SCI Pt. 2 Flashcards
What levels are the sympathetic nervous system
T1-L1
What are the effects of the sympathetic nervous system
- Inc. HR and BP and blood flow to skeletal mm
- RELAXES bronchial mm
- (one would think it would contract them BUT if a bear was chasing you, you would want the mm to relax to increase O2 supply
At what spinal levels do you find the parasympathetic NS
Craniosacral
Which parasympathetic nerve is of primary interest
Vagus nerve
effects of the parasympathetic NS
- Dec. HR and contractility
- Inc. blood flow to smooth mm (rest and digest)
- contracts bronchial mm
What is the sympathetic effect in SCI T6 and above
dependent on level of injury (b/c it goes from T1-L1)
What is the parasympathetic effect in SCI T6 and above
remains intact and UNOPPOSED via the vagus nerve in injuries T6 and higher
Normally, sympathetic increases HR but what occurs when the sympathetic NS is no longer in tact?
therefore must rely on removing parasympathetic
What is the effect of relying on the parasympathetic removal to control heart response
- Limits cardiac output + shunting of blood from inactive active ones
- Blunting of heart rate often to only 110 -120bpm
What is autonomic dysreflexia caused by?
With what level of injury does it occur?
caused by massive sympathetic discharge from a noxious or non-noxious stimuli below level of SCI (with injuries above T6)
Autonomic dysreflexia S&S
- Increase BP of 20-30mmHg from normal
- bradycardia
- severe headache
- blurred vision
- feeling of anxiety or impending doom
- dilated pupils
- flushing, sweating skin above level of injury
- cool, dry, pale skin (d/t vasoconstriction) below level of injury
- penile erection
Common causes of autonomic dysreflexia
- urinary or colon irritation (full bladder, UTI, kink in catheter)
- wound, painful stim
- tight clothing
- sex, pregnancy and labor
- diagnostic or therapeutic interventions
Rx + prevention of autonomic dysreflexia?
- place client in upright position!
- remove noxious stim/triggers, if necessary use antihypertensive drugs
- good bladder and bowel routines
- skin care, nail care
What is orthostatic hypotensioni
Sudden drop of 20mmHg systolic BP or 10mmHg diastolic BP upon changing positions
Orthostatic Hypotension S&S
o Asymptomatic
o Dizziness, fainting
o Light headedness
o Headache
Orthostatic Hypotension Rx
o mobilize slowly w/ therapy
o use compression stocking or binders
4 Health Risks with SCI
- DVT & Pulmonary embolism
- Heterotrophic ossification
- Osteoporosis
- Post traumatic Syringomyelia
What is DVT + Pulmonary embolism with SCI caused by
Venous stasis
Transient hypercoaguable state
DVT + Pulmonary embolism with SCI Signs
Sudden LE swelling + increase in temp
DVT +Pulmonary embolism with SCI prevention
- Anticoagulation meds
- Compression stockings
- Sequential compression devices
- PROM/AROM
- Early mobilization
Heterotrophic ossification w/ SCI S&S
- Pain (if sensory sparing)
- INc. spasticity
- warmth, low grade fever
- erythema
- local swelling
- sudden decrease in ROM with an abnormal firm or hard end-feel
Heterotrophic ossification w/ SCI Rx
+ 2 main contraindication for Rx
- PROM within tolerable range- mobilize as able
- Meds
- Surgery if long standing
Contraindications:
are forced PROM and serial casting
What causes OP in SCI
rapid increase calcium excretion within few days of SCI
What is Post Traumatic Syringomyelia
Formation of an abnormal tubular cavity in the spinal cord
What occurs with post Traumatic Syringomyelia
- dura tethers/scars to the arachnoid blocking CSF flow
- CSF is forced into the spinal cord progressively enlarging the cyst
- Leads to compression of cord + vascular supply
Does post Traumatic Syringomyelia only occur immediately following injury
No, can occur years after the original injury
post Traumatic Syringomyelia S&S
- pain at level and spreading upwards
- sensory changes
- motor weakness
- Inc. spasticity
- B&B dysfunction
- Inc. autonomic dysreflexia,
- hyperhidrosis
post Traumatic Syringomyelia Rx
Surgery - decompression or shunt
2 tests for spasticity
Modified Ashworth + Tardieu
What is spasticity
Velocity dependent resistance to passive stretch
Spasticity clinic characteristics
- Increased mm tone/firmness
- Increased stretch reflexes
- uncontrolled movements
Spasticity Pros
- maintain muscle bulk, venous return, useful for transfers, moving limbs
- reflex erection can be achieved
- acts as warning sign
Spasticity cons
o Lead to contractures
o Possibly painful
o Positioning difficulties
o Fatigue
Spasticity Rx
Meds: Intrathecal bacleonfen (makes muscles weak as well) and botox (for more local use)
Therapeutic exercise
Injuries of what level result in a spastic bladder
Above the conus
What are the implications of a spastic bladder?
How does emptying occur
- messages will continue to travel btw bladder and spinal cord since reflex arc is still intact
- may be triggered by “tapping”
- bladder can be trained to empty on its own
- bladder management: either intermittent catheters or condom/Foley drainage
Injuries of what level result in a flaccid bladder
In conus and cauda equina injuries
What are the implications of a flaccid bladder?
How does emptying occu
- messages don’t travel btw spinal cord and bladder since the reflex center is damaged
- bladder loses ability to empty reflexively
- bladder will continue to fill AND must be catheterized
Are peristalsis and reflex propulsion still intact in a spastic bowel?
Yes
What causes stool retention in a spastic bowel
Reflex contraction of sphincter
How do you void with a spastic bowel
need suppository or/& digital stim within anus for voiding- can be trained
Are peristalsis and reflex propulsion still intact in a flaccid bowel
not intact
Flaccid bowel: slow or fast stool propulsion?
slow
Risk of incontinence with a flaccid bowel?
yes
What are the implications of a SCI above t12 for sexual health?
Reflex and spontaneous erection, no ejaculation, fertility reduced
What are the implications of a SCI below t12 for sexual health?
psychogenic erection possible, reflex erection/ejaculation not possible
3 types of pain experienced by people with SCI
Neuropathic pain
nociceptive pain
Chronic pain
What causes neuropathic pain?
What are some descriptive words for its sensation?
Does this pain change with position changes?
Rx?
- Damage to nervous system
- Stabbing, burning, electric
- Normally not changed by position or activity
- Rx - Medications
What causes Nociceptive pain?
What are some descriptive words for its sensation?
Does this pain change with position changes?
Rx?
- Damage to viscera or MSK
- Dull, crampy, achy
- Yes
- Physical modalities, soft tissue, therapeutic exercise, education on posture + aggravating positions
What is Chronic pain?
Common in SCI?
Rx?
Pain lasting longer than 3mths
Yes, 2/3 of SCI have chronic pain
Interdisciplenary team, education, appropriate exercise
What are some causes of wounds in SCI Pts
- pressure, sheering, friction, deep tissue damage from banging and bumping
- Sitting, lying high pressure areas
What are some points to include in wound descriptions
o Location o Size o Wound base/edge o Surrounding skin o Stage photos
How are wounds prevented in SCI
o regular skin checks o change position regularly o skin care o exercise and eating well for skin health o no smoking
What are some important considerations for Exercise in SCI
Decreased sympathetic impact: HR + BP will not have normal responses (levels will be relative to before exercise)
Watch for orthostatic hypotension
How should you measure exertion during exercise for those with SCI
RPE and BORG
HR not reliable
What occurs to respiration with SCI?
Where is ideal length/tension relationship of the diaphragm
- paradoxical breathing
- vital capacity dec. from supine to sitting
- Dec. all lung volumes except residual volume
•ideal length/tension relationship of diaphragm occurs in lying
What is the major cause of death among SCI Pts surviving 30+ years
CVD
Atrophy of which part of the heart is seen in SCI
Left ventricular myocardial atrophy
100x higher rate of which type of cancer in people with SCI
bladder cancer
