Spinal Cord Injury Flashcards
What is the purpose of a tilt-in-space function on a wheelchair?
- provide pressure relief (20 minutes sitting, 2 minutes of pressure relief)
- facilitate easier area to access for caregiver
- reduce need to transfer to bed for catherization and rest throughout the day
- need for quick position change in the event of hypotension
Describe at least three different control devices for a motorized wheelchair.
- joystick
- head control
- chin drives
(4. breath control)
List at least five sensory tests you would perform to determine lesion level innervation for a person with SCI.
Static 2-pt discrimination Kinesthesia Prop Pain Light touch
What is a “universal cuff”? How is it used? It is most helpful for patients at what SCI level?
A piece of AE for holding utensils of all types: eating utensils, toothbrushes, pens, typing sticks. It is a simple and versatile device that offers increased independence (Pedretti, p. 966). It is most helpful for people with a C6 level injury (THIS IS NOT CONFIRMED, it was just listed in the equipment section on the Pedretti charts in the C6 section p. 974).
What is autonomic dysreflexia? List causes and symptoms. How is it treated?
Reflex action of autonomic nervous system in response to noxious stimuli seen in individuals with SCIs above the T4 to T6 level. Stimuli that cause reactions include full bladder or bowel, thermal or painful stimuli, injury, or discomfort related to clothing or medical equipment. Symptoms are sudden headache, anxiety, perspiration, flushing, bradycardia, paroxysmal hypertension, and chills. To treat client should be put into an upright position and quickly assessed to determine and remove noxious stimulus.
What is orthostatic hypotension? List causes and symptoms? How is it treated?
Pooling of blood in the abdomen and LEs that results in a decrease in blood pressure (hypotension). Caused by patient moving from supine to upright (or other position) too quickly. Symptoms are dizziness, nausea, and loss of consciousness. Immediate treatment involves putting client into a reclined position until symptoms diminish. Long term symptoms should decrease as activity and sitting tolerance increase, but can be aided by abdominal binders, compression garments, and some kinds of medication.
What is heterotropic Ossification? List causes and symptoms. How is it treated?
Development of bone in abnormal anatomic locations (aka ectopic bone). Often occurs around hip and knee, but can also be at the elbow and shoulder. Symptoms are swelling, warmth, and decreased ROM, occurring 1 to 4 months after an injury. Treatment involves medication and maintaining joint ROM to allow for maximal functional mobility. Early diagnosis and treatment is vital to limiting level of complications.
The person has an incomplete lesion with sensation in both hands, but he has lost all hand flexion/extension below the wrist. You tell me his ASIA classification.
He has a ASIA B classification because it is an incomplete lesion and he has sensation intact. He has lost motor function in the hands below the wrist in flexion and extension. However it does not say anything about abduction of fingers and if the person can use the interossei muscles and lumbricals to flex fingers than this person has some function in T1 and C8. This suggests a lesion of a C6 or above, thus retaining some motor function below the injury. If this was a T1 injury, this person could still have some functional flexion and all of extension intact because of C5-C8 would be preserved for median nerve, ulnar nerve, and radial nerve to compensate.
What is meant by ASIA A classification?
complete lesion; no motor or sensory function
What is meant by ASIA B classification?
incomplete lesion with sensory but not motor function
What is meant by ASIA C classification?
incomplete lesion in which motor function is preserved below the neurologic level and more than half of the key muscles below the neurologic level have a muscle grade of less than 3
What is meant by ASIA D classification?
incomplete lesion in which motor function is preserved below the neurologic level and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more
What is “spinal shock”? What are its symptoms? How long does it typically last?
After SCI, individuals can enter into “spinal shock” lasting from 24 hours to 6 weeks. Relfex activity ceases below the level of injury (known as areflexia). The bladder and bowel are atonic or flaccid. Deep tendon reflexes are decreased, and sympathetic functions are disturbed. The disturbance results in decreased constriction of blood vessels, low BP, slower heart rate, and no perspiration below the level of injury.
What is meant by ASIA E classification?
motor and sensory functions are normal
What is the prognosis for motor recovery for complete lesions?
total paralysis and loss of sensation (complete interruption of ascending and descending nerve tracts below the level of lesion); if there is no sensation or return of motor function below the level of lesion 24-48 hours after the injury for complete lesions, motor function is less likely to return; partial to full return of function to one spinal nerve root level below the fracture can be gained and may occur in the first 6 months after injury
What is the prognosis for motor recovery for incomplete lesions?
some degree of preservation of the sensory or motor nerve pathways below the level of lesion; progressive return of motor function is possible yet it is difficult to determine exactly how much and how quickly return will occur; frequently the longer it takes for recovery to begin, the less likely it is that it will occur
How can spinal cord injury affect “vital capacity”?
If a person has a cervical lesion or a high thoracic lesion, this can affect vital capacity.
How does reduced vital capacity impact rehabilitative efforts in SCI?
With reduced vital capacity, this can result in a markedly limited chest expansion and a decreased ability to cough because of weakness or paralysis of the diaphragm, the intercostals and the latissimus dorsi. This leads to a reduction in endurance so it could make for a much lower tolerance for activity during therapy. Many activities would have to be graded down and overall independence for the patient will take a longer time. With the limited ability to cough, this could have a major impact on feeding and eating. A major issue that could occur as a result of reduced vital capacity is a respiratory tract infection and this can also have a greater impact on therapy because they have to get treated for that first.
More damage occurs at the center of the cord than the periphery. Paralysis and sensory loss occur in the UE more than the LE, often seen in older adults who have arthritis that causes narrowing of the spinal canal
Central Cord Syndrome
One side of the cord is damaged, typically due to an injury like a puncture or gunshot wound. Proprioception and motor control are lost ipsilaterally while sensory function is lost contralaterally
Brown-Sequard Syndrome
Injury to anterior spinal artery or anterior area of cord. Loss of motor and sensory function, put proprioception is preserved.
Anterior Spinal Cord Syndrome
Injury to the peripheral nerves. Often related to fracture at L2 or below resulting in flaccid-type paralysis. Loss of motor and sensation is asymmetrical and contextual, but prognosis is better than other injuries due to potential for some regeneration
Cauda Equina Injury
Injury to sacral cord and lumbar nerve roots. Results in areflexic bladder, bowel, and LEs.
Conus Medullaris Syndrome
What is meant by “doing a pressure relief”?
Being able to move ones body off of their bony prominences such as Ischial Tuberosities, greater trochanters, sacrum or elbows to keep adequate blood flow. This could be done by routine of clients body in bed and soft seat cushions that better distribute the pressure area.
How would a wheelchair user do pressure relief?
This would be done by the wheelchair tilting to a 45 degree angle. If a person has enough strength, they could perform a weight shift while sitting.
How often should pressure relief be done?
every 20 minutes
What does pressure relief help prevent?
It helps prevent the loss of blood supply to the area which if left unchecked can lead to necrosis. It can also prevent decubitus ulcers
OTs actually encourage a particular kind of contracture among some SCI clients. What is it, how does it help, and how do you help a client develop this contracture?
Some clients will have active wrist extension, which will be used to substitute for absent grasp through tenodesis action of the long finger flexors. With these clients it is desirable to develop some tightness in these tendons to give some additional tension to the tenodesis grasp. The desirable contracture is developed by ranging finger flexion with the wrist fully extended and finger extension with the wrist flexed, thus never allowing the flexors or extensors to be in full stretch over all of the joints that they cross.
For tetraplegics, how does wrist extension assist function when the hands are not functional?
Allows for finger flexion, causing a pinch or three jaw chuck grasp.
What is a “tenodesis splint”? What is it for?
A tenodesis orthosis :-) is a wrist-driven flexor hand splint
From the International Encyclopedia of Rehabilitation:
“A dynamic wrist-hand orthosis whose function is… extension of the wrist… hence flexion of the fingers. Thus, the thumb being kept in the appropriate position of abduction and opposition, the three first digits, even if paralyzed, grasp in the manner of a three-jaw chuck.”
What functional substitution is available for C6 level patients who do not have active elbow extension?
Shoulder depression & protraction, external rotation, full elbow & wrist extension
As an OT, you may find yourself making recommendations for home-making assistance for a client with SCI who is modified independent in self-care and mobility. Why might that be necessary?
need to answer
In measuring a person for a wheelchair, what four primary measures are taken? How do you position the person for these measurements?
Shoulder/armpit to hip for seat/back height; hip to knee for seat depth; knee to floor for knee angle / footrest; hip to hip for seat width
What are the structural differences between a standard wheelchair and a wheelchair used for a sport such as basketball?
Standard wheelchair: cross bar under seat, bulky and heavy, arm rests, anti-tippers, removable footrests
Basketball wheelchair: no cross bar, lower back, lightweight, no arm rests, 5th wheel in back, fixed footrest
Be able to name and describe the primary advantages/features of various computer access technologies for people with SCI and other forms of paralysis, as explored in lab.
OK
What are the patterns of weakness for C1-C3 level SCI?
total paralysis of trunk, upper extremities, lower extremities; dependent on ventilator
What are the patterns of weakness for C4 level SCI?
paralysis of trunk, upper extremities, lower extremities, inability to cough, endurance and respiratory reserve low secondary to paralysis of intercostals
What are the patterns of weakness for C5 level SCI?
absence of elbow extension, pronation, all wrist and hand movement; total paralysis of trunk and lower extremities
What are the patterns of weakness for C6 level SCI?
absence of wrist flexion, elbow extension, hand movement; total paralysis of trunk and lower extremities
What are the patterns of weakness for C7-8 level SCI?
paralysis of trunk and lower extremities; limited grasp and dexterity secondary to partial intrinsic muscles of the hand
What muscles are innervated after C1-C3 injury?
sternocleidomastoid: cervical paraspinal; neck accessories
What muscles are innervated after C4 injury?
upper trap; diaphragm; cervical paraspinal muscles
What muscles are innervated after C5 injury?
deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus anterior (partially innervated)
What muscles are innervated after C6 injury?
clavicular pectoralis; supinator; extensor carpi radialis longus and brevis; serratus anterior; latissimus dorsi
What muscles are innervated after C7-8 injury?
latissimus dorsi; sternal pectoralis; triceps; pronator quadratus; extensor carpi ulnaris; flexor carpi radialis; flexor digitorum profundus and superficialis; extensor communis; pronator/flexor/extensor/abductor pollicis; lumbricals (partially innervated)
Functional activities impacted by C1-3 injury
Dependent on ventilator; total assist for bowel/bladder; bed mobility, bed/wheelchair transfers, wheelchair propulsion (independent with power chair); total assist for pressure relief; total assist for standing (ambulation not indicated); total assist for eating, grooming, dressing, bathing; total assist to independent with communication (depending on equipment)
24-hour attendant care to include homemaking
Functional activities impacted by C4 injury
May be able to breathe without ventilator but total assist for bowel and bladder; total assist for bed mobility, transfers, manual wheelchair propulsion (independent for power); total assist for pressure relief; total assist for standing (ambulation not indicated); total assist for eating, grooming, dressing, bathing; total assist to independent with communication (depending on equipment)
24-hour attendant care to include homemaking
Functional activities impacted by C5 injury
may require assistance to clear secretions; total assist for bowel/bladder; some assist for bed mobility; total assist for bed-> wheelchair transfer; independent mostly for manual wheelchair and power wheelchair; independent for pressure relief; total assist for standing/ambulation; total assist for setup then independent with eating equipment; total assist for grooming, dressing, and bathing; independent to some assist with communication (depending on equipment)
personal care: 10/hours a day; homecare 6/hrs/day
Functional activities impacted by C6 injury
may require assistance to clear secretions; some total assist for bowel/bladder; total assist for standing (ambulation not indicated); independent with or without equipment (except cutting) for eating; some assist to independent with equipment for grooming; independent UE dressing; some to total assist for LE; independent for upper body bathing; some to total assist for lower body bathing; independent driving from wheelchair
Personal care: 6hrs/day; homecare 4hrs/day
Functional activities impacted by C7-8 injury
may require assistance to clear secretions; some to total assist for bowel; independent to some assist for bladder; independent to some assist for bed mobility; independent for bed-wheelchair transfers if surface is even (otherwise independent to some assist); independent with manual wheelchair propulsion; independent with pressure relief and positioning; independent to some assist with standing (ambulation not indicated); independent with eating, grooming and UE dressing and bathing; independent to some assist with LE dressing and bathing; independent driving modified van
Personal care: 6hrs/day; homecare 2hrs/day
List a couple other adaptive devices that can help a person perform ADL impacted by injury at each level (two devices and two activities for injury at each level).
C1-4: Eating, Grooming, Dressing, and Bathing are all total assist. At the C3 level, bathing
completed a caregiver is made easier with a handheld shower, shampoo tray, and padded reclining shower/commode chair (if roll-in shower is available).
C5: Eating: total assist for setup, independent eating with long opponens splint and adaptive devices as indicated; Bathing: total assist using a padded tub transfer bench or shower/commode chair; a
handheld shower will be easier for caregiver
C6: Eating: independent with or without equipment except for cutting (total assist): universal cuff
