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MedCon Rehab II > SCI Part 1 EXAM 1 > Flashcards

SCI Part 1 EXAM 1 Flashcards

1
Q

Divisions of the NS (2)

A
  • CNS
    • Brain
    • SC
  • PNS
    • spinal nerves
    • cranial nerves
      • Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens
        • Some Say Marry Money But My Brother Says Big Boobs Mattr More
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2
Q

CNS vs. PNS Pathology

A
  • brain
  • SC
  • P. nerves
    • sensory AND motor components
  • NMSK Junction
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3
Q

Other NS divisions?

A

UMN (originate in cortex)

LMN (2nd order neurons)

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4
Q

UMN Syndrome

What are some POSITIVE sx’s?

A
  • Hyperreflexia== overactive
    • abnormal babinski
    • clonus
  • Altered mm tone
    • hypERtonicity
      • extra response to stretch
  • Spastic paralysis
    • cannot get individual mm to work or abnormal mvmt
    • only move in a stereotypical pattern
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5
Q

UMN syndrome occurs WHERE and found in WHAT?

A
  • Found in:
    • stroke
    • SCI
    • MS
    • CVA
    • PD
  • Brain + SC == UMN syndrome
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6
Q

Babinski reflex (UMN) NORMAL in what

A

infants

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7
Q

Babinksi reflex: how to do it

A

stroke outside of sole from heel to toe w/ pointed obj

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8
Q

Babinksi Reflex

Normal Response?

A
  • Normal Response:
    • Flex and ADD. of all toes
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9
Q

Babinski reflex:

Positive Response?

A

Babinski positive response:

Great toe EXT w/ ABD of toes 2-5

*re-emerges w/ motor system damage *

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10
Q

Clonus normally checked where?

A

ankle or wrist

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11
Q

What is Clonus ?

A
  • Clonus
    • Repetitive, rhythmic contraction of mm when held in a STRETCHED state
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12
Q

Clonus is an ________ SC reflex

A

abnormal spinal cord reflex

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13
Q

Clonus

–abnormal SC lvl reflex that is a sign of?

A

Damage to nerve tracts ABOVE reflex lvl

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14
Q

Clonus and the # of beats:

A
  • Unsustained:
    • # of beats
  • Sustained
    • Stays on as long as the stretch is on
  • NOTE: Clonus is NOT myoclonus​
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15
Q

Discuss Altered Muscle Tone

A
  • Tone== mm’s resistance to passive stretch
    • mm tension @ rest basically…
    • Normal tone resists the effects of gravity in posture and mvmt, yet is LOW enough to all FREE MVMT
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16
Q

In SC or UMN damage…explain Spinal shock

A
  • MM’s initially flaccid due to loss of descending stim. from GAMMA motor neurons RIGHT AFTER THE INJURY
    • NOTE: this is what we see in LMN syndromes
  • later, GMNs become hypERexcitable resulting in INC mm tone
    • ​INC mm tone is sign of UMN syndrome ***
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17
Q

Explain HypOtonia

A

DEC resistance to passive mvmt

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18
Q

Explain HypERtonia

A
  • INC resistance to passive mvmt
    • MAY be present w/ or w/out normal control of voluntary mvmt
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19
Q

What are the 2 types of HypERtonia?

A
    1. Spasticity
    1. Rigidity
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20
Q

Explain Spasticity: type of hypERtonia

A
  • Velocity dependent INC to PROM
  • measured w/ Mod’d Ashworth Scale
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21
Q

Explain Rigidity: type of hypertonia

A
  • NON-velocity dependent INC to PROM
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22
Q

NEGATIVE signs of UMN syndrome:

(meaning there is LOWER of this or LESS than should be)

A
  • Fatigue
  • Dyscoordination
  • Impaired motor planning and control ***
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23
Q

POSITIVE signs of UMN

(more of these things)

A
  • Athetosis
    • irregular contractions
  • Dystonia
    • prolonged
    • spastic
  • Emergence of primitive reflexes
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24
Q

LMN Syndrome: where is the damage?

A

Damage b/w anterior horn and the NMSK junction

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25
Q

3 symptoms of LMN Syndrome + examples

A
  1. flaccid paralysis –> mm’s do NOT work
  2. mm atrophy
  3. hypOreflexia

Examples: polio, P. nerve lesion (most common)

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26
Q

Comparing Syndromes: LMN vs. UMN

A
  • LMN
    • weakness
    • atrophy
    • fasciculations
    • DEC reflexes
    • DEC tone
  • UMN
    • ​weakness
    • NO atrophy
    • NO fasciculations
    • INC reflexes
    • INC tone
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27
Q

UMN vs LMN

Paresis or paralysis of ONE mm/myotome

A

LMN

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28
Q

UMN vs LMN

Paresis or paralysis of ONE SIDE/AREA of body

A

UMN

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29
Q

UMN vs LMN

Paralyzed MVMTS

A

UMN

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30
Q

UMN vs LMN

Paralyzed MUSCLES

A

LMN

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31
Q

SCI epidemiology

A
  • 6% first time admissions to hospitals
  • ~13,000 new SCI/yr
  • ~300,000 prevalence
  • most common cause: MVA,
    • falls, violence, sports
      • violence inc’ing!!!
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32
Q

Who is MOST vulnerable for SCI?

A

Young adult b/w 16-30—> risky behavior

NOTE: 4:1 ratio M:F

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33
Q

Racial disparity SCI

A

Blacks, Native-Am, Alaska native

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34
Q

Most common causes of death w/ SCI:

A

Respiratory

Sepsis

PE (blood clot in body comes loose into pulm aa system)

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35
Q

Where do MOST people go after SCI?

A

Private residence

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36
Q

CURRENTLY, what is the avg LOS for SCI

A

Acute== 11 days

IP Rehab== 34 days

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37
Q

SCI Costs:

A
  • 1st year medical costs w/ tetraplegia
    • ~$750,000-$1M
  • Annual medical costs
    • $15,000-$30,000/yr
  • Lifetime costs
    • $500,000- more than $3mil
      • severity
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38
Q

Mortality rates for SCI HIGHEST when?

A

1st year after injury

PNA, Septicemia

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39
Q

Explain an SCI: Complete Lesion

A
  • Complete Lesion
    • NO S or M function BELOW injury lvl
    • Complete transection…
      • compression or vascular impairment of cord
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40
Q

Explain SCI: Incomplete Lesion

A
  • Incomplete lesion
    • Sparing of some sensory/motor function
    • Contusion…
      • swelling in spinal canal or partial transection of cord
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41
Q

3 Common Incomplete SCI syndromes

A
  1. Anterior Cord
  2. Central Cord
  3. Posterior Cord
  4. Hemicord (aka Brown-Sequard)
  5. Conus Medullaris Syndrome (L1/L2 term end SC)
  6. Cauda Equina Syndrome (SCI, Horse’s Tail)
42
Q

Anterior Cord Syndrome

A
  • Most common incomplete syndrome***
  • Due to:
    • ​head on collision
    • blow to back of head
  • Common assoc’d fx:
    • ​Ant. Wedge fx
    • Fx of POST elements
      • SP, laminae, pedicles
43
Q

What would be 3 presentations of Anterior Cord Syndrome?

A
  • ​Loss of motor function
    • ​Dmg to corticospinal
  • ffLoss of pain and temp sensation
    • Dmg to spinothalamic
  • Proprio and kinesthesia intact!
    • ​DCML spared
44
Q

Neuro Flashback:

Corticospinal Tract

A

See attached photo

45
Q

Neuro Flashback:

DCML

A

See attached photo

46
Q

Neuro Flashback:

Spinothalamic (Anterolateral) Tract

A

See attached photo

47
Q

Central Cord Syndrome

Common w/…

A

Cervical hyperextension

48
Q

Central Cord Syndrome associated w/…

A

Narrowed vert. canal

  • common in OLDER adults due to spinal stenosis
49
Q

Central Cord syndrome Frequently caused by……

A

Rear end MVA

Fall in which chin strikes a stationary object

50
Q

Central Cord syndrome results in:

A

Edema and/or bleeding into the central grey matter of the cord

51
Q

3 Presentations of Central Cord Syndrome:

A
  • injury most often in cervical region
  • Loss of UE function w/ relative sparing of LEs
    • ​pts often ambulatory
    • INC risk of falls and injury from falls 2* to absent UE protective extension
    • diff. utilizing ADs
  • AKA “Walking Quad”
52
Q

Hemi-cord (Brown-Sequard) often caused by….

A

Penetrating wound to cord

53
Q

Prognosis for Hemi-cord (Brown Sequard)

Hemi==Half

A

*generally GOOD for regaining ambulation, hand and B&B function

54
Q

Presentation of Hemi-Cord Syndrome

*confusing, REMEMBER THIS!!!

A
  • IPSILATERAL LOSS of MOTOR function and Position sense
    • ​BELOW LVL OF LESION
    • Dmg to corticospinal AND DCML
  • CONTRALATERAL LOSS of Pain/Temp
    • ​begins a few lvls below lesion​
    • Dmg to spinothalamic-
      • ​Ascends ipsilaterally for a few segments BEFORE crossing
55
Q

Posterior cord syndrome is ____________

A

LESS common vs others

56
Q

Post cord syndrome USUALLY caused by___________

A

Compromise of Post spinal artery

*Often a long-term consequence of Tabes Dorsalis (untreated syphillis)

57
Q

Presentation of Posterior Cord syndrome: dmg primarily to what?

A
  • Dmg primarily to DCML
    • ​Loss of somatosensation BELOW lvl of injury
      • ​Can’t feel pos. of legs
        • Wide based gait
        • distal signs of Ataxia
          • ​Drunk Walking
58
Q

Explain Cauda Equina Syndrome

A
  • Below L1
  • NOT CNS injury
  • Results in LMN syndrome
  • ***Complete lesion is RARE because of # of nerve roots and the area they encompass
  • P.nerve–> so SOME poss. for REGEN
59
Q

3 MOI’s:

A
  1. Compression
  2. Shearing
  3. Distraction
60
Q

MOI: Compression

A

see attached photo

61
Q

MOI: Shearing

A

see attached photo

62
Q

MOI: Compression

***Burst Fx***

A
  • diving or football tackle
    • Axial blow to skull
    • Often coupled w/ FLEX INJURY
  • Leads to a Vertebral Burst Fx
    • ​Bony fragments enter cord and rupture IV disc
63
Q

MOI: Shearing

A
  • Horizontal Force applied to spine relative to an adjacent segment
  • Most common in T-spine
  • Results in Vertebral Fx and ligament damage
    • ​Think about it….
      • If it is most common in T-spine…T-spine is most common place for Vertebral fx’s
64
Q

MOI: Distraction

A
  • Think Whiplash!!!
  • LEAST common SCI
  • Longitudinal axonal shearing
65
Q

What is some Acute mgmt of SCI?

A
  • Pharmacologic
  • Sx realignment and stabilization
  • Prevention of 2* complications
66
Q

Primary damage in SCI

A
  • Trauma!!!
    • disrupted axons traversing injury site
67
Q

Secondary damage in SCI

A
  • inflammation
  • local infarction
    • ischemia, hypoxia
  • prevention of impulse transmission
    • Hemorrhage or edema
68
Q

Pharamcologic Mgmt for SCI: Methylprednisone

*strong anti-inflamms

What do they do???

A
  • DEC edema and compress ischemia
  • INC blood flow in the injured cord
    • prevents progressive post-traumatic ischemia
  • HIGH DOSES
    • ***MUST BE GIVEN W/IN 8 HRS OF ONSET OF INJURY!!!
69
Q

Surgical Mgmt SCI: what are 2 methods?

A
  • Surgical stabilization
    • ​stabilize spine
  • Sx decompression
    • ​recovery is INVERSELY RELATED to intensity and duration of compressive forces
      • ex. LOTS of compressive or high intensity compressive forces===SLOWER RECOVERY
70
Q

SX MGMT: SCI

Gardner-Wells Tongs

How are they used and where???

A
  • Used ACUTELY to provide TRACTION
    • ​DEC dislocation and maintain alignment
  • Inserted into SKULL w/ wts to provde traction
71
Q

Sx Mgmt: SCI

Internal Fixation

*Hardware

what is this and where is the STRONGEST site for it?

A
  • Fusion of unstable jts
  • Pedicle is the strongest site posteriorly for fixation
72
Q

NON-Sx Mgmt SCI

*Halo Traction

*exactly what it sounds like

Advantages?

A
  • Advantages Halo Traction
    • Early mobility
    • avoid/delay sx
73
Q

NON-SX mgmt SCI

*Orthoses

Explain…

A

May be used in lieu of sx, OR post-op to protect fusion site by limiting spinal mvmt

74
Q

Classification of SCI

3 Tools

A
  • American Spinal Injury Association Standardized
    • ASIA scale
      • ​MOST USED SCALE FOR SCI
  • S and M lvls tested bilaterally
  • Lvl of injury is represented by the MOST CAUDAL lvl w/ intact S and M function
75
Q

How is the Lvl of injury represented with an SCI?

A

Lvl of injury represented by most caudal (lowest) lvl w/ intact S and M function

76
Q

ASIA Scale Sensory testing based on……. and Grading???

A
  • Sensory testing based on 28 dermatomes
    • Light touch AND sharp/dull discrim
  • Grading:
    • 2= intact
    • 1= impaired
    • 0= absent
77
Q

ASIA Scale:

Motor Testing

A
  • Confounded by mult lvl innervation of mm’s
    • ​Mm tests may reflect function of 2 OR MORE cord segments******
  • MM tests are NOT the standard MMTs we reg. perform
  • To determine lvl of innervation….
    • ​tester looks for strength of 3/5 in one muscle, and AT LEAST 4/5 in the next ROSTRAL (superior) muscle
78
Q

ASIA Scale

Motor Testing

Determining lvl of innervation?

A

To determine lvl of innervation….

​tester looks for strength of 3/5 in one muscle, and AT LEAST 4/5 in the next ROSTRAL (superior) muscle

79
Q

ASIA Scale: Key Muscles

ID following:

C5-T1

L2-S1

A

C5: elbow flexion

C6: wrist extension

C7: elbow extension

C8: DIP flex of middle digit

T1: 5th digit ABD

L2: hip flexion

L3: Knee EXT

L4: ankle DF

L5: long toe EXT

S1: Ankle PF

80
Q

Explain Spinal Shock

3 common components:

A
  • Flaccid paralysis
  • Arreflexia
  • Sensory loss below lvl of lesion
  • Hrs to weeks, typ resolves w/in 24 hrs
    • early resolution==good
    • sepsis/malnutrition prolongs spinal shock
81
Q

Resolution of spinal shock indicated by what?

A

Return of bulbocavernosus reflex

82
Q

What is the Bulbocavernosus reflex?

A

Reflex contraction of anal sphincter in resp to pressure on glans penis or glans clitoris

83
Q

Although return of Bulbocavernosus reflex indicates end of spinal shock, what may it precede???

A

presence of DTRs or spasticity

84
Q

(+) reflex W/OUT later sensory or motor return====>

A

lesion is COMPLETE

85
Q

Severity of Injury class. SCI

A

Graded A thru E

86
Q

Severity of injury class.

Grade A ==

A
  • COMPLETE
    • NO MOTOR function is preserved in the sacral segments S4-S5
87
Q

Severity of Injury Class.

Grade B==

A
  • INCOMPLETE
    • SENSORY but NOT MOTOR function preserved below neurological lvl and includes sacral segments S4-S5
88
Q

Severity of Injury Class.

Grade C==

A
  • INCOMPLETE
    • MOTOR function preserved below neurological lvl, AND more than HALF of key mm’s below neuro lvl have a muscle grade LESS THAN 3
89
Q

Severity of Injury Class.

Grade D==

A
  • INCOMPLETE
    • MOTOR function is preserved below neuro lvl, AND at least HALF of key muscles below neuro lvl have a muscle grade of 3 OR MORE
90
Q

Severity of injury class.

Grade E==

A
  • NORMAL
    • Motor and Sensory function are normal
91
Q

ASIA Scale

Score guides, but does NOT dictate PT tx

Absence of fully functioning spinal lvl does not prevent attempt to strenghthen mm’s innvervated by that lvl

How do we still get improvements in strength?

A
  • Nerve Regen
  • Hypertrophy of remaining motor units
  • Improved motor control/learning
92
Q

Considering primary impairments w/ an SCI

Motor and Sensory lvls w/ resulting impairments and abilities

Based on EXPECTED lvl of function w/ ASIA A or B

A

NO MOTOR

93
Q

Considering primary impairments w/ an SCI

Motor and Sensory lvls w/ resulting impairments and abilities

Minimum expected lvl of function w/ ASIA C thru E

A

SOME Motor

94
Q

C1-C4 SCI

A
  • Active MM’s
    • Neck + Facial
    • Diaphragm to C4
  • Functional outcomes
    • Pt totally dependent, except power WC propulsion and pressure relief
    • No walking
95
Q

C5 SCI

A
  • Expected MM’s
    • C1-C4
    • biceps, brachialis, brachioradialis
    • deltoid
    • infrasp, subscap
  • Functional outcomes:
    • Min-assist w/ some ADLs, dependent bathing, standing dressing
    • No walking
96
Q

C6 SCI

A
  • Expected mm’s
    • C1-C5
    • ECR
    • Serratus Ant
  • Functional Outcomes
    • More independent w/ UE, min-Mod LE, independent grooming and eating
    • no walking
97
Q

C7-C8 SCI

A
  • Expected MM’s
    • C1-C6
    • triceps, FCU, finger extensors
    • finger flexors thru C8
  • Functional outcomes:
    • independent most ADLs, some min assist LE
    • no walking
98
Q

T1-T9 SCI

A
  • Expected MM’s
    • C1 to lvl of injury
    • Intrinsics hand
    • intercostals*** — breathing!!!
    • erector spinae***— posture!!!
    • abdominals to T6
  • Functional Outcomes
    • Independent all ADLs
    • walking not functional
99
Q

T10-L1 SCI

A
  • Expected MM’s
    • C1 to lvl of injury
    • intercostals, ext/int obliques
    • rectus abdominis
    • L1 partial hip flexor
  • Functional outcomes:
    • Independent all ADLs
    • walking functional; independent to min-assist
100
Q

L2-S5 SCI

A
  • Expected mm’s
    • C1-lvl of injury
    • Iliopsoas, QL, piriformis, obturators
  • Functional Outcomes
    • Independent all ADLs
    • Walking functional; independent to min-assist
101
Q
A

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