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Neuro III > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

What is the incidence of SCI?

A

54 cases/million per year

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2
Q

What is the prevalence of SCI

A

299,000 in US about 4,400 in CO

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3
Q

Who has the highest incidence of SCI and why?

A

males out-weight females 4:1
due to risk taking behaviors
Occupational Risk

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4
Q

What season has the highest incidence of SCI

A

Summer due to travel and outdoor activities

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5
Q

What are the two highest categories for is the etiology of SCI

A
  1. Vehicle crashes- 37%
  2. Falls 31%
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6
Q

What is the most common level of injury for SCI?

A

incomplete tetraplegia
followed by incomplete paraplegia

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7
Q

What is the average age for SCI?

A

39 craig hospital statistic

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8
Q

What does the ISNCSCI include and what position is the patient in?

A

Sensory: 28 dermatomes with pinprick and light touch
0-3
Motor: 10 muscles each representing a nerve root innervation
0-5: 5 is intact
supine: pt is in the most stable position if they fractured their spine and this is completed within 72 hours of the injury

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9
Q

What is the difference between a complete and incomplete SCI? what does AIS stand for?

A

complete- no sensation or motor function at S4-5 level (rectal)

incomplete- some sensation and or motor function at S4-5 level (rectal)

AIS: ASIA impairment scale

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10
Q

AIS A

A

Complete
No sensory or motor function is preserved in the sacral segments S4-5
No anal sensory or contraction
Tick: NOOOON sign on ISNCSCI

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11
Q

AIS B

A

Incomplete
Sensory but not motor function is preserved below the neurological level
Must include the sacral segments S4-S5

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12
Q

AIS C

A

Incomplete
Must be at least a B (sensory or motor function is preserved in the S4/5 segments)
and you must have either
1. voluntary anal sphincter contraction or
2. sacral sensation plus sparing of motor function more than 3 levels below the motor level

more than half of the muscles grades below the single neurological level are <3

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13
Q

AIS D

A

Incomplete
Must be at least a C (sensory or motor function is preserved in the S4-S5 segments and have either sparing of motor function more than 3 levels below the motor level OR voluntary anal sphincter contraction)
and
at least half of the muscles grades below the single neurological level are > or equal to 3
think 3D
should be walking with bracing or assistive device

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14
Q

How do you classify an ISNCSCI Level?

A

Last level with both intact motor and sensory that is how you name the spinal cord injury

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15
Q

What level is the cauda equina?

A

L1-L2

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16
Q

What can you expect the presentation of an Upper Motor Neuron Injury?

A

Central nervous system affected: brain and spinal cord
-hyper-reflexia
-spasticity (velocity dependent)
-neurogenic bowel and bladder- spastic sphincters
-preserved reflexive penile erections in males `

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17
Q

What can you expect the presentation of a lower motor neuron injury?

A

damage to the peripheral nervous system
-hypo reflexive
-flaccidity (muscle weakness)
-flaccid bowel/bladder- incontinence
-no reflexive penile erection in males

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18
Q

How often do we need to turn someone in bed to relieve pressure preventing skin breakdown?

A

turn in bed: every 2 hours “side- back- side”

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19
Q

How often do pt with a SCI need to weight shift in their wheelchair?

A

every 20 min for 2 minutes

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20
Q

What ares of the body need to be off loaded to relieve pressure and prevent skin breakdown?

A

Check sacrum, ischial, heels, shoulder blades and back of head

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21
Q

What 4 things are include in Autonomic Dysfunction for individuals with SCI?

A
  1. Neurogenic shock
  2. Cardiovascular Complications
  3. Temperature Regulation
  4. Altered Sweat Secretion
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22
Q

Orhostatic hypotension, loss of spinal reflexes in UMN

A

Neurogenic Shock

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23
Q

Bradycardia, bradyarthymias, orthostatic hypotension, increased vasovagal reflex, vasodilation and stasis

A

Cardiovascular Complications

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24
Q

reduced sensory input to thermoregulating centers and loss of sympathetic control of temperature and sweat regulation below the level of injury

A

temperature regulation

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25
Q

Sweat can be excessive, absent or simply diminished, reflexive sweating- exclusively occurs below the LOI

A

Altered Sweat Secretion

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26
Q

What is the definition of Orthostatic Hypotension?

A

decreased BP >20 mmhg systolic or decrease BP >10 mmhg diastolic

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27
Q

What are the causes of Orthostatic Hypotension

A

decreased vasoconstriction
decreased venous return
dehydration

28
Q

How will the patient present if they are experiencing Orthostatic Hypotension

A

Palor, diaphoresis, dizziness, nausea, light-headedness, blurry vision, shortness of breath, loss of conciousness

29
Q

What are 3 things to rule out that present like Orthostatic hypotension?

A

vestibular dysfunction
low oxygen saturation
stress/anxiety

30
Q

What are some treatments for orthostatic hypotension?

A

abdominal binder (to keep blood from pooling), medication, caffeine, hydrate (increase blood volume)

31
Q

What is autonomic Dysreflexia?

A

Increase in BP >20-40 mmhg above baseline usually with bradycardia (low HR)

32
Q

What are the causes of Autonomic Dysreflexia?

A

occurs in SCI of T6 and above

noxious stimulus below the level of injury
-full bladder, impacted/irritated bowel, pain
Vasodilation above level of injury only
Vasoconstriction below level of injury

33
Q

What to do if a patient is experiencing autonomic dyreflexia?

A

Sit the patient upright and find the noxious stimulus

34
Q

Dorsal column carries what info

A

localized fine touch, pressure, vibration and proprioception

35
Q

Dorsal column
Cell body
synapse
info carried

A

cell body: dorsal root ganglion
synapse: medula
info: thalamus integrated at the primary sensory cortex

36
Q

spinothalamic tract carries what info

A

pain temp crude touch

37
Q

Descending motor tracts path

A

from R internal capsule
medula
left side of body

motor tract right side moves the left side

38
Q

corticospinal tract

A

providing voluntary motor function. This tract connects the cortex to the spinal cord to enable movement of the distal extremities

39
Q

Blood supply of the spinal cord

A

1/3 posterior spinal blood supply
2/3 anterior spinal blood supply

40
Q

Anterior Cord Syndrome
MOI:
Affects:
Tract involved:

A

anterior cord syndrome
MOI: anterior spinal artery compressed by bone fragments
can be due to AAA
affect: motor paralysis
tract: corticospinal tract

41
Q

Anterior Cord Presentation

A

Loss of: motor function (corticospinal tract)
Loss of pain, temp, crude touch (spinothalamic tract)
Preservation of: position, vibration, and touch sense (dorsal tract)

42
Q

Posterior Cord Presentation

A

Posterior Cord
Loss of: pressure, light touch, proprioception, vibration (dorsal tract)

intact: muscle power, pain, temp, proprioception

-good power, pain temp sensation
-difficulty in coordinating movements of limb
rarest form

43
Q

Central Cord Presentation
MOI:
Tracts involved:
Presentaion
Prognosis:

A

Central Cord
MOI: due to hyperextension of C-spine
older adult falling down
Tracts: Dorsal column half impaired STT okay
Presentation: Greater UL weakness
some control over bowel and bladder
sensory loss is minimal
Prognosis: recovery possible

44
Q

Central cord presentation affects UL or LL more

A

UL

45
Q

Is there recovery possible for central cord

A

yes

46
Q

In central cord do you have sensory and bowel and bladder function

A

yes sensory
some bowel and bladder

47
Q

Brown- sequard syndrome

A

ipsilateral impaired or loss of movement
preserved pain and temperature sensation

contralateral normal movement
impaired pain and temp sensation

48
Q

Conus medullary syndrome

A

bladder dysfunction
bowel dysfunction
sexual dysfunction
low back pain
unilateral or bilateral leg pain
diminished rectal tone

49
Q

Cauda equina syndrome

A

Below vertebral level L2
LMN Injury peripheral nerves

injury to nerve roots
muscle weakness
decreased sensation
decreased bowel and bladder control

50
Q

Presentation of Autonomic dysreflexia

A

flushing/blotchy red rash
sudden headaches
diaphoresis
chills
blurred vision
nausea

51
Q

Are we worried about DVT in individuals with a spinal cord injury

A

yes 40-100% of new injuries need to be on heparin coumadin

52
Q

______ is the leading cause of death in acute SCI

A

PE

53
Q

Spastic spincters—>
High blood pressure—>
incomplete bladder drainage—>

A

spastic spincters—> retention of urine
high blood pressure—> autonomic dysreflexia
incomplete bladder drainage–> UTI

54
Q

What is intermittent catherization used for

A

maintain low urine volumes and pressure to avoid urinary tract damage
every 4-6 hours

55
Q

digital stimulation
suppository
regular schedule
diet considerations

A

all parts of a bowel management program

56
Q

Ideal bowel management program

A

less than 90 min
everday or everyother day
no routine use of suppositories
less than 3 incontinence episodes per year
low incidence of constipation

57
Q

HO what is it

A

bone growth in or near a joint after SCI and traumatic brain injury

58
Q

most common areas for HO

A

hips
knees
elbows

59
Q

% of individuals with SCI who have HO

A

20-50%

60
Q

Signs and symptoms of HO

A
  1. decreased ROM
  2. edema
  3. warmth
  4. low grade fever especially at night
61
Q

Diagnosis of HO

A
  1. asymmentrical PROM
  2. bone scan- 2-4 weeks
  3. Xray- progresive HO chronic
  4. Serum alkaline phosphate- 2-3 weeks
62
Q

management of HO

A

NSAIDs
AROM

63
Q

What is the primary cause of death after SCI

A

respiratory dysfunction

64
Q

Treatment to prevent respiratory dysfunction

A
  1. clear secretions
  2. maximize inspirations
  3. maximize cough/expiration
65
Q

Diaphragmatic pacer system

A

allows partial or full time weaning from the ventilator

Neuro III (23 decks)

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