Spinal cord Flashcards
central cord syndrome
what is it?
sentence?
resulting from hyperextension injuries and presenting as more UE than LE defecits
-Conor hyper-extended my elbow shooting a basketball which caused his arm to break but he was still able to run down court
Brown Sequard syndrome
what is it?
semtence?
ipsilateral paralysis, ipsilateral loss of position sense (proprioception), ipsilateral loss of discriminative touch, contralateral loss of pain, contralateral loss of thermal
sense
-bobby got hit by a car on his left side in which he previously had paralysis from a stroke he experienced loss of proprioception, and loss of discriminitive touch on the same side after he was hit, his wife was also hit in the accident and she was in extreme pain and couldn’t tell the temp outside
Anterior cord syndrome
what is it?
sentence?
caused by flexion injuries, motor function, pain, pinprick, and temperature sensation are lost bilaterally below the lesion while proprioception and light touch are stored
- Andrew was performing tricep curls (flexion exercises) and all of the sudden he could not move his arm he was experiencing pain, pinprick, and temperture sensation due to nerve damage in both arms. He used proprioception and light touch to determine where his hands were and which weights to use rubber or metal
Posterior cord syndrome
What is it?
sentence?
Proprioception is lost. Pain, temperature and touch is preserved. motor function is preserved to varying degrees.
P always smoked but never lost proprioception, he used previous pain he experienced, temperature, and touch from his girl to cope and get through the day
Conus medullaris
what is it?
sentence?
lower extremity motor and sensory loss, and an areflexic bowel and bladder
grandma is getting old and stated she can’t walk or feel her legs
Cauda equina syndrome
whats is it?
flaccid paralysis with no spinal reflex activity, an areflexic bowel and bladder
Autonomic dyreflexia
what is it?
what is the initial action?
an abnormal response to a noxious stimuli that results in an extreme rise in blood pressure, pounding headache, and profuse sweating could be deemed a medical emergency
client should be placed upright, restrictive clothing should be removed, and the bladder should be voided (or catheter tubing checked for obstruction).
Spina Bifida myelomeningocele?
what is it?
sensory and motor deficits occurring below the lesion and may result in lower extremity paralysis and deformities, bowel and bladder incontinence and debicutis ulcer and deep vein thrombosis
C5 spinal cord injury
movements?
splint?
Pt. can eat independent after set up with AE -Movements possible: Shoulder, flexion, abduction, extension. Elbow flexion, supination. Scapular adduction, abduction.
-Wrist splint in a
functional position with
a slot to hold a typing
stick
C6-C7 spinal cord injury
movements?
splint?
Pt. becomes MI-I for UB bathing, UB dressing, grooming, feeding etc with C6 tenodesis movements-Scapular protraction (partial horizontal adduction). Forearm supination. Radial wrist extension. C7: Elbow extension Ulnar/wrist extension. Finger extensions. Thumb flexion, extension & abduction
Tenodesis splint. c6
(wrist driven flexor
hinge splint during a
prehension activity).
C1 – C3 movements possible? necessity? patterns of weakness? Functional potential ADL's? Adaptive equipment name 10?
-neck flexion, extension and rotation
-Complete paralysis of trunk, upper &lower extremities
Limited head and neck control
No motor innervations to diaphragm; ventilator dependent
-Dependent for all ADLs. Focus of rehabilitation should be on
education for verbalization of care, caregiver training
maintaining ROM,
assistive technology needs
positioning and respiratory care.
-total assist with bed mobility, w/c transfers, transportation etc.
Ventilator supports: suction equipment. generator/battery backup, vent tray
Bathing: padded reclining shower/commode chair
Postural support devices: electric hospital bed w. side rails, specialty bed/pressure relief mattress, power/mechanical lift w/sling
Wheelchair: power recline/tilt w/c, w/c pressure relief cushion, postural support/head control devices, transfer board. Can operate electric w/c using head control, mouth stick, or chin control
Computer access: Integra Mouse with sip/puff select (can operate with tongue or lips), morse code with switch operated by tongue, eye movement or other facial muscles, single switch scanning, limited voice recognition for commands and using macros/shortcuts, eye gaze t
C4 movements possible? patterns of weakness? Functional potential ADL's? Adaptive equipment?
Inspiration
Neck flexion, extension and rotation
Scapular elevation
-Paralysis of trunk, upper &lower extremities
Inability to cough
Low endurance/respiratory reserves
- may be able breathe without a ventilator. Ventilator weaning and increased voluntary motor control of diaphragm, head, and neck.
Total assistance for all ADL’s can provide instructions on all aspects of care
-Power W/C propulsion: independent
Pressure relief/positioning: total assist (independent w/ equipment)
-Manual w/c, transfers, transportation etc. total assistance
-Ventilator supports: ventilators as required, generator/battery backup as needed, vent tray
Wheelchair: power recline/tilt w/c, w/c pressure relief cushion, postural support/head control devices, sip-n- puff, head switches, voice-control technology to operate power wheelchair, transfer board
Bathing: reclining shower/commode chair
Postural support devices: electric hospital bed w/ side rails, specialty bed/pressure relief mattress, tilt table, hydraulic standing table, power/mechanical lift w/sling
Other: call systems, environment controls, mouthstick for page turning and computer operation with use of lap trays, book holders, and mouthstick docking stations.
Computer access: Mouthstick and holder/mini keyboard, trackball mounted at chin, onscreen Keyboard, separate switch and interface for L/R click (operated by sip/puff, cheek, shoulder shrug, eye movement, mouse devices designed to be mounted at chin, mouth, “Hover” or “dwell” software for automatic selection of icons/controls, single or double switch scanning, morse code/switch activation, voice recognition
C5
movements possible?
patterns of weakness?
Functional potential ADL’s
Shoulder, flexion, abduction, extension
Elbow flexion, supination
Scapular adduction, abduction
-Absent elbow extension, pronation, all wrist/hand movement
Complete paralysis of trunk, lower extremities
-Respiratory low endurance
total assist for setup, I eating using AE
Grooming total A to min A/ using AE
total A in all other ADL’s and functional activities
-bed mobility: some assistance
w/c to bed transfers total assistance
Manual W/C propulsion: May have strength to push a manual w/c for short distances over smooth surfaces.
Power W/C propulsion: With hand controls for daily activities.
Pressure relief/positioning: Leaning forward or side-to-side
Transportation: independent w/ specialized equipment, some assist w/ public transportation, total assist for attendant operated vehicle. Driving may be possible
Eating- modified I with mobile arm support
Writing- modified I with typing stick
-Wheelchair: power recline/tilt w/c, transfer board
Postural support devices: w/c pressure relief cushion, power/mechanical lift, specialty bed/pressure relief mattress, electric hospital bed w/ cx controls, side rails, hydraulic standing table
Bathing: Padded shower/commode chair
Day (wrist cock up) and night (intrinsic plus) splints needed.
U-cuff with right angle pocket for feeding, long straw, plate guard, mobile arm support or offset feeder, long wanchik brace for writing, cadeusus stylus or stylus in u-cuff, with proper setup of phone or tablet on lap tray or clasp on holder.
Air splints to maintain elbow extension for home exercise program for increasing shoulder/scapula strength.
Computer Access: Typing aids (with/without wrist support), mouthstick as back up, or if UE pain is present, mini-keyboard, laptray, trackball/joystick/touchpad for mouse movement, separate switch and interface for L/R click, keyboard shortcuts (StickyKeys, Hotkeys, etc.), word prediction/completion software for rate enhancement, voice recognition for ease and e
C6
movements poossible?
patterns of weakness?
Functional potential ADL’s
Scapular protraction (partial horizontal adduction)
Forearm supination
Radial wrist extension
Absent wrist flexion, elbow extension, hand movement
Complete paralysis of trunk, lower extremities
tenodesis grasp pattern to pick up and handle objects.
Respiratory function: low endurance/vital capacity, may be unable to clear secretions
Standing: total assist
Feeding: modified independent/total assist for cutting
Grooming: modified independent
Dressing: modified independent for upper extremity, moderate assistance lower body
Bathing: independent for upper body, some to total assist for lower extremity
Home management and maintenance: some assist w/ light meal preparation, total assist for all other activities
Transfers: Begin bed mobility and transfer training to min-a to mod-a
Other: can begin to participate in own skin checks and padding/positioning as well as (IADLs)
-Bed mobility: some assist
Bed & W/C transfers: some assist to independent on level surface, some to total assist on uneven surfaces. Use of a sliding board for Independence
Manual W/C propulsion: Can use for daily activities
Power W/C propulsion: Greater ease with independence
Pressure relief/positioning: independent do pressure relief and skin checks and turn in bed
Transportation: independent w/ driving
-Wheelchairs: Power recline W/C. Manual chair use should be monitored and limited to decrease scapular dysfunction, transfer board
Postural support devices: Hydraulic standing table, w/c pressure relief cushion, power/mechanical lift, specialty pressure relief mattress/overlay, electric hospital bed w/ side rails (standard full to king bed as indicated)
Feeding: dining with dignity silverware, u-cuff with right angle pocket, or other adaptive utensils, including knives, but can begin to use standard utensils. Begin cutting and opening packages.
Writing: short wanchik, u-cuff with right angle pocket, build-up foam or other custom writing utensils.
Grooming: adapted makeup and makeup stand, adapted nail clippers, u-cuff for oral care, large top toothpaste with rubber bands.
Dressing: elastic shoe laces, dycem gloves, loops in pants, sock aid, maternity clothes.
Bathing: adapted sponges, bath mitts, adapted long-handled sponges with splinting material, grab bars, padded shower/commode chair
Driving: vehicles adapted for driving with hand control.
Computer Access: Typing aids ( with/without wrist support),
mouthstick as back up, or if UE pain is present, mini-keyboard, laptray, trackball/joystick/touchpad for mouse movement, separate switch and interface for L/R click, keyboard shortcuts (StickyKeys, Hotkeys, etc.), word prediction/completion software for rate enhancement, voice recognition for ease and e
C7-C8
movements possible?
patterns of weakness?
Functional potential ADL’s
Elbow extension Ulnar/wrist extension Wrist flexion Finger flexions & extensions Thumb flexion, extension & abduction
-Paralysis of trunk & lower extremities
Limited grasp & dexterity secondary to partial intrinsic muscles of the hand
-Respiratory: low endurance & vital capacity secondary to paralysis of intercostals;
Standing: independent to some assist
Ambulation: not indicated
Feeding & grooming: independent
Dressing: mod-I upper extremities, min-a lower extremities
Bathing: independent in upper body, some assist to independent in lower body
Home management & maintenance: independent light meal preparation and homemaking; some to total assist for complex meal preparation and heavy housecleaning
Transfers: With use of triceps, a person can Independently transfer safely with or without use of a sliding board.
At C8 level, patients may begin to have more finger movement and thus more hand function, allowing them to manipulate objects to increase independence with self-care and mobility and decrease need for adaptive equipment
-Bed mobility: independent to some assist
Bed & W/C transfers: independent on level surfaces, independent to some assist on uneven surfaces
Manual W/C propulsion: Daily use. Independent on all indoor surfaces & level outdoor surfaces; some assist on uneven terrain
Pressure relief/positioning: W/C pushups for pressure relief
Transportation: independent in car if independent with transfer & W/C loading and unloading; independent in driving modified van from captain’s seat
-Adaptive devices as indicated for
Wheelchair: Manual rigid or lightweight folding W/C with modified rims, transfer board as needed
Postural support devices: Full electric hospital bed or full to king standard bed, hydraulic or standard standing frame, pressure-relief w/c cushion & mattress or overlay,
Adaptive devices similar as with someone at a C6 level
Bathing: padded tub bench with commode cutout or shower/commode chair, handheld shower, padded tub transfer bench or shower/commode chair
