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
2
Q
Look over types of
forces applied to the cervical spine and resultant injury
DONT MEMORIZE
A
- rotational hyperflexion mechanism: facet dislocation, wedged compression FX
- hyperextension mechansim: posterior arch fx, handman fx
- Hyperflexion or hyperextension mechanism: teardrop fx, spinous process fx, odontoid process fx
- Lateral flexion mechanism: transverse process fx, uncinate process fracture
- axial compression mechanism: burst fx of atlas, burst or vertical fx of C2-C7
3
Q
Cervical wedge fx from hyperflexion injury
A
- multiple vertebral bodies fx
- disrupts structures its protecting
- hyperflexion injury
4
Q
burst fracture
A
- from vertical compression
- bulk of inside of body gets compressed fx
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
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
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
8
Q
Minerva brace (SOMI)
A
- can go right into this or transition to this from a Halo
- Sterno-occipital-mandibular immobilizer
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
10
Q
Examination with SCI
A
- medical history
- medications
- cognition: may have hit their head
- social history
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
12
Q
Skin management with SCI
A
- bed and wheelchair positioning
- patient education
- high risk areas = bony prominence
- treatment of pressure ulcers
13
Q
Autonomic dysfunction
A
- most frequent in complete SCI above T6
- orthostatic hypotension
- thermoregulation
- autonomic dysreflexia
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
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
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
evalutation: after objective measures
- treatment plan/intervention
- goals
- different plans and goals depending on intact abilities
- C5, C6, C7, C8, T1
- see physical rehabilitation table 20.5
26
universal cuff
- above C8 will have limited hand function
- can be strapped to wrist or hand to help them use spoons, toothbrush etc
27
tenodesis grasp
- want to maintain wrist extension and tightness in finger flexion
- with wrist extension allows fingers flexing to grasp
28
Lift assist options
- hoyer lift,
- stand assist lift
- rifton tram
- arjo sara stedy
- *C5 can stand with some assistance*
29
Interventions types
| SCI
- FES
- gait
- developmental positions
- sitting, long sitting
- bed mobility
- transfers
- wheelchair use
30
# intervention types
FES
- 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
# Intervention types
Gait
- body-weight support gait training
- robotic gait training: support is more passive
- exoskeleton: helps person to move
- brain-spine inerface: reuiqres surgery/new
32
# Intervention type
sitting/long sitting
| For SCI
- good for LE dressing and self care
- want to maintain LB tightness to make them stable but allow adequate hamstring length
33
# intervention types
bed mobility/transfers
| Patient's w/ SCI- goal of intervention
- want them to be as independent as possible
34
# Intervention types
wheelchair
| SCI
- positioning
- mobility
- wheelies
35
wheelchair types
- 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
# SCI
participation
- 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
Asia impairment scale:
A, B, C, D, E
- **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
Sympathetic and parasympathetic control of bladder
- sympathetic: relax detrusor and contract internal urethral sphincter
- parasympathetic: contracts detrusor and relaxes internal urethral spincter
39
bowel and bladder with SCI
- 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)
