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PCE - Neurology > SCI Pt. 1 > Flashcards

SCI Pt. 1 Flashcards

1
Q

The majority of traumatic SCI injuries result in ______

A

Quadriplegia

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2
Q

The majority of non-traumatic SCI injuries result in _____

A

Paraplegia

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3
Q

What are some causes of non-traumatic SCI

A 
Cancer
Infection + Inflammation 
Motor neuron disorders 
Vascular diseases
Congenital
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4
Q

4 goals of early management for SCI

A

o spinal stability
o limiting neurological deficit and promote recovery
o minimize complications
o create environment for spinal column to heal

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5
Q

When is surgery warranted for a SCI

A

o unstable # or soft tissue injury,

o neuro symptoms getting worse

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6
Q

What is myelopathy

A

refers to pathology of the spinal cord - when due to trauma, it is known as spinal cord injury

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7
Q

What is a lumbar laminectomy

A

Surgery that helps to decompress the cauda equine/roots by removing portions of the lamina

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8
Q

What do you want maintain MAP as following SCI

A

80-100 mmHg

because the ANS is interrupted regulation of BP, temp, and HR is altered:
- if patient has fever make sure it’s not due to sepsis or other injuries

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9
Q

Why is it important to moinitor BP, temp and HR following SCI

A

because the ANS is interrupted regulation of BP, temp, and HR is altered:
- if patient has fever make sure it’s not due to sepsis or other injuries

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10
Q

2 forms of shock following SCI

A

Spinal shock

Neurogenic shock

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11
Q

What is spinal shock?
How long can it last?
Symptoms?

A
  • temporary suppression of all reflex activity below level of injury
  • can last weeks to months
  • SYMPTOMS
    i. areflexia
    ii. flaccid paralysis below level of lesion
    iii. loss of sensation below level of lesion
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12
Q

What marks the beginning of spinal resolution in spinal shock

A

the return of sacral reflexes

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13
Q

What is neurogenic shock?
When does it occur?
Symptoms?

A
  • body’s reaction to sudden loss of sympathetic control
  • occurs with injuries above T6
  • SYMPTOMS:
    i. decreased vasomotor tone = hypotension & hypothermia despite normal blood volume
    ii. bradycardia (because of unopposed vagal stimulation of heart)
    iii. can lead to metabolic issues
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14
Q

What does spine unstable mean?
Is there risk of additional injury?
What are the necessary precautions with these patients?

A
  • column is assumed unstable
  • +/- neuro deficits
  • definite risk for additional injury

Pt must:

  • maintain neutral spine at all times
  • bed rest
  • HOB at zero degrees
  • 2-3 person turns at all times
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15
Q

What does spine stable but requires protection mean?

What are the necessary precautions with these patients?

What can the patient do independently?

What begins at this point?

A
  • confirmed spinal column
  • +/- neuro deficits
  • Pt must maintain neutral spine at all times
  • Pt can turn independent with neutral alignment
  • mob and rehab begins
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16
Q

What does spine stable but requires protection mean?

What can the patient do independently?

What must be monitored closely when first mobilizing?

A
  • injury decided stable by surgeon
  • patient may do all movements of spine within comfort limits
  • Pt may be taught to log roll with neutral spine
  • watch for changes in BP when first mobilizing
  • may use stockings, binders, or meds to help with postural hypotension**
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17
Q

Explain the ASIA scale

A

International standard for neurological classification of SCI
A= Complete. No motor of sensory function is preserved in the sacral segments S4-S5
B= Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5
C = Incomplete. Motor function is preserved below the neurological level and more than of key muscles below the neurological level have a muscle grade less than 3
D = Incomplete. Motor function is preserved below the neurological level and at least half of key muscles below the neurological level have a muscle grade of 3 or more
E = Normal: Motor and sensory function are normal

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18
Q

What is the normal reference for dermatomes

A

skin on cheek

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19
Q

What is tested on each point for dermatomes

A

light touch and pin prick

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20
Q

How many dermatomes are there

A

28

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21
Q

What are the grades for light touch

A
  • Grade 0: absent
  • Grade 1: altered, including hyperesthesia
  • Grade 2: Pt normal
  • NT = not tested
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22
Q

what are the response options for pin prick

A

Normal
Impaired (different from reference point)
Absent (unable to differentiate)

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23
Q

How do you test Sacral sensory

A

deep anal pressure

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24
Q

What does a present Deep anal pressure mean

A

Pt has a sensory incomplete injury ASIA B

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25
Q

Sacral sensory is classified as…

A

present or absent

26
Q

How many myotomes are there

A

10 bilateral (20 total)

27
Q

How do you test myotomes

A

start with grade 3 and watch for compensation

- grade 4 and 5 = static hold in a shortened position

28
Q

How do you test sacral motor

A

voluntary anal contraction

29
Q

If voluntary anal contraction is present what does this indicate

A

Motor incomplete (ASIA C)

30
Q

How do you grade sacral motor

A

absent or present

31
Q

What is the level of lesion defined as?

What is the sensory level defined as?

What is the motor level defined as?

A

the most caudal segment with normal sensory and motor function on both sides of body

most caudal segment w/ bilateral score of 2 for both light touch and pin prick

most caudal segment with a grade greater than or equal to 3 provided ALL segments above are grade 5

32
Q

What is an indicator of good prognosis of motor function to return and ability to walk

A

Pinprick preservation (LE and sacral) within 72 hours

33
Q

Clinical presentation of complete sci

A
  • no sensory or motor function is preserved in the sacral segments S4-S5
  • may be dermatomes below the sensory level and myotomes below the motor level that remain partially innervated: The Zone of Partial Preservation
  • the most caudal segment with some sensory defines extent of ZPP (within 3 segments below injury)
34
Q

What is the zone of partial preservation

A

dermatomes below the sensory level and myotomes below the motor level that remain partially innervated

35
Q

Clinical presentation of anterior cord syndrome

A
  • loss of motor function (weakness at or below depending on location)
  • bilateral loss of pain and temperature below level of the lesion
  • dorsal column is spared (i.e. kinesthesia, proprioception, vibration)
36
Q

Clinical presentation of posterior cord syndrome

A
  • Loss of vibration and proprioception below level of lesion

- Vitamin B12 deficiency

37
Q

Clinical presentation of central cord syndrome?

What is it often associated with

A
  • most common syndrome, generally in hyperextension injuries
  • upper motor and sensory function more impaired than LE
  • often associated with spinal canal stenosis
38
Q

Clinical presentation of Brown sequard syndroms

MOI?

A
  • One side of cord more damaged than the other
  • IPSILATERAL loss of motor function and dorsal column function (vibration, proprioception) because they cross in medulla
  • CONTRALATERAL loss of pain and temperature sensation a few levels below the lesion

hemi-section with stab wound, tumor, etc.

39
Q

Clinical presentation of cauda equina syndrome

A

o more LMN lesion

o areflexive and flaccid bladder and bowel

40
Q

At one level does the SC terminate?

A

L1-L2

41
Q

What is conus medullaris? what can it affect?

A

o injuries at conus  can affect both conus and root resulting in a varied neuro picture

Mixture of UM and LMNL

42
Q

What information travels via the Lateral spinothalamic tract

A

Pain and temp

43
Q

What information travels via the anterior spinothalamic tract

A

Crude touch + pressure

44
Q

What information travels via the dorsal columns

A

Fine touch
Stereognosis
Vibration

45
Q

What information travels via the Lateral corticospinal tract

A

the 90% that cross in the pyramid motor

46
Q

What information travels via the anterior corticospinal tract

A

the 10% cross at the level of innervations motor

47
Q

How does cough function vary depending where spinal lesion is

A

o C1-C3 absent, C4-T1 nonfunctional, T2-T4 poor, T5-T10 weak, T11 and below is normal

48
Q

What level is needed for patients to breath independently

A

C4

49
Q

What level of lesion is needed for normal vital capacity

A

T11

50
Q

What levels innervate accesssory mm of breathing

A

C2-C7

51
Q

What levels innervate diaphragm

A

C3-C5

52
Q

What levels innervate intercostals

A

T1-T11

53
Q

What levels innervate abdominals

A

T6-L1

54
Q

C1-C4 SCI:

  • Patterns of weakness:
  • Possible movements:
  • Role of PT
  • Major mm innervated full and partial
A

o Patterns of weakness: paralysis of trunk and UE, probably diaphragm

o Possible movements: neck movements, slight shoulder retraction and adduction

Role of PT: ROM, spasticity management, neck strengthening, chest physio, prevent contractures

Major mm innervated:
o FULL:
- C1-C3 SCM, neck extensors, neck flexors
- C2-C4 traps
o PARTIAL:
- C3-C5 Lev scap, diaphragm, supraspinatus, infraspinatus
- C4-C5 rhomboids

55
Q

C5 SCI :

  • Patterns of weakness:
  • Possible movements:
  • Role of PT
  • Major mm innervated full and partial
  • Hand function
A

Patterns of weakness

  • sig imbalance around shoulder girdle
  • absence of elbow ext, wrist pronation, ext, flex or any hand/finger movement

Possible mvmt
- shoulder abd, flex, ext, elbow flexion and supination, scapular add and abd

Major mm innervated:

  • FULL:
    • all of the C4 mm plus diaphragm, rhomboids (C4-5 dorsal scapular), levator scapula (C3-4 and dorsal scapular)
  • PARTIAL:
    • Deltoid, biceps, brachioradialis, teres minor (C5-6)
    • at risk of contracture because of unopposed antagonist

Hand function: use wrist splints and universal cuffs
- may be able to use tenodesis grip with forearm supination and pronation to achieve wrist flexion and extension

56
Q

C6 SCI :

  • Patterns of weakness:
  • Possible movements:
  • Role of PT
A

• FIRST LEVEL OF SCI to have potential to live in community w/o care

Patterns of weakness: no wrist flexion, elbow ext, hand movement

Possible mvmt
- radial wrist ext, some horizontal adduction
- can extend elbow in some positions using ER of shoulder
- have tenodesis grip which permits a weak grasp w/o any hand mm
• Slide board transfer possible, manual W/C possible

PT role:

  • maximize strength for transfer to functional tasks, teach “trick” mvmt strategies, ROM and stretching, prescribe equipment
  • lats, serratus, and pecs allow weight bearing through extremity and appropriate hamstring length will allow them to sit upright and free up hands
57
Q

C7-C8 SCI:

  • Patterns of weakness
  • movement possible
  • Hand function
A

Patterns of weakness: limited grasp and release dexterity d/t lack of intrinsic mm of hand

Mvmt possible

  • elbow ext (C7), wrist ext, DIP/PIP flex, MP flex (C8)
  • Triceps allow independent transfers, manual W/C, independent with most/all ADL’s

Hand function
C7
-Uses more of the tenodesis grip
C8
- Have more finger flexors
- gives finger and thumb flexors (which are weak) and no lumbricals
-can get more hand function but fine motor control is still hard

58
Q

Clinical presentation of T1-T9 SCI

A
  • intact UE function, mainly use W/C * living primarily in community*
  • respiratory function compromised above T6
  • can have spasticity in trunk that is worse the higher the lesion level
  • can stand in standing frame
59
Q

Clinical presentation of T10-L1 SCI

A
  • respiratory function is intact, cough is normal
  • community dwelling
  • IND
  • limited ambulation may be possible with bracing
60
Q

Clinical presentation of L2-L5 SCI

A
  • intact trunk
  • sparing of LE muscles allows for potential of functional walking
  • need brace and grade 3 quads to walk w/o KAFO
  • cauda equina = hidden disability, a reflexive bladder and bowl and flaccid paralysis

PCE - Neurology (8 decks)

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