Spinal Cord Injury Flashcards
What is the major cause of SCIs in the US?
Vehicle Crashes
What is the average length of days hospitalized and in acute care?
Hospitalized 11 days
Acute Care 36 days
What is paraplegia?
Impaired movement in both lower extremities, but
movement in the upper extremities is preserved.
– The trunk may also be impaired
What is tetraplegia (quadriplegia) ?
Impaired movement in all four limbs
What is a complete SCI?
No muscle preservation at and below the level of injury
T/F An incomple SCI is defined as Preservation of ALL sensation or motor capabilities at or
below the level of the injury
False
Preservation of SOME sensation or motor capabilities at or below the level of the injury
What is Anterior Spinal Cord Syndrome?
Loss of all sensation (except proprioception) and motor function below the injury to the anterior spinal artery
What is Brown-Sequard Syndrome?
Lateral damage as a result of damage to only one side of
the spinal cord, usually because of a stabbing or gunshot wound.
What will a client with brown sequard syndrome experience?
Patient experiences motor paralysis and loss of
propriocetion in the ipsilateral side of the injury and the
loss of pain, temp, and touch on the contralateral side of
the injury
What is cauda esquina syndrome?
Occurs with fractures below L2 with flaccid paralysis as the primary feature
What are the causes and symptoms of central cord syndrome?
Destruction of the central cord and Paralysis and sensory loss are greater in theupper extremities than in the lower extremities.
– More common in the elderly because the narrowing
of the spinal cord
which SCI is classified as an Injury to the sacral cord and lumbar nerve roots, resulting in the loss of bowel and bladder function and lower extremity function
Conus Medullaris Syndrome
What is a spinal cord infarct ?
Stroke within the spinal cord vascular distribution
What is Transverse mylelitis?
Inflammation across one level of the spinal cord
The myelin sheath is attacked and causes paralysis below the level of the inflammation, which can progress over the course of several weeks.
One third recovery partially but with spasticity and
bowel and bladder deficits.
What happens within the SCI acute phase?
Spinal Schock
Spasticity
Patient might need surgery stabilization procedure
What is a spinal Schock?
characterized by areflexia at and below the level
of injury and become hyperactive. Happens right after the injury can last 24 hours to 6 weeks
What is the initial goal of a spinal decompression?
relieve any pressure on the
spinal cord.
- This could involve removing portions of the
vertebrae that have broken and are compressing
the spinal cord.
– If the spinal cord is being compressed by the
injury (tumor, infection or severe arthritis),
surgery can be performed to reduce the amount
of compression
What is the second goal of a spinal cord injury?
To stabilize the spine
A combination of metal screws, rods and plates
may be necessary to help hold the vertebrae
together and stabilize them until the bones heal.
What OT assessments are performed during a SCI?
Physical Evaluation – Muscle Evaluation • Passive range of motion • Manual Muscle test: test all muscle/key muscles – Sensory evaluation • Dermatomes • Light touch, pin prick, joint proprioception, stereognosis, kinesthesia • Muscle tone • Endurance
What is the ASIA Scale?
National classification system of spinal cord injuries
The testing of 10 key muscles and 28 sensory points on
each side of the body
According to the ASIA scale what is the neurological level?
The neurological level is the lowest level at which key
muscles grade 3 or above on MMT and sensation is
intact for that level’s dermatome.
According to the ASIA scale what is the functional level?
The functional level is the lowest segment at which
strength of key muscles graded 3+ or above out of 5 on
MMT and sensation is intact.
What is the grading scale of the Neurological Assessment Motor ?
All testing is done in supine (Not traditional MMT)
• Grading
– O- No visible movement
– 1-A visible movement or contraction
– 2-Muscle is able to move at least once in gravity
eliminated position
– 3-Muscle is able to move at least once against
gravity
– 4-Muscle is able to some provide resistance
– 5-Muscle is able to exert normal force
– NT ( Not testable)
What is the grading scale of the Neurological Assessment Sensory?
Each key point on the scale is given a 0-2 point grade • Testing of pin prick and light touch maximum score of 112 each – Normal sensation =2 – Impaired sensation =1 – Absent sensation =0 – Not testable =NT
What does the ASIA A scale mean?
A=Complete: No motor or sensory function is preserved in the sacral segments S4-S5
What does the ASIA B scale mean?
B=Incomplete: Sensory but not motor function is preserved below the neurological level and included the sacral segments S4-S5
What does the ASIA C scale mean?
C=Incomplete: Motor function is preserved below the
neurological level and more than half of the key muscles
below the neurological level have a muscle grade less than 3.
What does the ASIA D scale mean?
D= incomplete: Motor function is preserved below the
neurological level, and at least half of the key muscles below the neurological level have muscle grade of 3 or more.
What does the ASIA E scale mean?
E= Normal: Motor and sensory functions
Which level of the spinal cord is Autonomic Dysreflexia associated with?
Associated with lesions T6 and above
What is Orthostatic Hypotension and what level of the spinal cord is it associated with?
A sudden drop in BP when patient sit ups – Common in T6 and above – Associated with prolonged supine positioning • Clinical tip: – Face turns red raise the head – Face turn pale raise the tail
With pressure ulcers how often should you reposition the patient in bed and in wheelchair?
Recommended reposition in bed every 2 hours
Wheelchair : every hour with one minute relief
What spinal segment controls Bowel and bladder management?
spinal segment S2-S5
what does an OT help manage in bowel and bladder deficits?
OT to help mange: • medication for optimal feces consistency • establishment of daily routine • management of clothing • skin integrity (consider low vision) • trunk control
Differentiate between Mechanical, Radicular and Neuropathic pain.
Mechanical pain- Example: overuse of the shoulder
Radicular pain-follow distribution of nerve
Neuropathic pain- originates from spinal cord
What part of the body are Deep Vein Thrombosis (DVT) most common in ?
Lower Extremities
what is Heterotopic Ossification?
Pathological bone formation in joints
Connective tissue calcifies around the joint
What are the Functional Expectationsof C1-C3?
Preserved Muscles and Movements – Face and neck muscles allow for neck movement and facial expression, use of mouth • Patterns of Weakness – Total Paralysis • Expected Functional outcomes – Dependent with all ADLs – Can use electronic activation devices
What are the therapeutic interventions for C1-C3 ?
– Improve ability to use sip and puff with tasks such as
blowing with a straw to push paper across the bedside
table
– Neck ROM
– Caregiver instruction
– Use of sling lift
– Monitor vital sings
What are the Functional Expectationsof C4?
Patterns of Weakness
– Paralysis of trunk and UE’s and LE’s and inability to
cough
• Expected Functional outcomes
– Dependent with all ADLs
– May be able to breathe without a respirator
What are the interventions for C4 ?
Focus on scapular elevation to strengthen accessory
muscle for respiration and vent weaning and
isometrics
– Quad cough—After maximal inspiration, an assistant
exerts pressure at the abdomen to increase the
strength of the cough
– Teach caregiver instruction methods
– OOB to chair using Hoyer lift
– Monitor vital signs
What are the weaknesses of C5?
– No elbow extension
– No hand function
– Total paralysis of trunk and LE’s
– Patient at high risk for scapular hiking or winging
What are the expected functional outcomes and interventions of C5?
Expected Functional outcomes
– Mod to Max assistance with functional mobility
– Min to Mod assistance for setup then able to perform BADL’s with adaptive devices
• Therapeutic Intervention
– Out of bed to chair, Monitor vitals
– Teach caregiver instruction methods
– BADL’s
– Prevent elbow tightening resulting from lack of inhibitory action
from elbow extensors. Daily PROM.
– Address DME
Which preserved movement is important in C6?
tenodesis grasp
What are the expected functional outcomes of C6?
Independent with BADL’s with the following exceptions: cutting, shoe tying, lower body dressing and bathing, Uneven surface transfers
An injury to C7-C8 will cause paralysis of what part of the body?
trunk and limbs
What are the expected functional outcomes of C7-C8 ?
Independent with all BADL’s with adaptive equipment and DME
True or False
An individaul with injury to T1 to T9 will be able to perform all ADLs independently?
True
Injury to T1-T9 will cause paraplegia or quadriplegia?
paraplegia and limited trunk stability
An individual with Injury to L2 to L5 can perform all ADLs but will have_________ dysfunction.
bowel dysfunction
What is areflexia?
It is an absence of reflexes; it’s a characteristic of spinal shock, which occurs in the acute phase of an SCI
When does the greatest recovery happen with clients with an SCI?
•The greatest recovery time occurs within the first 3 months
•Most UE recovery occurs within the first 6 months
–This can be a ‘rehab effect’
