to increase blood volume

40
Q

Autonomic Dysreflexia (AD)

A
  • Increase in BP (>20 - 40 mm Hg above baseline) usually associated with bradycardia

CAUSES:
-noxious stimulus below LOI
—full bladder, impacted/irritated bowel, pain (cannot feel)
-vasodilation above the level of injury only
-vasoconstriction below LOI

PRESENTATION:
-flushing/blotchy red rash
-sudden headache
-diaphoresis
-chills
-nasal congestion
-blurred vision
-anxiety
-nausea

TREATMENT:
-needs to be treated emergently
-sit the person UPRIGHT to reduce BP
- find the cause

41
Q

How does automatic dysreflexia occur with SCI?

A

NORMAL:
-afferent stimulus triggers peripheral sympathetic response–> vasoconstriction–> BP rises –> inhibitory signals sent down from the brain to reduce vasoconstriction

WITH SCI:
-can’t sent inhibitory signals from the brain through spinal cord to reduce vasoconstriction

42
Q

Cardio issues with SCI

A

DVT
-40-100% of new injuries
-prophylaxis with Heparin, Coumadin, Lovenox

PE
-2-5% of new injuries
-leading cause of sudden death in acute SCI

**6-12 MONTHS OF ANTICOAGULATION MEDS REQUIRED - POST SCI

43
Q

HO and neurogenic heterotopic ossification following SCI

A

-bone growth in or near joint after SCI and traumatic brain injury

-most common near hips (most common), knees, elbows

-20-50% of SCI

-most common 4-12 weeks after injury (as early as 2-3 weeks)

CAUSE:
-due to whole-body trauma and immobilization (neurologically driven)

PRESENTATION:
-decreased ROM unilaterally
-edema
-warmth
-low-grade fever, especially at night
-can have palpable mass beneath inguinal ligament or laterally near greater trochanter or femoral head

44
Q

Diagnosis of HO:

A

1.) Asymmetrical PROM - decreased hip flexion and internal rotation; pain

2.) Bone scan- detects early phase 2-4 weeks after onset

3.) xray- can only detect progressive HO (3-6 months after formation)

4.) Serum alkaline phosphatase- elevates 2-3 weeks after bone formation but also durign fx healing; not well-correlated

45
Q

Medications for HO

A

Bisphosphonates

NSAIDs (Indicin) - may be prophylactic in acute stages

Low field radiation

Surgical Resection - often unsuccessful due to highly vascularized tissue–> regrowth

46
Q

What drug is now banned by FDA for HO?

A

DIDRONEL

-if taken for 2 months or less can cause rebound ossification

47
Q

Respiratory dysfunction following SCI:

A

-PRIMARY CAUSE OF DEATH AFTER SCI

TREATMENT:
-clear secretions

-maximize inspiration:
–stacking breaths
–inspiratory muscle trainers
–incorporate ventilatory strategies into mobility

-maximize cough/expiration
–assisted or self-assisted cough
–abdominal FES

48
Q

Diaphragm and its effect on respiratory function after SCI:

A

INNERVATION: phrenic nerve C3-C5

-contributes to 65% of vital capacity
-an abdominal binder or supine
positioning can help to increase VC by 16 to 28%

DPS- diaphragmatic pacer system:
-stimulates the phrenic nerve and allows partial or full time weaning from the ventilator

49
Q

Sexual dysfunction and SCI

A

DEPENDS ON:
-complete or incomplete
-muscle movement and mobility
-sensation and hypersensitivity
-medical complications
-fatigue, energy levels
-interest and desire

CONSIDERATIONS:
-AD
-spasticity
-positioning
-skin integrity
-neurogenic bowel/bladder
-orthostatic hypotension
-pain- somatic and neuropathic

  • women can have full-term pregnancies with SCI
50
Q

Neurogenic bowel and bladder with SCI

A

UMN
-spastic sphincter> retention of urine
-high amount of bladder pressure -> AD
-incomplete bladder drainage > UTI
-deterioration in renal function

LMN
-flaccid sphincters > leaking

INTERMITTENT CATHETERIZATION
-will need intermittent catheterization –> maintain low urine volumes and pressures to avoid urinary tract damage -400-600 cc
-clean technique taught to patients and caregivers –> Compliance is higher
-LMN injuries, may need to cath more frequently due to leaking

51
Q

Suprapubic catheter

A

-Constant drainage of bladder through
indwelling catheter directly into
bladder via stoma located above
pubic bone

-Decreased infection risk from foley
catheter, allows improved peri-care
and confidence with potential sexual
functioning (decreased risk of UTI)

-reversible

52
Q

Bowel management after SCI:

A

UMN
-spastic sphincters can lead to stool retention, impaction, AD
-daily bowel program: digital stimulation, suppository, upright, regular schedule
-diet: aim to keep stool loose

LMN
-flaccid sphincters –> harder to hold in
-BID or TID bowel program: no dig stimulation, suppository, upright, regular schedule (30 min after meals)
-diet: keep stool slightly formed

53
Q

The ideal bowel program:

A

– Less than 90 minutes
– Every day or every other day
– No routine use of suppositories
– Less than 3 incontinence episodes
per year
– Low incidence of constipation

*MOST SIGNIFICANT CONCERN AFTER SCI

54
Q

What is a colostomy?

A

-can be easier and faster to empty than bowel program BUT external to the body

  • Surgical procedure to re-route
    colon to the external stoma and
    attached bag
  • Eliminates the need for daily bowel
    program
  • Can be easier for the caregiver
    management
  • Significant surgery and recovery,
    but can be reversed surgically
55
Q

Where should the tip of a wheelchair user’s middle finger be in relation to the axel of the wheelchair?

A

tip of middle finger near center axel

56
Q

What levels of SCI are you more unlikely to teach a supine-to-sit transfer/

A

above C7 injury

57
Q

Exercise recommendations after SCI

A

2-3 days per week of strength training
150 per week moderate to high-intensity cardio exercise

58
Q

Postural asymmetry can lead to _______ if not managed well

A

respiratory compromise

59
Q

How can bone mineral density loss with aging be mitigated with SCI?

A

PT can provide education, training, and equipment evaluation for a safe, regular supported standing program to slow bone mineral density loss

NM III (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions