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Canadian Exam > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

What is the most common cause of traumatic SCI?

A

MVA (40.4%)

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2
Q

How are they classified?

A

Traumatic or non-traumatic

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3
Q

Mechanisms of injury

A

Flexion (most common in lumbar injury)
Flexion-rotation (most common in cervical injury)
Axial compression
Hyperextension
Penetrating injuries

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4
Q

Spinal shock

A

A transient period of areflexia immediately following SCI
Approximately 24 hours
Hypotension, loss of control of sweating
Goosebumps
Will eventually lead to hyper reflexia (UMN S&S)

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5
Q

Tetraolegia

A

All four extremities
Lesions of Cx SC
56%

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6
Q

Paraplegia

A

Tx Lx L2 (caudal equina)
46%

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7
Q

How is SCI standardized

A

international standards for neurological classification of SCI *ISNCSCI

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8
Q

Neurological level of injury

A

Most caudal level of SCI level with INTACT motor and sensory fxn

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9
Q

Motor and sensory level

A

Most caudal level Intact

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10
Q

Complete and incomplete SCI

A

Complete is every paralysis below neurological level
Incomplete are those with some persevered function (zones of partial preservation)

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11
Q

ASIA impairment scale

A

A- complete
B- incomplete: has sensory
C- incomplete: has sensory and motor but muscle grade is less than 3
D- incomplete: has sensory and motor but muscle grade is more than 3
E- normal

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12
Q

Clinical syndromes

A

Incomplete
- brown-sequard
- anterior cord
- central cord
- posterior cord

Other
- conus medullaris
-caudal equine

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13
Q

Brown- Sequard syndrome

A

Damage to one half of the spinal cord (usually penetrating injury)
Ipsilateral loss of:
- all sensory modalities at the level of lesion
- motor function (descending: lateral corticospinal tract)
- proprioception, discriminative touch, and vibratory sense (ascending- dorsal column)

Contrateral loss:
- pain and temperature (spinalthalamic tract)

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14
Q

Anterior cord syndrome

A

Commonly due to flexion injuries
Loss of motor fxn, pain and temp below level of lesion

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15
Q

Central cord syndrome

A

Hyperextension in Cx- compressive forces cause edema
Loss of motor > sensory
motor loss UL>LL

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16
Q

Posterior cord syndrome

A

Loss of proprioceptions, pressure, and vibratory sense
NO motor loss

17
Q

Caudal Equina

A

Damages to the nerve roots below L1
Flaccid paralysis
LMN injury, areflexive bowel/ bladder, and sacral anesthesia

18
Q

Autonomic Dysreflexia

A

Sympathetic over activity in the body
Typically in lesions above T6
EMERGENCY SITUATION

19
Q

Pathophysiology of autonomic dysreflexia

A

Noxious stimulus, increased sympathetic outflow, wide spread vascoconriction (Increase HR an BP), basorecetirs stimulate increase in fatal output causing decreased HR, but insufficient to counteract Increased BP

20
Q

Most common triggers of AD

A

Bladder and bowel distenson/irritation
Lots more

21
Q

AD S&S

A

Hypertension
Initial tachycardia but then bradycardia
Severe headache
Profuse sweating
Increased spasticity/ hypertonia
THERES MORE

22
Q

AD interventions

A

Sit patient up to decrease BP
Notify nearby nurse or doc
Check catheter for kink, block or fullness
Loosen tight clothing
Look for other potential noxious stimulus below NLI
Document

23
Q

Functional outcomes: NLI C1-4

A

Most severe
Paralysis of arms, hands, trunk and legs
Require assistance with breathing and secretion clearance
Dependent in all ADLs
Dependent in transfers
Power wheelchair

24
Q

Functional outcomes: NLI C5

A

Can breathe but labored because lack of abdominal tone so no diaphragm counterpressure
Dependent in transfers
Manual wheelchair with propulsion aids for short distances
Can drive a van using adaptive hand controls
Power wheelchair with adapted joystick for communities

25
Q

Functional outcomes: NLI C6

A

Tenodesis grasp allows for limited self-care activities
Independent to min assist with sliding board
Independent with manual cough
Wheelchair propulsion possible with the use of hand rim projections for short distances
Power wheelchair for community
Independent with pressure relief maneuvrss in wheelchair
Can drive a car or van using adaptive hand controls
Capable of living independently

26
Q

Functional outcomes: NLI C7

A

Easier for sliding board transfers
Most ALDs are possible
Manual wheelchair with friction surface hand rims

27
Q

Functional outcomes: NLI C8

A

Independent more
No wheelchair adaptions needed

28
Q

Functional outcomes: NLI T1-T12

A

The Lower the lesions level the better the trunk control
HKAFO and KAFO for short distances
Wheelchair for comminutit

29
Q

Functional outcomes: NLI L1-3

A

Same as previous

30
Q

Functional outcomes: NLI L4-S1

A

AFO with assistive device. NLI L4 may choose to use wheelchair for long distances

31
Q

Respiratory management

A
  • IPPV
  • deep breathing exercises
  • Glossophryngeal breathing (frog breathing)
  • Respiratory muscle strengthening
  • Assisted cough
  • Abdominal binder
32
Q

Skin care

A

Positioning
- every two hours
Pressure relief
- maneuvers every 15 ins
Skin inspection
Education
Wound care

33
Q

Early strengthening and ROM

A

Perform daily (except for areas that are contraindicated)
Pelvis should be let in neutral
LSP injury- SLR >60 deg and hip flex ion > 90 degs
Tetraplegic- mvmt of the head/neck, and shoulder flex ion/abduction >90 deg is contraindicated until given orthopedic clearance
Selective stretching
- tightness in certain muscles can enchanted function
- adequate length in certain muscles can enhance function
Splinting (intrincsic plus splint- hamburger hands)

34
Q

Early mobility

A

May experience postural hypotension
Focus on transfers and functional mobility

35
Q

Active rehab

A

Continue with resp care, skin and ROM
Strengthin
Cardiovascular endurance training
Wheelchair skills
Bed mobility skills
Balance
Transfers
Gait training

Canadian Exam (55 decks)

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