SCI part 1 Flashcards
1
Q
what are the deficits associated with Brown Sequard syndrome?
A
paralysis/proprioceptive deficits on the same side of the body
loss of pain/temp on the CL side
2
Q
what are the deficits associated with central cord syndrome?
A
loss of pain, vibration, proprioception, motor loss (with motor loss worse above the segment)
3
Q
what are the deficits associated with anterior cord syndrome?
A
loss of motor/pain/temp
preserved proprioception, touch, and vibration
4
Q
what are the deficits associated with anterior cord syndrome?
A
loss of light touch/proprioception/vibration, preserved motor fxn
5
Q
what are the signs of an UMN lesion below the level of the lesion?
A
hyperreflexia, spasticity, hypertonicity
6
Q
what are the signs of an UMN lesion at the level of the lesion?
A
lost dermatomes/myotome, hyporeflexia, hypotonic
7
Q
what are the signs of a LMN lesion below the level of the lesion?
A
flaccid paralysis, hyporeflexia
8
Q
what are the signs of a LMN lesion at the level of the lesion?
A
lost dermatomes/myotome, hyporeflexia, hypotonic
9
Q
what is the myotome action of C1?
A
upper cervical flexion
10
Q
what is the myotome action of C2?
A
upper cervical extension
11
Q
what is the myotome action of C3?
A
cervical lateral flexion
12
Q
what is the myotome action of C4?
A
shoulder girdle elevation
13
Q
what is the myotome action of C5?
A
shoulder abduction
14
Q
what is the myotome action of C6?
A
elbow flexion
15
Q
what is the myotome action of C7?
A
elbow extension
16
Q
what is the myotome action of C8?
A
thumb extension
17
Q
what is the myotome action of T1?
A
finger abduction
18
Q
what is the myotome action of L1/2?
A
hip flexion
19
Q
what is the myotome action of L3?
A
knee extension
20
Q
what is the myotome action of L4/5?
A
ankle DF
21
Q
what is the myotome action of L5?
A
great toe extension
22
Q
what is the myotome action of S1?
A
ankle PF
23
Q
what is the myotome action of S4?
A
bladder and rectum motor supply
24
Q
is weakness diffuse or focal in UMN lesions?
A
more diffuse
25
is weakness diffuse or focal in LMN lesions?
more focal
26
is atrophy mild or severe in UMN lesions? is it more general or focal?
atrophy is mild and general
27
is atrophy mild or severe in LMN lesions? is it more general or focal?
atrophy is severe and focal
28
UMN lesions have ____ weakness with relatively ____ atrophy
severe, mild
29
LMN lesions have ____ atrophy with ____ weakness
severe, milder
30
are fasciculations seen in UMN lesions?
no
31
are fasciculations seen in LMN lesions?
sometimes
32
is ms tone increased or decreased in UMN lesions
increased (spasticity)
33
is ms tone increased or decreased in LMN lesions?
decreased
34
are ms stretch reflexes increased or decreased in UMN lesions?
increased
35
are ms stretch reflexes increased or decreased in LMN lesions?
decreased to absent
36
is there clonus in UMN lesions?
sometimes
37
is there clonus in LMN lesions?
never
38
are there pathological reflexes (Babinski sign) in UMN lesions?
sometimes
39
are there pathological reflexes (Babinski sign) in LMN lesions?
never
40
what is the first step in acute management of SCI?
stabilization
41
t/f: when an injury is consistent with spinal trauma, spinal immobilization is crucial for better outcomes
true
42
t/f: as soon as safety allows, immobilizing devices should be removed
true
43
25-50% of pts with acute SCI also have what injury?
a head injury
44
what is involved in medical management of SCI?
structural stabilization
neurochemical stabilization
45
what is the purpose of structural stabilization?
prevention of further cord or nerve root injury by normalizing the alignment and decompressing the neurologic tissues
46
what is involved in neurochemical stabilization?
induced hypothermic treatment
47
what is involved in post-surgical stabilization?
cervical collar or thoracic collage
48
what are the types of cervical collars?
Philadelphia collar
Aspen collar
Halo vest
49
what are the types of thoracic stabilization?
Jewett hyperextension brace
custom TLSO brace
50
C3-5 injuries can affect what innervation?
innervation of the diaphragm
51
t/f: cervical injuries can lead to risk for regurgitation and pulmonary aspiration secondary to paralytic ileus
true
52
what is neurogenic shock?
decreased systemic vascular resistance resulting in profound hypotension, bradycardia, and unopposed vagal tone
53
what is spinal shock?
the acute stage of diminished spinal fxn characterized by loss of all sensorimotor fxn caudal to injury
54
if we do an ASIA exam during spinal shock, will the results be accurate?
no
55
what kind of imaging do adults with distracting injuries, spinal pain, limb weakness/paresthesia, priapism, confusion, or altered consciousness require?
CT scan
56
what kind of imaging is recommended for pts under the age of 16 and with strong suspicion of c spine injury?
MRI
57
it seems evidence supports what early intervention for SCI?
surgery (decompression)
58
what are the benefits of surgery in SCI?
decompression
reduce morbidity
reduce LOS
reduce healthcare costs
if early enough, improve neurologic recovery
59
at this time, are corticosteroids currently recommended for acute SCI?
nope
60
what is the most clinically urgent complication associated with SCI?
autonomic dysfxn
61
autonomic dysfxn is most common in SCI above what SC level?
T6
62
what is autonomic dysfxn?
loss of descending control (inhibition) of the sympathetic NS
63
what is autonomic dysreflexia?
a hyperactive response of the ANS to a noxious stim or a trigger below the level of the injury
64
what happens in autonomic dysreflexia?
something painful isn't consciously perceived as painful, but the body responds to it with excess sympathetic response above the level of injury (or red face, inc BP, sweating)
65
how do we stop autonomic dysreflexia?
find and remove the trigger
66
what is a very common trigger of autonomic dysreflexia (AD)?
catheter kinking
67
what should we do if a pt is experiencing AD?
find and remove the trigger
call 911
DO NOT LAY THEM DOWN
68
t/f: repeat episodes (even if short lived) of AD can really impact long term CV health
true
69
what are some common triggers of AD?
full B/B
blocked catheter
UTI
ingrown toenail
tight clothing
pressure sores
prolonged pressure of an object, such as an abdominal binder or tight shoe
70
what are common sx of AD?
sudden inc in BP
altered HR (bradycardia)
anxiety
blurred vision
flushing of skin (blotchy) and sweating above the level of injury
goosebumps
severe HA
71
how do we manage AD?
SIT THEM UPRIGHT to manage BP
find/remove the noxious stim
call 911
72
how can we prevent AD?
recognize triggers and take preventative measures
antihypertensive meds
73
what does bladder distention/irritation result in with AD?
HTN (>20-30 SBP)
74
what does bowel distention/irritation result in with AD?
bradycardia
75
what does stimuli that would normally be painful below the level of lesion result in with AD?
severe HA
76
what does GI irritation result in with AD?
feeling of anxiety
77
what does sexual activity result in with AD?
constricted pupils
78
what does labor result in with AD?
blurred vision
79
what does skeletal fx below the level of injury result in with AD?
flushing and piloerection above level of lesion
80
what does ESTIM below level of lesion result in with AD?
nasal congestion
inc spasticity
may be asymptomatic
81
what is OH?
los of sympathetic vasoconstriction combined with the loss of ms pumping action for blood return caudally (below)
82
what can be used to improve tolerance to upright in OH?
tilt table or compression
83
when using a tilt table for OH, how much should we tilt the table every 3-5 min?
10 deg
84
if the pt becomes symptomatic or BP drops by 20 mmHg when using the tilt table, what should we do?
lay them in supine
85
what is the actual definition of OH?
a dec in SBP of 20mmHg or more and/or 10mmHg or more in DBP occuring within 3 min of transitioning from supine to an upright position
86
OH occurs more often in individuals with higher level injuries, specifically ___ and above
T6
87
when is OH more prevalent and severe in SCIs?
during the acute phase
88
what is the cause of OH?
a dec in the efferent sympathetic NS activity, causing a loss of regular adaptability of BP and disturbed reflex control
89
what are the sx of OH?
light-headedness
dizziness
fatigue or weakness
blurred vision
temporary loss of consciousness
dyspnea
restlessness
tinnitus
nausea
90
how do we manage OH?
meds (midodrine to inc BP)
FES
tilt table/standing frame
compression (abdominal binders, TEDS)
91
t/f: in SCI there is often poor thermoregulation leading to lack of sweating below the lesion
true
92
t/f: the higher the levels in the more complete a SCI is, the greater the risk for poor thermoregulation
true
93
t/f: the change in body core temp is less pronounces in SCI with thermal challenges
false, it is more pronounced
94
those with SCI are at inc risk of cardiometabolic disease (CMD) due to what factors?
physical deconditioning
nutritional balance
inflammation
95
physical deconditioning is prevalent in ppl with SCI and is associated with what factors?
obesity, insulin resistance, HTN, and dyslipidemia
96
t/f: those with SCI may have dec energy expenditure relative to energy intake leading to nutritional imbalance
true
97
t/f: ppl with SCI tend to have higher systemic inflammatory state compared to ppl w/o SIC
true
98
due to the inc CV risks in SCI, there is also higher risk for developing what diseases?
atherosclerotic disease, HF, and DM
99
what endurance tests can we use in the SCI population?
6MWT for ambulatory pts
6 min push test for WC bound pts
100
what are some ways to treat CMD in pts with SCI?
changing physical activity, diet, and meds
101
what physical activity can we do to combat CMD in SCI?
upper arm ergometry and FES training of LEs
102
what diet changes can be made to combat CMD in SCI?
DASH eating plan (limit foods high in sat fat and sugar)
Mediterranean diet
103
what meds can be used to combat CMD in SCI?
stations (for cholesterol)
Ca2+ channel blockers/ACE inhibitors (for HTN)
104
pts with a higher SCI, above _____, will experience loss of sympathetic control to the heat and blood vessels below the level of the injury and intact parasympathetic input to the heart
T6
105
parasympathetic signals arises from what nerve and does what?
it arrives from the vagus nerve and decreases HR and contractility
106
pts with SCI at/below _____ have intact sympathetic and parasympathetic control to the heart but loss of sympathetic control to the blood vessels below the level of the injury
T6
107
outflow to blood vessels of the lower body come from what SC level?
T5 (T6-L2)
108
if the SCI occurs above C4, is artificial breathing support required?
yes
109
if the SCI occurs above C4, is there AD, poor thermoregulation, OH?
yes
110
if the SCI occurs above C4, is there voluntary control of B/B and sexual fxns?
no
111
if the SCI occurs bw C4 and T6, is artificial breathing required?
no
112
if the SCI occurs bw C4 and T6, is there AD, poor thermoregulation, OH?
yes
113
if the SCI occurs bw C4 and T6, is there voluntary control of B/B and sexual fxns?
no
114
if the SCI occurs bw T6 and S2, is artificial breathing support required?
no
115
if the SCI occurs bw T6 and S2, is there AD, poor thermoregulation, OH?
no, there is adequate BP and thermoregulation
116
if the SCI occurs bw T6 and S2, is there voluntary control of B/B and sexual fxns?
no
117
if the SCI occurs bw S2-4, is artificial breathing required?
no
118
if the SCI occurs bw S2-4, is there AD, poor thermoregulation, OH?
no, there is adequate BP and thermoregulation
119
if the SCI occurs bw S2-4, is there voluntary control of B/B and sexual fxns?
no
120
if the SCI occurs bw S2-4, is there reflexive control of pelvic organs?
no
121
what is the #2 cause of death post-SCI?
reduced exercise tolerance, inability to manage secretions, and pneumonia
122
what are the respiratory effects of SCI?
dec resp capacity
dec strength of primary and secondary resp ms
effective coughing is limited w/o adequate abdominal strength/activation
123
normal breathing patterns should occur in pts with SCI below what level?
T12
124
what is involved in PT for maximizing respiration?
support through positioning
instruction in assisted coughing techniques and incentive spirometry
postural drainage
chest PT
125
B/B and sexual fxns have both ___ and ____ components
voluntary, reflexive
126
what is required for voluntary control of B/B and sexual fxns?
intact pathways bw the organ (B/B and penis) and the cortex
127
what is required for reflexive control of B/B and sexual fxns?
intact afferents T11-L2 and S2-S4
somatic, sympathetic, and parasympathetic efferents
128
lesions at or below ____ damage the reflexive bladder circuit, thus the bladder won't empty when full
T12
129
lesions above ____ result in an UMN type bladder, with hyperreflexia and reflexive emptying when full
T12
130
neurogenic bowel is common in what SCI levels?
at or below T1 2
131
what is neurogenic bladder?
the sphincters remain closed and have uncontrollable bowel movts
132
what is frequently used to manage neurogenic bowels?
digital stim accompanied by use of suppositories to initiate bowel movts
133
areflexive (flaccid) bowel is common in what SCI levels?
below T12
134
what is areflexive (flaccid) bowel?
no reflex to initiate reflexive bowel emptying
135
what is frequently used to manage areflexive (flaccid) bowels?
manual digital removal of feces and may need to empty their rectal vaults following meals
136
areflexive (flaccid) bowel is common in individuals classified with ____ lesions
LMN
137
how is B/B dysfxn managed in SCI?
with scheduled bowel programs
managing fluid intake to 2 liters/day
exercise, upright tolerance, standing frame on locomotion
abdominal massage
138
in neurogenic bowel, how often is the scheduled bowel program?
once a day
139
in areflexive bowel, how often is the scheduled bowel program?
1-2x/day
140
what are the different catheter options?
intermittent catheter
condom catheter
indwelling catheter
141
what catheters are good options for areflexive bladders?
intermittent catheters and indwelling catheters
142
what type of catheter is temporarily inserted into the bladder and removed once the bladder is empty?
intermittent catheters (self cath)
143
which type of catheter simply catches the urine as it comes out of the bladder?
a condom catheter
144
will a condom cath work on an areflexive bladder?
nope
145
what is a huge benefit of the condom cath?
it prevents UTIs, which are a common complication of SCIs
146
what type of catheter remains in place for many days/weeks?
indwelling catheters (Foley cath)
147
what kind of indwelling catheter remains inserted in the bladder through the abdomen?
suprapubic catheter
148
t/f: UTIs are SUPER common in SCIs
true
149
t/f: the use of catheters is associated with higher rates of UTIs in SCIs
true
150
what are some common causes of UTIs in SCIs?
not fully emptying the bladder causing static urine to sit in the bladder
inc time bw voiding
not using clean caths
151
if incomplete emptying of the bladder more common in neurogenic or areflexive bladders?
neurogenic bladders
152
what are the sx of UTI?
fever
nausea
fatigue
sweating
inc ms spasms kidney or bladder discomfort
AD
RISK FOR kidney infections
153
what can we do to prevent UTIs?
be consistent with the bladder voiding schedule
use clean techniques when performing catheterization
154
how often should the bladder be emptied on a schedule?
every 4-6 hrs
155
if the S2-4 sacral plexus reflex remains intact, is the reflex for erection with manual stimulation possible?
yes
156
are psychogenic erections possible in incomplete lesions through the psychogenic pathway (T11-12)?
yes
157
is ejaculation possible in SCIs?
yes, but limited in both UMN and LMN injuries
158
can women still become pregnant after a SCI?
yes, but they may experience fertility issues
159
bone density rapidly declines after a SCI with the most bone loss occurring when?
in the first 6 months post injury
160
after 2 yrs, does bone loss still occur?
yes, but the rate of decline decreases
161
about what % of bone is lost in the first 2 yrs following a SCI?
40%
162
in the SCI population, we see that bone reabsorption ____ and bone formation _____
increases, decreases
163
what are some signs of fx to look out for?
possibly pain (depending on their sensation)
AD
swelling/hematoma (at fx site)
inc difficulty with fxnal mobility
inc spasticity/tone
164
if there is an increase in spasticity in SCI populations, what things should we be thinking may be contributing?
UTI, fx, and pain sources
165
what is the stand test for assessing bone mineral density (BMD)?
dual-energy x ray absorptiometry (DEXA)
166
lower BMD on a DEXA scan at what landmarks is correlated to higher fx risk, as these regions lose 30-40% on bone density within 2 yrs?
the distal femur and proximal tibia
167
to monitor progression of BMD loss in SCI, a DEXA scan is recommended how often?
every 2-3 yrs to track bone loss, particularly in the knee region
168
t/f: SCI pts face a 2x higher lifetime risk of lower limb fx, often from min trauma
true
169
what is the most common fx type in SCI populations? why?
spiral fxs bc of the reduced torsional bone stiffness
170
how often should pts with SCI be standing to preserve leg BMD?
>1 hr for 5 or more days/week
171
t/f: at 2 yrs post-SCI, standing pts had 12% higher leg BMD compared to non-standing peers
true
172
how is BMD loss managed medically?
vit D and calcium supplements
biphosphanates/denosumab to dec bone resorption
173
how can bone be built?
WBing
ESTIM while standing
possibly FES cycling (mixed info in lit)
174
if a pt's DEXA scan is anything less than ____ they are unable to WB and they're at more risk for fx
-2.5
175
a higher (-) score on the DEXA is associated with what?
higher fx risk
176
if a pt with SCI hasn't been WBing in a while, what should we do?
call their PCP and ask about their bone health and fragility risk
177
what two risk factors especially contribute to LE fx after SCI?
prior fragility fx
knee region BMD below the fx threshold
178
what are the risk factors for LE fragility fx after SCI?
prior fragility fx
knee region BMN below the fx threshold
age of injury <16 yo
alcohol intake >5 servings/day
BMI<19
duration of SCI>10 yrs
women>men
motor complete (ASIA A-B)
paraplegia/quadriplegia
fam hx in men
anticonvulsant use
spasticity meds
opioid analgesia use
SSRI
PPI
179
what is heterotopic ossification (HO)?
bone development in soft tissues/jts where bone shouldn't exist
180
acquired HO is frequently seen with what injuries?
MSK trauma
SCI
CSN injury
181
what are common sites of HO?
on the jts of long bone/ms tissue of long bones (femur, hips, knees, humerus at shoulder/elbows)
182
t/f: the risk of developing HO increases with aggressive PROM/stretching in the presence of spasticity
true
183
what are the signs of HO?
fever
swelling
erythema
occasional jt tenderness in early HO
184
t/f: HO is often seen with high spasticity
true
185
HO in SCIs is commonly occuring in what area of the body and causes the pt to lock into what positions?
common in the hip and causes pts to lock in ER, abd, flex
186
what is involved in pt management of HO?
monitoring pain and changes in pain
monitoring integ changes
monitoring temp
cautious of ROM
refer out once developed
187
what is the only way to manage HO once it has developed?
surgery with wedge resection of the bone
188
t/f: pts with SCI are at very high risk for skin breakdown and pressure injuries
true
189
why are pts with SCI at very high risk for skin breakdown and pressure injuries?
bc of decreased peripheral blood flow, diminished pressure sensation, and decreased mobility
190
what is a precursor to infection, sepsis, and death?
pressure injuries
191
what is involved in PT management and prevention of pressure injuries?
EDUCATION
frequent and adequate pressure relief maneuvers
proper seating and positioning
daily visual and manual skin checks
192
weight shifts should occur how often?
every 15-20 min
193
how long should weight shifts last to relieve the pressure properly?
at least a full 60-180 sec
194
t/f: if a pt often gets pressure injuries, they should be weight shifting more often
true
195
although the air filled seat cushions provide good pressure relief, what is their downside?
they decrease sitting stability
196
what are the causes of DVT/PE?
Dec ms pumping
Peripheral vasodilation
Immobility
Blood viscosity
Accumulation of procoagulants in localized areas
197
who is at inc risk of DVT/PE?
Male
Flaccid paralysis
Complete SCI
Paraplegia
198
DVTs/PEs are often seen in what phase of SCIs?
in the acute phase (72 hrs to 2 weeks post injury)
199
if you suspect a DVT, should you continue with therapy?
no, hold therapy until medically managed
200
what are some signs of PEs?
chest pain
SOB
tachycardia
sweating
apprehension
fever
cough
201
what are the signs of DVT?
swelling
erythema
warmth
pain
202
how is DVT managed?
with prophylactic anticoagulants for 2-6 months
203
how can DVTs be prevented?
PROM
compression (TEDS)
LE positioning to facilitate venous drainage
204
what factors combine to create risk for contractures?
immobility
prolonged seated positioning
ms imbalances
tonal imbalances
spasticity
205
how much HS length should be available with SCI to promote fxn and independence?
110 deg
206
how should the HS be stretched to maintain tight lumbar musculature for stability?
complete stretching in supine
207
t/f: tenodesis grip is important in SCI to maintain fxn
true
208
what should we NOT stretch in order to maintain tenodesis grip?
don't stretch wrist ext and finger ext simultaneously
209
what fxnal task requires full shoulder motion?
UE WBing (LSP, SPP, transfers)
210
what fxnal tasks require at least 0-10 deg ankle DF?
foot position on WC
BOS for transfers
ambulation
211
what fxnal tasks require hip and knee flex to at least 90 deg?
WC positioning
dressing in ring sitting
212
what fxnal tasks require hip ext to 10-20 deg and knee ext to 0 deg?
fxnal ambulation
213
what is involved in PT management of ROM?
independent stretching program of key motions
prone positioning program
standing program
FES
nutrition
PRESERVE TENODESIS GRIP
214
how frequent should pts be doing prone positioning?
20 min/day
215
what is the point of prone positioning?
to promote hip and knee extension
216
what is one of the biggest barriers to improving someone's fxn in SCIs?
spasticity and hyperreflexia
217
t/f: reflex activity resumes below the level of the injury in SCIs
true
218
the flexor withdrawal response emerges in response to what?
noxious stim and then evolves to other stim
219
what is the flexor withdrawal response?
when stim causes the hip/knee to flex
220
does the flexor withdrawal response occur in the UE or LE first?
in the LE first
221
spasticity is highest in what ASIA levels?
B and C
222
how is spasticity in SCI managed?
with meds and PT
223
why is shoulder pain common in SCIs?
bc of UE overuse
224
t/f: half of adults with SCI reporting shoulder pain will have BL sx and the majority will have chronic pain that lasts more than a yr
true
225
what are common pathologies of the shoulder in SCI?
RCT injuries
impingement syndrome
arthritis
226
what are the medical interventions for shoulder management?
surgery and steroid injections
227
what is the risk with steroid injections for shoulder management?
risk for 2ndary injury to the tendons with prolonged use
228
when is surgery used for shoulder management?
for acute traumatic RCT
229
t/f: conservative tx is usually prescribed first for nonacute tears in the shoulder
true
230
what is involved in PT management of shoulder injury in SCI?
relative rest
modification of equipment, environment, or movt
ther ex
231
what is involved in modification of equipment, environment, or movt in shoulder management?
modifying ADLs to Dec OH movt
232
can ther ex reduce pain and improve shoulder fxn in SCI?
yes!!!
233
what is the STOMPS program for shoulder management?
a very prescriptive rehab plan that involves strengthening and optimal movt for painful shoulders
SCI specific home-based exercise program effective in reducing long-standing shoulder pain in ppl with SCI
234
what are the 3 phases of STOMPS?
stretching
warm up
resistive shoulder exercise
235
how often is STOMPS done?
3x/wk
236
t/f: pts with SCI experience many of the same age-related changes as the general population but they occur earlier/at an accelerated rate
true
237
research has shown a decline in motor abilities was most prevalent how long after injury?
25 yrs post SCI
238
t/f: age-related changes in SCI are not modifiable
false, they are modifiable and PT has an important role in education, training, and equipment prescription to optimize aging
239
what CV changes are accelerated in SCI?
CAD
DM
Lipid disorders
Obesity
240
what GI and urinary changes are accelerated in SCI?
Dec bladder capacity
241
what GI and urinary change is unique to SCI?
bowel incontinence
242
what integ changes are accelerated with SCI?
Dec collagen and skin elasticity
243
what integ change is unique to SCI?
pressure ulcers
244
what MSK changes are accelerated with SCI?
Ms mass reduction
Loss of strength and power
Bone mineral density loss
245
what MSK changes are unique to SCI?
HO
Shoulder pain
Contractures
246
what neuro changes are accelerated with SCI?
loss of CNS neurons
dec motor speed
247
what neuro changes are unique to SCI?
inc occurrence of spasms
inc occurrence of AD
248
what respiratory changes are accelerated with SCI?
Dec vital capacity
obstructive sleep apnea
respiratory complications/infections
249
what respiratory change is unique to SCI?
poor secretion management
250
what is the gold standard SCI classifications?
ASIA exam
251
what does the ASIA exam consist of?
sensory and motor assessment of the myotomes and dermatomes at ALL levels used to provide insight of the level and completeness of injury to assist with prognosis
252
what is an ASIA A SCI?
Complete: no sensory/motor fxn of S4/5 (vol anal contraction and deep anal pressure)
253
what is the most complete SCI in ASIA classifications?
ASIA A
254
what is an ASIA B SCI?
Incomplete: sensory preserved below the neurological level of injury, including S4/S5, no motor
255
what ASIA level SCI is a motor complete SCI?
ASIA B
256
what is an ASIA C SCI?
Incomplete: sensory preserved below the neurological level of injury, including S4/S5, no motor
257
what is an ASIA D SCI?
Incomplete: motor fxn is preserved below the neurological level of injury
More than half of the key ms are greater than or equal to 3/5 MMT
258
what is an ASIA E SCI?
normal, no impairments noted
259
what is the most incomplete ASIA SCI?
ASIA E
260
what is involved in sensory testing in the ASIA exam?
testing all 28 dermatomes going down the midaxillary line L and R comparing light touch and pin prick in supine
261
what pathway is light touch?
DCML
262
what pathway is pin prick?
spinothalamic
263
what is the scoring system for sensory assessment in the ASIA exam?
0-absent
1-impaired
2-normal
NT-not testable
264
what is involved in the motor assessment of the ASIA exam?
testing all 10 myotomes (5 UE, 5 LE) in supine graded like an MMT but not in MMT positions
265
what are the UE myotomes in the motor assessment of the ASIA exam?
C5: biceps, brachialis
C6: extensor carpi radialis and brevis
C7: triceps
C8: flexor digitorum
T1: abductor digiti minimi
266
what are the LE myotomes in the motor assessment of the ASIA exam?
L2: illiopsoas
L3: quadriceps
L4: tibialis anterior
L5: extensor hallicus longus
S1: gastroc
267
how is the motor exam scored in the ASIA exam?
0: total paralysis
1: palpable or visible contraction
2: active movt, full ROM with gravity eliminated
3: active movt, full ROM against gravity
4: active movt, full ROM against mod resistance in a ms-specific position
5: normal; active movt, full ROM against full resistance in a ms-specific position expected from an otherwise unimpaired person
NT: not tested due to immobility, pain, amputation, contracture
268
the anorectal exam tests sensation and motor fxn at what SC levels?
S3, S4, S5
269
what does it mean if there is no deep anal pressure (DAP)/voluntary anal contraction (VAC) and no S4/5 sensation in the ASIA exam?
it is a complete SCI
270
what is the sensory level in the ASIA exam?
the last level where BOTH light touch and pin prick are normal (2/2) on BOTH R and L
271
what is the motor level in the ASIA exam?
the lowest level of a 5 with the level below at a 3
the most inferior level with antigravity fxn (3/5 or greater) provided that the level immediately above is fully intact (5/5)
272
what is the neurologic level of injury in the ASIA exam?
the most caudal (inferior) segment of the SC with normal sensation AND antigravity motor fxn (3/5) on BOTH sides provided there is normal motor fxn and sensation superiorly
273
if there is preservation of ANY sensory and/or motor fxn below the neurologic level in the S4/5 region (sacral sparing) in the ASIA exam, is the SCI complete or incomplete?
incomplete
274
if there is an absence of sensory and motor fxn in the lowest segments (no sacral sparing) in the ASIA exam, is the SCI complete or incomplete?
complete
275
the zone of partial preservation is ONLY in what ASIA level SCI?
ASIA A SCIs
276
in the ASIA exam, what is the zone of partial preservation?
the lowest level of ANY motor fxn or sensation in ASIA A SCIs
277
t/f: in the ASIA exam, if motor is intact up to T1, the motor level follows the sensory level
true
278
what is the primary predictor of recovery in SCI?
the injury severity
279
order the ASIA levels from least to most likely to recover
A-->B-->C-->D
280
t/f: an ASIA A SCI is unlikely to walk
true
281
will an ASIA B SCI walk?
possibly (33%)
282
will an ASIA C walk?
probably (65%)
283
t/f: time has been shown a significant factor in walking recovery in SCIs
true
284
longer time out from dx to ASIA exam is associated with ____ prognosis
poorer
285
preservation of pin prick sensation after SCI in LEs or sacral region is associated with _____ prognosis and ______ ______ 1 yr post SCI
good, walking ability
286
LE ASIA motor score and ____ and _____ muscles can be useful predictors of fxnal walking ability post SCI
gastroc, quads
287
what factors contribute to the clinical prediction rule for ambulation post SCI?
younger age
stronger motor score of quads and gastroc
higher light touch sensory scores at L3 and S1
288
t/f: higher light touch sensory scores at L3 and S1 were able to accurately distinguish bw independent home ambulators and those who require assistance and those who cannot ambulate
true
289
what is the WISCI 2?
Scoring an individual’s ability to ambulate, from the level of most severe impairment (0) to least severe impairment (20) based on the use of devices, braces, and physical assistance of one or more persons
Through variety of walking conditions
290
what is the WHOQOL BREF?
subjective outcome measure with 26 items to assess an individual's perception of their QOL
291
what items/measures are included in the PT exam of SCI
Aerobic capacity/endurance
Integumentary integrity
Mental fxn
Motor fxn/ms performance
pain
ROM
Reflex integrity (tone and spasticity too)
Assistive technology
Balance (sitting vs standing)
Gait
Mobility (WC, bed, transfers, sit to/from stand)
FIST SCI
