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Neuro Rehab II > SCI (Part 1) > Flashcards

SCI (Part 1) Flashcards

1
Q

Traumatic SCI

A
  • Mechanical forces (non-reversible damage)

- Secondary microvascular, biomechanical, cellular processes (apoptosis, edema, information)

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2
Q

Non-traumatic SCI

A
  • Vascular damage (AVM, hemorrhage)
  • Occupying space (neoplasm, abscess, syrinx)
  • Secondary damage (MS, ALS)
  • infection (transverse Myelitis)
  • compression (DJD)
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3
Q

% break down of SCI

A
  • incomplete tetraplegia: 47% (C5-C7)
  • incomplete paraplegia: 20% (T12-L2)
  • complete paraplegia: 20%
  • complete tetraplegia: 12%
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4
Q

SCI: Prognosis

A
  • decreased life expectancy

- mortality rate highest in the first year

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5
Q

Causes of Death for SCI

A
  • pneumonia

- sepsis (urinary infection, pressure ulcers)

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6
Q

SCI: Initial Management

A
  • ABC (airway, breathing, circulation)
  • management of life threatening injuries
  • It might be in SCI if there is… (Paresthesia, spinal pain, sensory loss, altered mental state)
  • Stabilize or immobilize the spine (no A/PROM, backboard, c-collar)
  • transport to trauma center
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7
Q

SCI: Trauma Center

A
  • Ensure optimal ventilation and circulation

- Physical exam, neurological exam, imaging (CT, MRI)

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8
Q

SCI: ICU Management

A
  • Check to see if ventilation is
  • Organ function
  • Ensure proper circulation (avoid hypoxia and hypotension)
  • Bowel/bladder management (catheters inserted)
  • Integumentary integrity
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9
Q

SCI: High Dose Steriods

A
  • no evidence to support use
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10
Q

SCI: Local and Systemic Hypothermia

A
  • Goal = minimize secondary damage and no protection
    • Reducing cell death, oxidative stress, information, Adema, and minimize secondary
      ischemia
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11
Q

SCI: Fracture Management

A
  • Facture stabilization (open reduction)
    • Unstable fracture site, cord compression, malalignment, deteriorating neuro status)
  • performed with 24hrs of injury
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12
Q

SCI: Non-surgical Intervention

A
  • Closed reduction
  • Traction devices (fracture/dislocation, cervical subluxation)
  • Immobilization (positioned in a rotating bed)
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13
Q

SCI: Immobilization

A
  • Used in surgical and nonsurgical interventions
  • Halo (good at preventing cervical rotation)
  • spinal orthodox
  • recumbent positioning
  • monitor skin integrity
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14
Q

Spinal Shock

A
  • Transient reflects depression (abrupt loss of connection between cortex and spinal cord)
  • Areflexia
    • Loss of reflexes = bulbocavernosus, cremasteric, babinski
    • impaired regulation of hormones: hypotension, lack of piloerrection, no sweating
    • Can last 24 hours
    • It’s slowly regained after 72 hours up to four weeks
  • Do not assess spinal cord level until after 72 hours
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15
Q

Hypertonia

A
  • UMN injury (common in cervical SCI)
  • Spasticity, high muscle tone, clonus, muscle spasms, hyperactive reflexes
  • Gradually increases during the first six months, plateaus after year one
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16
Q

Hypertonia Management

A
  • Stretching
  • Surgery
  • Medication
    • oral: (mm relaxants and spasmolytic agents: baclofen, tizandine, diazepam, dantrolene sodium)
    • botulinum neurotoxin intramuscular injection
    • baclofen pump: intrathecal
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17
Q

Autonomic Dysfunction: Cardiovascular Impairments

A
  • Parasympathetic (Vagus n.) (vasodilation, slows HR)
  • Sympathetic nervous system (T1 to L2)
    • Cardiac function is innervated above T6
  • C7 injuries implications
    • Only have parasympathetic to the heart
  • T10 injury implications
    • Have parasympathetic and sympathetic intact
    • less complications due to imbalance of sympathetic and parasympathetic
18
Q

SCI: Orthostatic Hypotension

A
  • most severe in above T6 injuries
  • unopposed parasympathetic, and impaired sympathetic to the heart —> bradycardia and vasodilation of peripherals
  • decreased muscle activation —> pooling in peripheral limbs
  • pro-longed bed rest —> deconditioning
  • sx: dizziness, blurred vision, headache
19
Q

SCI: Orthostatic Hypotension Management

A
  • gradual progression of upright tolerance (head of bed —> recliner w/c —> standing frame/tilt table)
  • abdominal binder
  • compression stocking
  • medication
  • as vasomotor stabilizes, sx decrease
20
Q

Cardiovascular Presentation during Tx Sessions

A
  • tetra (decreased peak HR, post exercise hypotension, abnormal response to exercise)
  • Para (reduced exercise tolerance, stroke volume, cardiac output)
21
Q

Impaired Temperature Control

A
  • depends on level and completeness of injury
  • inability to regulate cutaneous blood flow or sweating
  • may result in hypo- and/or hyperthermia
22
Q

Autonomic Dysreflexia

A
  • typically occurs in patients with chronic, complete, above T6 SCI
  • noxious stimuli below level of in injury —> afferent input to SC —> overactive sympathetic activity (mass reflex response) —> increase BP —> (over active parasympathetic above injury level above level of injury
    • common causes: bowel, bladder, painful stimuli
  • if not address: seizure, cardia arrest, SAH, stroke, or even death
    • because the BP on keep on increasing
23
Q

Autonomic Dysreflexia: symptoms

A
  • HTN
  • Bradycardia
  • profuse sweating above LOI
  • vasodilation (flushing) above LOI
  • vasoconstriction below level of injury
  • increased spasticity
  • headache
  • constricted pupils, blurred vision, nasal congestion, pilo-errection
24
Q

Autonomic Dysreflexia: Management

A
  • upright position
  • remove noxious stimuli
    • bladder distention/ catheter kink
    • tight clothes
    • pressure sore
    • possible bowl impaction
  • monitor vitals
  • seek medical attention
  • education
25
Q

Pulmonary Impairments

A
  • depends on the level of injury
    • more rostral = more impairment
  • rib fx
  • other comorbidities (like COPD)
  • pulmonary complications are the leading cause of death in early and late stages of recovery
26
Q

Pulmonary Impairment: C1-C2

A
  • only accessory muscles are innervated
  • ventilator is needed to breathe
  • passive expiration: airway clearance required
27
Q

Pulmonary Impairment: C3-C4

A
  • partial diaphragm, partial scalenes, lev scap
  • ventilator needed for acute (maybe be able to ween off)
  • passive expiration: airway clearance required
28
Q

Pulmonary Impairment: C5-C8

A
  • full diaphragm, partial pec, serratus anterior
  • no ventilator required
  • forceful cough is severely impaired (no abdominal mm)
29
Q

Pulmonary Impairment: T1-T5

A
  • intercostal mm (T1-T11)

- posterior serratus (T1-T3)

30
Q

Pulmonary Impairment: T6-T10

A
  • abdominal (T6-L1)

- Intercostals (T1-T11)

31
Q

Pulmonary Impairment: T1 and below

A
  • lack QL, and full abdominals
32
Q

Pulmonary Impairment:Ventilator

A
  • endotracheal intubation
  • tracheostomy (allows speaking and eating; speaking during expiration)
  • portable units
  • phrenic n. stimulator (help reduce need of ventilator)
  • diaphragmatic pacer
  • emergency response (ambuBag)
33
Q

Pulmonary Impairment: Forced expiration

A
  • secretion management
    • coughalator
    • suctioning
34
Q

Pulmonary Impairment: Respiratory Function

A
  • vital capacity = the max amount of air that can be push out after the deepest breathe possible
  • <25% of normal in cervical injuries
  • 70-80% of normal in TS injuries
35
Q

Pulmonary Impairement: functional cough

A
  • 2 coughs with 1 exhalation
  • weak: 1 cough with 1 exhalation
  • nonfunctional: no explosive force (clearing throat)
36
Q

Bowel/bladder/and sexual dysfunction

A
  • UMN (spastic/reflexive/neurogenic)
    • bladder contracts reflexively with filling pressure
  • LMN (arreflexive/flaccid)
    • bladder can not contract on reflex
  • leads to failure to store urine or failure to release
37
Q

Pain: musculoskeletal

A
  • over use (UE, shoulders)
  • poor posture/ body mechanics
  • muscle imbalance
38
Q

Pain: Neuropathic

A
  • can occur at or below the level of injury
    • injury to the SC or nerve root
    • can be central (allodynia and hyperalgesia)
    • diffuse
  • above the level of injury (peripheral pain)
  • difficult to manage (tens, massage, mental imagery, pharmacology)
39
Q

Secondary Implication: Integumentary

A
  • pressure ulcers
    • leading cause of death
  • infection is leading cause of death (UTI, pneumonia, pressure sore)
40
Q

Secondary Implication: Pressure Ulcer: Risk Factors associated with it

A
  • tetra
  • incontinence
  • spasticity
  • nutrient deficiency
  • decreased mobility for self care
  • smoking
  • poor compliance with skin care
  • immobilized for long durations
41
Q

Secondary Implication: Pressure Ulcer Prevention

A
  • minimize staying in one position
  • weight shifting to allow adequate blood flow to the area
  • bed (every 2 hours, pressure relieving bed)
  • wheelchairs (every 15-30 min for 2 minutes)

Neuro Rehab II (4 decks)

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