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Physical Conditions > SCI- Spinal Cord Injury > Flashcards

SCI- Spinal Cord Injury Flashcards

1
Q

True or false

SC receives afferent (sensory) info

Motor cortex transmits descending info- efferent (motor) in back to the peripheral NS

Vertebral column protects SC

A

True

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2
Q

How many vertebrae’s do we have?

A

33

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3
Q

How many pairs of spinal nerves exit SC to form PNS?

A

31

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4
Q

Spinal nerves C1-C7 exit above or below vertebrae?

A

Above

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5
Q

Spinal nerves C8-S5 exit above or below vertebrae?

A

Below

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6
Q

What is SC gray matter?

A

Located centrally

Cell bodies

Synapses

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7
Q

What is SC white matter?

A

Contains ascending and descending pathways

Periphery of SC

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8
Q

What is the leading cause of SCI in the US?

A

Motor vehicle accidents

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9
Q

What are other causes of SCI?

A

Falls/ acts of violence (gunshot wounds)

Sports related- diving (most common)

Spina bifida (nontraumatic cause)
- congenital neural tube dysfunction

Bacterial/ viral infections can damage SC tissue

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10
Q

What are the 2 major classifications of SCI?

A

Complete

Incomplete

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11
Q

What is complete SCI?

A

Cord completely transected

All ascending and descending pathways interrupted

Total loss of motor and sensory function below the level of injury

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12
Q

What is incomplete SCI?

A

Cord NOT completely transected

Some degree of voluntary movement or sensation below level of injury

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13
Q

Can upper motor neuron (UMN) and lower motor neuron (LMN) injuries be either complete or incomplete?

A

Yes

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14
Q

True or false

Anterior horn to muscle = LMN (lower motor neuron)

A

True

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15
Q

True or false

Brain to spinal cold to anterior horn = UMN (upper motor neuron)

A

True

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16
Q

What is anterior cord syndrome?

A

Loss of motor function below level of injury

Loss of thermal, pain, and tactile sensation below level of injury

Retain light touch and proprioception

Incomplete injury

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17
Q

What is Brown-Sequard’s Syndrome?

A

One side of SC damage

Often results from a penetrating wound (gunshot or stab wound)

Incomplete Injury

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18
Q

What are clinical signs of Brown-Sequard’s Syndrome?

A

Ipsilateral of motor function below level of injury

Ipsilateral reduction of deep touch and proprioceptive awareness

Contralateral loss of pain, temp and touch

incomplete injury

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19
Q

What is a central cervical cord syndrome?

A

More impairment in neural fibers serving UEs (compared to LEs)

Often occurs with structural changes to the vertebrae

Arthiritic changes can lead to spinal canal narrowing

Syndrome prevalent in aging pop

incomplete injury

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20
Q

What are clinical signs of central cervical cord syndrome?

A

Motor and sensory functions in the lower extremities less involved than in upper extremities

Improvement in intrinsic hand function are generally evidenced last, if at all

A potential for flaccid paralysis of the upper extremities, as the anterior horn cells in the cervical spinal cord may be damaged b/c synapses for motor pathways, an LMN injury may result

21
Q

What is a cauda equina injury?

A

Without injury to SC

Injury to nerve roots/ spinal nerves

Direct trauma most common use

incomplete injury

22
Q

What are clinical signs of cauda equina injury?

A

Loss of motor function and sensation below the level of injury

Absence of a reflex arc, as the transmission of impulses through the spinal nerves to their synapse point is interrupted

Motor paralysis is of the LMN type, with flaccidity and muscle atrophy seen below the level of injury. Bowel and bladder function are also a-reflexic

some chance for nerve regeneration and recovery of function if the roots are not too severely damaged or divided

23
Q

What is a conus medullaries injury?

A

Similar to cauda equina injury

incomplete injury

24
Q

What are clinical signs for conus medullaries injury?

A

Loss of motor function and sensation below the level of injury, although typically not severe

Absence of a reflex arc, as the transmission of impulses through the spinal nerves to their synapse point is interrupted

Motor paralysis is of the LMN type, with flaccidity and muscle atrophy seen below the level of injury

Bowel and bladder incontinence and sexual dysfunction are typically more severe than cauda equina injuries

25
Q

Complete and incomplete is quadriplegia, tetraplegia or paraplegia?

A

All

26
Q

How long is the average length of stay in acute care for SCI?

A

12 days

27
Q

After the average length of stay in acute care what is next?

A

Transfer to inpatient rehab

Depending on other complications

28
Q

What is the therapists primary role in acute care?

A

Preserving ROM

Vital sign stability during functional mobility

Acute care addresses life threatening issues by stabilizing medical status

29
Q

What are some post traumatic complications?

A

Spinal shock (altered reflex activity)

Catherization

Foley (indwelling catheter)

Increase in spasticity (flexor) after spinal shock subsides- reflex arc fires

6-12 months after jury, increased spasticity may occur in the extensors

1 yr post tone fluctuations cease

30
Q

What is Spinal shock (altered reflex activity)?

A

Spinal cord segments below level of injury deprived of excitatory input from higher CNS centers

Flaccid paralysis below level of injury

Absence of reflexes

31
Q

Foley (indwelling catheter)?

A

Bladder may be flaccid

32
Q

How long does spinal shock generally last?

A

1-3 months post injury

33
Q

What are some respiratory conditions?

A

Injuries below T12 usually have normal respiratory status

Above T12 can have some level of compromise

Complete injuries above C4 require a respirator- may be candidate for a phrenic nerve stimulator (diaphragm pacing)

C4 and below:

  • breathing may be shallow
  • productive cough may be compromised
  • MOST COMMON CAUSE OF DEATH AFTER SCI
34
Q

What is autonomic dysreflexia (hyperreflexia)?

A

Exaggerated response of the autonomic nervous system (flight or fight)

Occurs in people with injury above T6

Signs include:

  • intense headache
  • diaphoresis
  • flushing
  • goosebumps
  • tachycardia followed by bradycardia
  • dramatic increase BP

What can trigger this response?

  • full bladder/ bowl
  • UTI
  • decubitus ulcers

Upright position helps decrease BP

35
Q

What is postural hypotension/ orthostatic hypotension?

A

Decrease BP

Often seen in people with cervical or thoracic SCI

Blood tends to pool in legs

Symptoms include:

  • light headed
  • dizziness
  • pallor
  • sudden weakness
  • unresponsiveness

Prevention measures:

  • antiembolism hosiery
  • abdominal binders
  • slow positional change to upright position
  • maintain semi reclined position until symptoms subside
36
Q

What are potential complications and signs of deep vein thrombosis (DVT)?

A

Potential complication in SCI due to:

  • reduced circulation
  • direct trauma to legs causing vascular damage
  • prolonged bed rest

Signs include:

  • swelling in legs
  • localized redness
  • low grade fever

Greatest risk period first 2 weeks post injury

37
Q

What is thermal regulation?

A

Function of RNS

Difficulty maintaining body temp- injuries above T6

Body tends to assume temp of external environment (Poikilothermia)

Extreme temp difficult

  • lack of blood vessel constriction below injury level to conserve heat
  • excessive sweating above injury level, but not below
38
Q

What is musculoskeletal issues of spasticity?

A

UMN lesions increased tone following spinal shock

Increased spasticity can be triggered by infections, pressure stores, UTI, emotional state

Spasms can be advantageous to maintain muscle bulk circulation, bowel and bladder transfers

Excessive spasticity can lead to contractures, pain and reduced function

39
Q

What is musculoskeletal issues of heterotopic ossification (ectopic bone)?

A

Abnormal formation of bone deposits on muscles, joints and tendons

Most often occurs at the hip and knee (followed by shoulder and elbow)

Clinical signs of HO include:

  • heat
  • pain
  • swelling
  • decrease in active or passive ROM
40
Q

What is a genitourinary complications?

A

UTI common and dangerous complication

Nature of bladder function dependent on injury causing LMN or UMN deficits

41
Q

What is a UMN bladder in genitourinary complications?

A

Spastic bladder

Bladder can contract and void reflexively

May be able to trigger

Must have voiding schedule since cannot sense when bladder is full

42
Q

What is a LMN bladder in genitourinary complications?

A

Flaccid bladder

May continue after spinal shock if injury to cauda equina

No reflex arc so no spontaneous emptying

Schedule catherization

External abdominal pressure with fist- Credé’s maneuver

Glottic closure and abdominal muscle contraction- Valsalva maneuver

43
Q

What are UTI signs of genitourinary complications?

A

Cloudy urine

Particles in urine

Dark/ foul smelling urine

Fever

Chills

Increased spasticity

44
Q

What are bowel complications?

A

May be spastic or flaccid

Spastic may use reflexive elimination techniques

Must follow bowel schedule

Flaccid bowel cannot be stimulated reflexively- may require manual removal of stool prevent impaction

Constipation or impaction may trigger autonomic dysreflexia in people with SCI above T6

Diarrhea is problematic

  • avoid overuse of laxatives
  • proper diet
  • adequate hydration
  • bowel schedule
45
Q

What are dermal complications?

A

Pain and temp and potential skin damage not sensed below level of injury

Danger of pressure sores

  • major reason for hospital admissions
  • impaired circulation

Preventable

  • visual inspection (2x a day)
  • areas prone to breakdown sacrum, ischium, calcaneous, scapula
  • proper nutrition
  • attention to environment
46
Q

What are some mental health challenges in SCI?

A

High rate of depression

Depression can lead to

  • pressure ulcers
  • decreased occupational performance

Signs include:

  • disinterest
  • feeling worthless
  • fatigue
  • changes in weight and appetite
  • suicidal ideation
47
Q

What are medical/ surgical management for SCI?

A

Immobilize with backboard/ neck brace

Decompress, realign and stabilize SC

Laminectomy

Spinal fusion

Throacolumbosacral orthosis (TLSO) “clamshell”

“Halo” orthosis (most restrictive cervical device)

Steroids

Therapeutic hypothermia

Stem cells

Epidural stimulation

Functional electric stimulation

Assisted movement/ enhanced (AMES) tech

48
Q

What does SCI impact on occupational performance?

A

Grooming/ dressing

Driving

Employment/ work roles

Bladder/ bowl elimination

Feeding/ meal prep

Social relationships

Sexual expression

Home maintenance

Education

Leisure pursuits

Pet care

Family roles

Physical Conditions (14 decks)

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