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
