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NPTE > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Level that spinal cord ends

A

T12-L1

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2
Q

Dorsal column medial lemniscus tract

A

DCML - sensory, ascending
Located posterior of spinal cord

Proprioception
Vibration
Graphesthesia
Barognosis
Stereognosis
2 pt discrimination
Kinesthesia
Fine touch

“Poor Val Found GBS Twice”

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3
Q

Corticospinal tract

A

CST - motor, descending

all movement

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4
Q

Spinothalamic tract

A

STT - sensory, ascending

Anterior: crude touch
Lateral: pain, temperature*

*to contralateral side

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5
Q

Posterior cord syndrome

A

Bilateral DCML affected
Bilat sensation loss

function: all DCML functions (proprioception, vibration, fine touch, graphesthesia, barognosis, stereognosis, 2 pt discrimination)

Cause: iatrogenic (medical error; rare)

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6
Q

Anterior cord syndrome

A

Bilateral CST and STT affected

Function: pain/temp and motor

Cause: hyperflexion injury

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7
Q

Central cord syndrome

A

Small lesion: bilat STT affected (pain and temp; interrupts where STT crosses)

Large lesion: all tracts affected bilaterally (center lesion touching all tracts)
- “walking SCI”
- “MUD-E”
> motor > sensory
> UE > LE
> Distal
> hyperEXTENSION MOI

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8
Q

Brown sequard syndrome

A

Hemi-cord

DCML and CST same side lesion
STT opposite lesion

Cause: stab injury, gunshot wound

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9
Q

Conus medullaris

A

Location: bilat and symmetrical in perineum and thighs

sensory: saddle distribution, bilat, symmetric

motor: symmetric

type: UMN & LMN (b/t spinal cord and cauda equina)

EMERGENT CALL 911

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10
Q

Cauda equina

A

Location: unilateral and asymmetrical in perineum, thighs, leg, back

Sensory: saddle distribution, unilateral, asymmetric

motor: asymmetric

type: LMN

EMERGENT CALL 911

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11
Q

Complete vs incomplete SCI

A

complete: no sensory or motor function in the lowest sacral segments (S4-5)

incomplete: motor AND/OR sensory function below neurological level including sensory and/or motor function at S4-5 (sacral sparing)

All cord syndromes are classified incomplete

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12
Q

Standardized ASIA UE myotomes
C5-T1

A

C5 - elbow flexors
C6 - wrist extensors
C7 - elbow extensors
C8 - finger flexors
T1 - fifth finger abductors

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13
Q

Standardized ASIS LE myotomes
L2-S1

A

L2 - hip flexors
L3 - knee extensors
L4 - ankle DF
L5 - great toe extensors
S1 - ankle PF

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14
Q

ASIA motor level

A

BOTH sides

  1. lowest level at which strength is at least 3/5 (this is the named level if step 2 is true)
  2. all levels above being 5/5

Scored for each side, overall score is last normal for both

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15
Q

ASIA sensory level

A

The level where sensory function is normal on both sides of body

  1. lowest level where you have “2s”
  2. All levels above also “2s”
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16
Q

ASIA neurological level

A

Most CAUDAL level with NORMAL sensory and motor function on BOTH sides of body

  1. find motor and sensory level
  2. Pick anatomically higher level < this is NLI
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17
Q

ASIA A

A

Complete

No motor or sensory at S4-5

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18
Q

ASIA B

A

Sensory incomplete

Sensory but no motor function present below NLII and S4-5

19
Q

ASIA C

A

Motor incomplete

Majority of key muscles below NLI have grade <3/5

20
Q

ASIA D

A

Motor incomplete

Majority of key muscles below NLI have grade >3/5

21
Q

ASIA E

A

Motor and sensory function normal

22
Q

Systemic complications of SCI

A

Cardiac: OH, autonomic dysreflexia
Pulmonary: respiratory dysfunction
GU: urinary and bowel retention +/- incontinence
Integumentary: pressure ulcers
MSK: contracture, weakness, tone

23
Q

Autonomic dysreflexia/hyperreflexia

A

At or above T6
Noxious stimuli below level of lesion
Inc systolic BP of 20-30 mmHg is diagnostic
More common in chronic stage (3-6 mo post injury) however can be seen acute
More common with complete SCI

24
Q

Causes of AD

A

bladder/bowel irritation
noxious stimuli below level of injury
GI irritation
sexual activity
labor
fracture below level of lesion

25
Q

S/S of AD

A

Inc BP (systolic rise 20-30 mmHg)*
Dec HR*
Severe headache, anxiety*
Constricted pupils, blurred vision*
Flushing, goose bumps (piloerection) above level of injury
Dry ,pale skin below level of lesion
Inc spasticity*

*most notable

26
Q

AD intervention

A

SIT UP and LOWER LEGS (dec BP)

Remove painful stimulus (loosen clothing/abdominal binder, check bladder, unclamp catheter, drain bag)

Monitor vitals throughout > if no change req medical/nursing assistance; if OP call 911

27
Q

Respiratory function at C1-2 SCI

A

Intact muscles:
SCM
Upper trap

Intervention:
Phrenic n. stimulator
Artificial ventilator

28
Q

Respiratory function at C3-4 SCI

A

Intact muscles:
Partial diaphragm
Scalene
Levator scapulae

Intervention:
Mechanical ventilator
C4- With recovery they can breathe on their own, part-time w/o vent > glossopharyngeal breathing (gulping air)

29
Q

Respiratory function at C5-8 SCI

A

Intact muscles:
Diaphragm
Pec major/minor
Serratus ant.
Rhomboid
Lat dorsi

Intervention:
Weak cough (no abs)
Must teach assistive coughing to people w/ respiratory compromise

30
Q

Respiratory function at T1-5 SCI

A

Intact:
Some intercostals
Erector spinae

31
Q

Respiratory function at T6-10 SCI

A

Intact:
Intercostal and abdominals

Respiratory function fully intact below T10

32
Q

Spastic bladder

A

UMN
Reflexic bladder

Seen in SCI above S2 spinal

Tx:
Intermittent catheterization every 3-6 hours
Suprapubic tapping

33
Q

Flaccid bladder

A

LMN
Areflexic bladder

Seen in SCI below S2 spinal

Tx:
Intermittent catheterization every 3-6 hours
Valsalva or Crede’s (external pressure on bladder) maneuver

34
Q

General recommendations on assist and activities per spinal region affected: C1-4

A

Dependent w/ ADLs, breathing, transfers, mobility

35
Q

General recommendations on assist and activities per spinal region affected: C5-6

A

Modified independent with ADLs, breathing, mobility, transfers

C5 mm. spared:
“3BIRDS”
biceps
brachioradialis
brachialis
infraspinatus
rhomboids
deltoid
supinators

C6 mm. spared:
“PET SLIP”
pec major
ECR
Teres minor
Serratus ant.
lat dorsi
infraspinatus
pronator

36
Q

General recommendations on assist and activities per spinal region affected: C7 and below

A

Independent with ADLs, transfers, mobility, breathing.

C7 mm. spared:
“FEET”
flexor carpi radialis
extensor pollicis brevis
extensor pollicis longus
extrinsic finger ext.
triceps

37
Q

C1-4 functional level

A

mechanical lift transfers

power wheelchair - head/chin/mouth control

38
Q

C5 functional level

A

Dependent slide board transfer

Manual WC - plastic coated hand rims

39
Q

C6 functional level

A

Independent slide board transfer

Manual WC - plastic coated hand rims

40
Q

C7-8 functional level

A

Even: indep w/o slide board
uneven: dependent on slide board

C8 may be able to do floor to WC transfer

Manual WC plastic coated hand rimis

C7 - indep on even surfaces

C8 - indep on ramps, curbs

41
Q

T1 functional level

A

floor to wheelchair transfer

independent WC

42
Q

T4 functional level

A

sitting pivot transfer

independent WC

43
Q

L3 functional level

A

stand pivot transfer (quads intact)

independent WC

NPTE (40 decks)

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