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Neuromuscular PT 2 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Traumatic spinal cord injury: what population is it most common in

A
  • most common in young men (80%)
  • most common cause: car accidents, violence, falls, sports injuries
  • most injuries cause crushing, edema, hemorrhage or infarct
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2
Q

Look over types of

forces applied to the cervical spine and resultant injury

DONT MEMORIZE

A
  1. rotational hyperflexion mechanism: facet dislocation, wedged compression FX
  2. hyperextension mechansim: posterior arch fx, handman fx
  3. Hyperflexion or hyperextension mechanism: teardrop fx, spinous process fx, odontoid process fx
  4. Lateral flexion mechanism: transverse process fx, uncinate process fracture
  5. axial compression mechanism: burst fx of atlas, burst or vertical fx of C2-C7
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3
Q

Cervical wedge fx from hyperflexion injury

A
  • multiple vertebral bodies fx
  • disrupts structures its protecting
  • hyperflexion injury
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4
Q

burst fracture

A
  • from vertical compression
  • bulk of inside of body gets compressed fx
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5
Q

acute treatment of SCI

A
  • people go into spinal shock
  • stabilization of vital signs due to possible autonomic dysfunction is first
  • administration of anti-inflammatory drugs to limit swelling (recently shown to no have a significant long term improvements)
  • stabilization/traction of spine
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6
Q

Acute treatment: repair and stabilization of fracture

A
  • repair and stabilize fx
  • fusion, rods, plates, external stabilization via Halo, SOMI, TLSO, jewitt etc
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7
Q

Halo immobilizer

A
  • screws into skull and a vest around the shoulders that provides traction.
  • can have a supine traction for just stabilization or a brace they wear if they still need traction
  • halo brace is stable and hard to dislodge but do not pull directly on bars
  • isometrics can be helpful to maintain strength since they cannot move their neck
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8
Q

Minerva brace (SOMI)

A
  • can go right into this or transition to this from a Halo
  • Sterno-occipital-mandibular immobilizer
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9
Q

TLSO

A
  • can be used for children w/ scoliosis
  • not as many precautions w/ it off
  • taken off in bed but you must log roll in and out of it
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10
Q

Examination with SCI

A
  • medical history
  • medications
  • cognition: may have hit their head
  • social history
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11
Q

Respiratory management with SCI

A
  • diaphragmatic breathing: may not be able to use all the respiratory muscles
  • may need a ventilator
  • Glossopharyngeal breathing: recue breathing for short periods of time
  • maximizing function
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12
Q

Skin management with SCI

A
  • bed and wheelchair positioning
  • patient education
  • high risk areas = bony prominence
  • treatment of pressure ulcers
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13
Q

Autonomic dysfunction

A
  • most frequent in complete SCI above T6
  • orthostatic hypotension
  • thermoregulation
  • autonomic dysreflexia
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14
Q

Autonomic dysreflexia signs and symptoms

A
  • hypertension: can be life-threatening
  • sweating above level of lesion (where they can sweat)
  • flused skin above level of lesion
  • nasal congestion: due to HTN
  • Headache
  • blurry vision or seeing spots
  • goose bumps
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15
Q

Autonomic dysreflexia: causes

A
  • Noxious or potentially noxious stimuli
  • bladder distension
  • UTI
  • bowel impaction
  • wheelchair or bed positioning causing pressure (cant feel it but body reacts to it)
  • invasive testing
  • DVT
  • pulmonary embolus
  • blister
  • hetertopic ossification
  • fx
  • surgery
  • sexual intercourse
  • ingrown toenail
  • insect bit
  • burn
  • temperature flucuations pain
  • pregnancy
  • ETC
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16
Q

Autonomic dysreflexia treatment

A
  • get patient upright (cause orthrostatic hypotension)
  • look for cause and correct it
  • emergency procedures if you cannot find the problem
  • contact nursing - catheterization PRN
  • DO NOT CONTINUE WITH THERAPY
17
Q

Autonomic dysreflexia treatment afterwards

A
  • pt may need medication to reduce BP: nitroglycerin, nifedipine
  • monitor BP and symptoms for abour 2 hours after episode
18
Q

Heterotopic ossification

A
  • extra bone gets laid down in response to trauma
  • complete injuries it is common
  • hips and knees
  • red, swollen joint/limb
  • prevention: ROM (gentle to maintain), NSAIDS
  • treatment: bisphosphonates
19
Q

Spinal shock

A
  • occurs shortly after injury
  • hypertension => hypotension
  • flaccid paralysis below level of lesion (complete or incomplete injury)
  • last hour to weeks
  • just tells you there is injury to SC but not how severe
20
Q

end of spinal shock

A
  • return of spinal reflexes
  • stretch reflexes
  • bulbocavernosus reflex: center reflex - pulling on the their catheter to see if there is movement in gential region
  • hypertonia and spasticity below level of lesion may begin to develop
21
Q

Spasticity

A
  • impairments
  • treatment: rhythmic rotation
  • medications: baclofen, tizanidine, benzodiazepines (addictive and cause sleepy feeling), BoTox
  • measurement
22
Q

post stroke hypertonia
vs hyperreflexia in complete SCI

A
  • post stroke: paresis - myoplastic changes: contractures, weak actin-myosin bonds, atrophy
  • Complete SCI: stretch reflex hyperreflexia, myoplastic changes: contracture, weak actin-myosin bonds, atrophy
23
Q

Classification of SCI

A
  • quadriplegia: impairments or arm, trunk and leg function: all four some could be just weakness
  • paraplegia: impairment of trunk and leg function
  • complete: lack of sensation/mmotor function at lowest scaral segment (S4-S5)
  • incomplete: preservation of some sensation and or motor function including S4-S5
24
Q

Neurological level of injury

A
  • lowest level where both sensory and motor function are normal
  • zone of partial preservation: might have some sensory/motor function usually occurs with complete injury
  • determined by testing (ASIA): left and right, motor and sensory function
25
Q

evalutation: after objective measures

A
  • treatment plan/intervention
  • goals
  • different plans and goals depending on intact abilities
  • C5, C6, C7, C8, T1
  • see physical rehabilitation table 20.5
26
Q

universal cuff

A
  • above C8 will have limited hand function
  • can be strapped to wrist or hand to help them use spoons, toothbrush etc
27
Q

tenodesis grasp

A
  • want to maintain wrist extension and tightness in finger flexion
  • with wrist extension allows fingers flexing to grasp
28
Q

Lift assist options

A
  • hoyer lift,
  • stand assist lift
  • rifton tram
  • arjo sara stedy
  • C5 can stand with some assistance
29
Q

Interventions types

SCI

A
  • FES
  • gait
  • developmental positions
  • sitting, long sitting
  • bed mobility
  • transfers
  • wheelchair use
30
Q

intervention types

FES

A
  • functional electrical stimulation
  • may have a brace for ankle DF/PF
  • cycles on and off to get appropriate muscles to activate
  • surface electrodes are placed on muscle groups on one or both sides of your body
31
Q

Intervention types

Gait

A
  • body-weight support gait training
  • robotic gait training: support is more passive
  • exoskeleton: helps person to move
  • brain-spine inerface: reuiqres surgery/new
32
Q

Intervention type

sitting/long sitting

For SCI

A
  • good for LE dressing and self care
  • want to maintain LB tightness to make them stable but allow adequate hamstring length
33
Q

intervention types

bed mobility/transfers

Patient’s w/ SCI- goal of intervention

A
  • want them to be as independent as possible
34
Q

Intervention types

wheelchair

SCI

A
  • positioning
  • mobility
  • wheelies
35
Q

wheelchair types

A
  • wheels can be angled to maintain upright posture and better turning
  • tongue drive, sip and puff for those who cannot use hands well
  • one arm drive wheelchairs
36
Q

SCI

participation

A
  • pain and overuse injuries
  • community re-entry is tough
  • lifestyle: sports/hobbies
  • sex: above T6 make sure they are aware what to do with autonomic dysreflexia
37
Q

Asia impairment scale:
A, B, C, D, E

A
  • A= complete: no motor or sensory function is perserved in the sacral segments
  • B= incomplete: sensory but not motor function is perserved below the neurological level and includes the secral segments S4-S5
  • C = incomplete: motor function is perserved below the neurological level and more than half of key muscles below neurological level have a muscle grad of less than 3
  • D= incomplete: motor function is preserved below the neurolgocial level and at least half of key muscles below the neurological level have a muscle grade of 3 or more
  • E = normal: motor and sensory function are normal
38
Q

Sympathetic and parasympathetic control of bladder

A
  • sympathetic: relax detrusor and contract internal urethral sphincter
  • parasympathetic: contracts detrusor and relaxes internal urethral spincter
39
Q

bowel and bladder with SCI

A
  • lesion above S2= spastic and not going to relax easily
  • below S2 the bladder will be flaccid always be full - need catheter
  • getting them on a bathroom schedule can be helpful
  • may need catheter (risk of UTI)

Neuromuscular PT 2 (12 decks)

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