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NEURO > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Mechanisms of Injury for SCI

List + 1 Example

A
  1. Flexion (most common in L/S)
  2. Flexion-Rotation (most commin in C/S)
    - INC risk of SCI
    - Ex. Passenger turning to talk to driver & gets rear-ended
  3. Axial Compression
    - Heavy falls onto someones head OR driving into a pool head first
  4. Hyperextension
    - Rear end collision or elderly person falls & chin clips something ie. counter
  5. Penetrating injuries
    - Gunshot OR stab wound
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2
Q

Spinal Shock

Defintion & Characteristics

A

A transcient period of arereflexia immediately following SCI

Characterized by:
1. Absense of all reflex activity (approx 24 hr)
2. Impaired autonomic regulation
- Hypotension
- Loss of control of sweating
- Piloerection (goosebumps)

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3
Q

Spinal Shock Recovery

A

Total Areflexia = approx 24 hr
Gradual Return of Reflexes = 1-3 days
Increasing Hyperreflexia = 1-4 weeks
Final hyperreflexia = 1-6 months <- UMNL

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4
Q

ASIA Impairment Scale: A

A

ASIA A = Complete

No sensory or motor function in the lowest sacral segments (S4/5)

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5
Q

ASIA Impairment Scale: B

A

ASIA B = Sensory Incomplete

Sensory but not motor function is perserved below the neurological level (NLI) including sacral segments

Have sensory but motor loss

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6
Q

ASIA Impairment Scale: C

A

ASIA C = Motor Incomplete (Non-functional)

Motor function is perserved below the NLI & more than half of key muscles below the NLI have a muscle grade less than 3

Majority of key muscles below this level are grade <3

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7
Q

ASIA Impairment Scale: D

A

ASiA D = Motor Incomplete (Functional)

Motor function is perserved below NLI & more than half of key muscles below the NLI have a muscle grade of 3 or more

Majority of key muscles below this level are grade >3

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8
Q

ASIA Impairment Scale: E

A

ASIA E = Normal

Motor and sensory function is normal

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9
Q

Brown-Sequard Syndrome

Definition & Losses

A

Damage to one side of the spinal cord (hemi-section). Typically d/t penetrating wound

IPSI-lateral loss
1. Motor function (descending: lateral corticospinal tract)
2. Proprioception, discriminative touch, vibrations (ascending: dorsal column)

CONTRA-lateral loss
1. Pain & temperature (ascending: spinothalamic tract - crossed @ lvl of the spinal cord)

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10
Q

Anterior Cord Syndrome

A

Damage to the anterior portion of SC - commonly d/t cervical flexion injuries (damage to the ant portion of the cord &/or its vascular supply = anterior spinal artery)

Loss:
1. Motor function (corticospinal tract)
2. Pain & temperature (spinothalamic tract)
Below NLI

** Almost everything EXCEPT Dorsal Column

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11
Q

Central Cord Syndrome

A

Damage to central portion of the spinal cord with peripheral portions spared - commonly d/t hyperextension injury in C/S region

Compressive forces cause hemorrhage & edema damaging the central portion of the cord

Loss:
1. Motor > sensory
2. UE > LE
- L/E & sacral tracts are more LATERAL = less likely to be affected (spared)
- Sacral sensation spared. Sacral motor function often spared.

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12
Q

Posterior Cord Syndrome

A

Damage to the posterior portion of SC - very rare

Loss:
1. Proprioception, discriminative touch, vibration sense (ascending: dorsal column)

No motor loss - corticospinal tract is NOT affected - lateral

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13
Q

What is the most common spinal cord syndrome?

A

Central Cord Syndrome

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14
Q

Difference b/t FLACCID bladder & SPASTIC bladder?

A

FLACCID
- Detrusor mm does not have innervation - no tone
- Will not respond to stretch in the bladder > as it fills - pt does not get sensation that they need to pee (full) > so overfilled that it begins to dribble out = WET & pt cannot feel it

SPASTIC
- Detrusor mm reflexively contracts & bladder empties to a certain filling pressure (less than what is normal) = essentially HYPERreflexia & does not take a lot of volume before it starts reacting & contracting
- Dysenergy b/t mm & spincter = INC urinary frequency & urgent incontinence

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15
Q

AUTONOMIC DYSREFLEXIA

A

A pathological autonomic reflex xausing sympathetic over-activity in the body

Typically occurs in lesions above T6

More common in complete or near complete injuries

Usually occurs in first 3-6 months post-SCI

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16
Q

ASIA Impairment Scale: Pathophysiology

A
  1. Noxious stimulus below level of lesion
    - May not be a true noxious stimulus. Ie tight or wrinkled clothing
  2. INC sympathetic outflow (mass reflex response)
  3. Wide spread vasoconstriction, INE BP, INC HR
    - HR the behins to DEC even though there is sympathetic activity that is overactive
    - Bradycardia & hypertension @ the same time
  4. Baroreceptors stimulated leading to INC vagal output causing DEC HR, but insufficient to counteract INC BP
    - Vagus nerve is acting on th heart - slowing down its electrical impulses > effort to normalize BP (dangerous)
    - Body’s mechanism of trying to normalize things & bring it back to homeostatis
17
Q

Autonomic Dysreflexia: Triggers

(9)

A
  1. Bladder distention/ irritation **
  2. Bowel distention/irritation **
  3. Stimuli that would be normally be painful below NLI
  4. GI irritation
  5. Sexual activity
  6. Labor
  7. Skeletal fracture below NLI
  8. Electricial stimulation below NLI (careful w/ TENS/ IFC)
  9. Pressure sores ** (even more important they do not get pressure sores)
18
Q

Primary & Secondary Complications of SCI

(7) + (7)

A
  1. Autonomic Dysreflexia
  2. Postural HYPOtension (loss of SNS - vasoconstriction & mm tone = more venous pooling = DEC cerebral BF = lightheadness, dizzy, etc)
  3. Impaired Temp Control (depends on lvl - more likely with C/S)
    Impacts hypothalamus ability to regulate BF - ex. heat to skin to sweat - not able to let off heat = impairment in themoregulation
  4. Respiratory Impairment - weakness of inspiratory & expiratory mm makes it difficult to clear secretions > infection. Also, acts as a restrictive disease b/c unable to take a deep breath > atelectasis.
  5. Spasticity
  6. Bladder & bowel dysfunction
  7. Sexual dysfunction

Secondary Complications:
1. Respiratory complications
2. Pressure sores
3. DVT
4. Contractures
5. Hetertropic Ossification - most common = hip & brachialis
6. Pain - repetitive use (W/C)
7. Fracture/ Osteoposis

19
Q

NLI C1-4

(6)

A
  • Most severe of the SCI lvls - greatest amount of impairments
  • Patient requires assistance with breathing, secretion clearance (all respiratory muscles are affected)
  • C1-3 requires ventilation - C4 is main innervation for DIAPHRAGM * Not strong enough on C3 alone
  • Dependent for ADLs
  • Totally dependent in transfers (mechanical lifts)
  • Power wheelchair (tilt in space or reclining to help with pressure relief)
20
Q

NLI C5

(4)

A
  • NLI past this lvl can breath independently, may be laboured; abdominal binder may improve breathing (acts like INC tone = mechanical advantagous for the diaphragm - piston affect (push against))
  • Dependent in transfers
  • Manual W/C w/ propulsion aids for short distances (flat surfaces)
  • Power W/C with adapted joystick for community
21
Q

NLI C6

(6)

A
  • Able to perform limited self-care activities with use of tenodesis grasp
  • Independent to min. assist wtih sliding board - locked elbow (CCP), shoulders can flex b/c elbow locks & uses depressors of scapulas to lift up
  • Independent w/ manual cough - hemlick manuever
  • W/C propulsion for short distances / Power W/C for community
  • Independent with pressure relief manuevers in W/C - arms into loops to pull themselves from side-to-side
  • Capable of living independently
22
Q

NLI C7

(3)

A
  • Can extend elbow allowing for easier use of sliding board transfers
  • Can do most ADLs by themselves, bed mobility much easier
  • Manual W/C with fricton surface hand rims - may require assistance with ramps, curbs, etc b/c pt do not have use of intrinsic hand mm - need it for “wheelies” to get over obstacles
23
Q

NLI C8

A
  • Full use of hand instrinic mm, allowing for grapsing of objects w/ ease and less need for adaptive equipment
  • Independent in all ADLs; may require adaptive equipment
  • Manual W/C with standard hand rims
24
Q

NLI T1-T12

(3)

A
  • The lower the level of injury in the T/S, the better the trunk control as more abdominals and paraspinals will be functional
  • May use orthoses (prescribed based on function) w/ assistive devices for short distances
  • W/C for community
25
Q

NLI L1-3

A
  • May use orthoses (HFAFO, KAFO, AFO) with assistive devices for short distances
  • W/C for community

L3 & > - using an AFO b/c it is less bulky

26
Q

NLI L4-SI

A
  • AFO w/ assistive device.
  • NLI L4 may choose to use W/C for long distances
27
Q

What is Glossopharyngeal Breathing (high cervical lesions)?

A

“Frog Breathing” = gulping the air.
Strategy to get bigger breaths

  • Emergency situation where they are not on a ventilator
28
Q

When should positioning and pressure relief manuevers be conducted?

A

Positioning = every 2 hours
Pressure relief = every 15 minutes when in a W/C & should be held for 2 minutes

29
Q

Why should the pelvic be kept in neutral during the ACUTE/ EARLY phase?

A

L/S Posterior pelvic tilt can put tension on the SC & cause damage / irritation

30
Q

LSP injury & Tetraplegia contraindications until orthopedic clearance?

A

LSP = SLR > 60 & hip flexion > 90 should be avoided

Tetra = mvmts of head/neck & shoulder flexion/abduction > 90 (spine stability & fully healed)

31
Q

Selective Stretching: what do you stretch/ not stretch

A

Tightness in certain mm can enhance function
- Tight lower trunk muscles may INC trunk stability & sitting positions
- Tight long finger flexors will improve tenodesis grasp

Adequate length in certain mm can enhance function
- SLR ~100 needed for long sitting & LE dressing
- Functional:
1. Helps w/ assisted cough - lean forward fast = rapid flexion - INC intraabdominal pressure & this assist w/ the cough
2. Functional position to help put on their pants

32
Q

Splinting (Intrinsic-plus splint)

A
  1. Wrist: 20 extension
  2. MCP: full flexion
  3. IP: full extenstion or slight flexion
  4. Thumb: natural opposition

Think: hamburger hands about to eat a burger

NEURO (13 decks)

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