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Neurology II > Spinal cord injury assessment and management > Flashcards

Spinal cord injury assessment and management Flashcards

1
Q

nerve level injury that leads to tetraplegia

A

C1-T1

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2
Q

What nerve level injury leads to paraplegia

A

T2-S1

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3
Q

Describe the state of physical dependence of patient with C1-3 tetraplegia

A

Ventilator dependent
Can move head
Fully dependent for all motor tasks and ADLs and transfers
Can use assistive technology

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4
Q

what muscles are preserved in C1-4 tetraplegia

A

SCM,
trapezius,
cervical paraspinal
neck accessory muscles

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5
Q

Describe the state of physical dependence of patient with C4 tetraplegia

A

Can breathe independently
* Fully dependent for all motor tasks and
ADLs
* Can use assistive technology

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6
Q

what muscles are preserved in patients from C5 tetraplegia

A

deltoid, biceps

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7
Q

Describe the state of physical dependence of patient with C5 tetraplegia

A

No wrist or hand function, may use “trick extension” (passive elbow locking) for transfers
can use hand control power wheelchair
assists w/ t/f and most ADL
can use UL for simple tasks w/o fine hand control

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8
Q

Describe the state of physical dependence of patient with C6 tetraplegia

A

Potential to live independently if adequately equipped and set-up
May be able to transfer, roll, move from lying to sitting, dress, bathe and tend to personal hygiene
Manual or power wheelchair
Tenodesis grip for minimal hand function
Trick elbow extension useful for transfer

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9
Q

what muscles are preserved in the C6 tetraplegia

A

Extensor carpi radialis longus,
brevis

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10
Q

what muscles are preserved in the C7 tetraplegia

A

triceps

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11
Q

what muscles are preserved in the C8 tetraplegia

A

Flexor carpi radialis, finger
flexors

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12
Q

what muscles are preserved in the T1 tetraplegia

A

Lumbricals, abductor pollicis

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13
Q

Describe the state of physical dependence of patient with C7 tetraplegia

A

Tenodesis grip, minimal finger control
Active elbow extension and power
Rely on tenodesis grip for hand function
Independent in ADLs and transfers

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14
Q

Describe the state of physical dependence of patient with C8 tetraplegia

A

Full active wrist movement
Limited fine hand function
Good hand function, not reliant on
tenodesis grip
Independent in ADLs and transfers

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15
Q

Describe the state of physical dependence of patient with T1 tetraplegia

A

Normal Full fine hand function
Independent in ADLs and transfers
Remains difficult to sit unsupported

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16
Q

Describe the state of physical dependence of patient with T2-12 tetraplegia

A

Normal hand function
Varying degrees of trunk paralysis
Varying cough efficacy
Lower limb paralysis
Potential ambulation with HKAFO

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17
Q

what muscles are preserved in the T2-T9 paraplegia

A

Full upper limb function

18
Q

What are the physiotherapy implications for T2-9 paraplegia

A

Weak trunk, impaired sitting balance, possible
swing-to ambulation with HKAFO and ZF

19
Q

What are the physiotherapy implications for T10-L1 paraplegia

A

Better sitting balance, possible swing-to
ambulation in HKAFO + ZF

20
Q

What are the physiotherapy implications for L2 paraplegia

A

Reciprocal ambulation in long leg splints or
KAFOs + crutches

21
Q

What are the physiotherapy implications for L3 paraplegia

A

Reciprocal ambulation in AFOs + crutches

22
Q

What are the physiotherapy implications for L4 paraplegia

A

Ambulation with crutches ± AFOs

23
Q

What are the physiotherapy implications for L5 paraplegia

A

Independent ambulation ± AFOs, crutches

24
Q

What are the physiotherapy implications for L5 paraplegia

A

Independent ± stick

25
Q

what muscles are preserved in the T10-L1 paraplegia

A

+ paraspinal and
abdominal muscles

26
Q

what muscles are preserved in the L2 paraplegia

A

Hip flexors

27
Q

what muscles are preserved in the L3 paraplegia

A

Quadriceps

28
Q

what muscles are preserved in the L4 paraplegia

A

Tibialis anterior

29
Q

what muscles are preserved in the L5 paraplegia

A

Long toe extensors

30
Q

what muscles are preserved in the S1 paraplegia

A

Gastroc

31
Q

difference between complete and incomplete spinal cord injury

A

complete - spinal cord is completely severed, function below site of injury is completely eliminated
incomplete - spinal cord is compressed and some of the signals can be sent below sight of injury

32
Q

list the outcome measures for spinal cord injury

A

spinal cord independence measure - self care, respiratory and sphincter Mx, mobility
functional independence measure - motor skills, socio-cognitive skills
barthel index - personalc are, mobility

33
Q

functional goals for SCI

A
  1. Tolerate sitting out of bed in an appropriately prescribed
    seating system for a specified time period
  2. Maintain skin integrity
  3. Able to ask for help and direct care needs from others
  4. Caregiver independence (nursing staff at first)
34
Q

Management of SCI

A

24 postural Mx
readjustment of vasomotor control - to sit out tilt bed 30 degrees then gradual 90
DBE and monitor vitals in each position
introduce leg hhanding
10-15mins 3hrs in 1 week
progress to chair
standing programme - 3 or more times a week 30-60mins each
wheelchair prescription - provision, skills, position changes, OR HKAFO or KAFO or AFO, or Dictus splint
transfers, bed mobility (rolling, lying to long sit)
postural control and sitting balance
gait re-education - orthoses, aids, therapist assistance
hand function

35
Q

treatment plan to restore hand function for C4 tetraplegic patient

A

Prevent complications, maintain range (low load sustained stretch)

36
Q

treatment plan to restore hand function for C5 tetraplegic patient

A

Strengthen biceps and deltoid, maintain length of paralysed muscles
(aids, orthoses, splints, exercise)

37
Q

treatment plan to restore hand function for C6,7 tetraplegic patient

A

Tenodesis grip: active wrist extension + passive tightening of finger
flexors for crude but very useful grip.
Essential point: Never stretch fingers and wrist into extension

38
Q

treatment plan to restore hand function for C8 tetraplegic patient

A

Have active grip, limited fine hand function

39
Q

treatment plan to restore hand function for T1 tetraplegic patient

A

Full function

40
Q

outcome measures to assess hand function

A

Handheld dynamometry
Graded and Redefined Assessment of Sensibility, Strength and Prehension (GRASSP)
9 hole peg test

41
Q

outcome measurement for walking

A
  • 6 minute walk test
  • 10 metre walk test
  • Berg Balance Test
  • Timed Up and Go Test

Neurology II (3 decks)

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