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Semester 5 PMNM Exam 8 > Spinal Cord Injury (Mercuris) > Flashcards

Spinal Cord Injury (Mercuris) Flashcards

1
Q

ASIA stands for

A

American Spinal Injury Association

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2
Q

drawback of ASIA

A

only clinically essential data is considered

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3
Q

ASIA is

A

an international standardization that ensures consistency in measurement technique, data and communication. ASIA should be supplemented with other assessment tools

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4
Q

define neurological level (ASIA)

A

The most caudal segment with normal sensory and motor function on both sides of the body.

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5
Q

define skeletal level (asia)

A

The level at which the greatest vertebral damage is found by radiographic examination.

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6
Q

define motor level (asia)

A

The lowest key muscle that has grade 3 or more as muscle power and all the muscles receiving innervations from above that level are normal

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7
Q

define complete injury

A

No sensory and motor function in the lowest sacral segment

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8
Q

define incomplete injury

A

Partial preservation of sensory and/or motor functions below the neurological level and the sacral segment.

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9
Q

what is the zone of partial preservation?

A

includes the dermatomes and myotomes that remain innervated caudal to the level of injury in complete injuries only.

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10
Q

ASIA SCALE

A

LOOK AT PP SLIDE AND BE FAMILIAR WITH IT :)

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11
Q

neuro complications (7)

A

decreased motor fxn, decreased sensory fxn, altered muscle tone, altered temp regulation, respiratory problems, b/b dysfxn, sexual dysfxn

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12
Q

what is spinal shock

A

After injury, CNS shuts down, period of hypotonicity. After this wears off, spasticity sets in. Shock lasts anywhere from a week to 6 months.

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13
Q

spasticity is most prevalent in which 2 SCI’s?

A

cervical and thoracic. 2/3rd of all SCI cases have spasticity

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14
Q

SCI patients often have disabling (3) that impairs motor performance and ADL

A

pain, musculoskeletal complications and skin breakdown

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15
Q

spastic hypertonia includes what 5 characteristics

A

spasticity, muscle spasm, hypertonia, increased DTRs, clonus

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16
Q

management of spastic hypertonia includes

A

wt bearing, PROM, meds, Baclofen pump, botox

- start with oral meds and progress to pump if needed

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17
Q

benefits of spastic hypertonia include

A

LE extensor spasticity can help with standing, prevent osteoporosis, maintain muscle bulk, calorie burning

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18
Q

spastic hypertonia aka

A

UMN

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19
Q

Respiratory fxn C1-C3

A

C1-C3 will be on mechanical ventilator. Unlikely to survive to hospital

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20
Q

C1-C3 ventilation is limited I nwhich plane

A

limited in all planes

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21
Q

weak muscles in c1-c3 for respiration?

A

pecs, SA, scalenes, trap, SCM, diaphragm

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22
Q

result of decreased respiration in c1-c3?

A

significant decrease in TV and VC. 95% require mechanical vent

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23
Q

respiratory fxn in C4 - vent needed?

A

may or may not need mechanical vent

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24
Q

muscles involved in C4

A

scalenes, diaphragm, SA, pecs

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25
Q

planes of ventilation C4

A

marked decrease in anterior and lateral expansion, slight decrease in inferior and superior expansion

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26
Q

results of C4 ventilation

A

decreased TV

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27
Q

REspiratory fxn C5-C8 muscles

A

weak pecs, SA, scalenes

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28
Q

C5-C8 planes of ventilation

A

limited, therefore decrease in ant/lat expansion and slight decrease in posterior expansion

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29
Q

results of C5-C8 respiratory fxn

A

decrease in VC, FEV, cough effectiveness, paradoxical breathing

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30
Q

weak muscles in T1-5 (3 muscles)

A

weak or absent abs, intercostals and erector spinae

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31
Q

T1-T5 limited in which planes of ventilation

A

anterior and lateral expansion limited

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32
Q

results of T1-T5 resp fxn

A

slight to moderate decrease in VC, decreased cough effectiveness, may show paradoxical breathing, issues w/ chest expansion

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33
Q

what about respiration below T5?

A

respiration below T5 is usually ok

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34
Q

Quad cough info

A
  • assisted cough for weak abs
  • lay pt down, hand below zyphoid and above belly button
  • assist cough during expiration
  • sitting or supine
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35
Q

sweating does not occur where in relation to the lesion?

A

no sweating below the level of the lesion

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36
Q

S/S of altered temp regulation

A

HA, nasal congestion, tiredness, reduced concentration

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37
Q

treatment for lack of temp regulation

A

water intake, sponging, patient education!!!!

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38
Q

What are the 2 levels of control of bladder dysfxn?

A

1) Spinal reflex center of micturition at conus medullaris (S2-S4)
2) Pontine micturition center

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39
Q

function of pontine micturition center? (bladder)

A

integrates the reflex, coordinates contraction of detrusor muscle and sphincter relaxation. Some voluntary control

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40
Q

Spastic bladder aka what other 2 names

A

hyperreflexic or UMN

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41
Q

where is the lesion for hyperreflexic bladder

A

lesion above the conus medullaris

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42
Q

reflex arc for spastic bladder?

A

reflex arc for emptying bladder is intact

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43
Q

detrusor muscle spastic bladder?

A

Detrusor muscle contracts reflexly in response to pressure built within the bladder – bladder may empty spontaneously

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44
Q

triggers of bladder emptying in spastic

A

Bladder emptying can be spontaneous, triggered by manual stimulation (tapping suprapubic region, pinching the thigh, pulling hair of thigh/lower abdomen/suprapubic region)

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45
Q

what happens if sphincter cant relax - spastic bladder

A

urinary retention - can cause UTI or kidney infection

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46
Q

flaccid bladder aka

A

areflexic or LMN

47
Q

lesion location for flaccid bladder (2)

A

lesion of conus medullaris or cauda equina

48
Q

reflex arc in flaccid bladder

A

reflex center absent

49
Q

characteristics of flaccid bladder

A

Urinary retention

Emptying by Valsalva maneuver/ manual compression / Clean Self Intermittent Catheterization (CSIC)

50
Q

2 types of catheterization

A

1) indwelling

2) intermittent

51
Q

goals of cathertization

A

prevent UTIs, infection, kidney stones

52
Q

Indwelling cath info

A

Risk of infection
Often unsatisfactory, difficult to transfer because of bag
Other: Condom/ suprapubic catheter
Condom catheters will never stay on during transfers
Suprapubic: surgically inserted, for long-term use

53
Q

intermittent cath info

A

Self catheterization
Emphasis on clean rather than sterile
Timed voiding program - autonomous bladder
Residual volume drainage – automatic bladder
May need to reschedule time seeing pt for PT based on cath schedule. May also need to limit fluids and/or tract amount they drink

54
Q

2 types of bowel dysfxn

A

1) reflexic/spastic

2) areflexic/flaccid

55
Q

reflexic/spastic bowel dysfxn

A

internal anal sphincter relaxes reflexively when rectum is distended. SCI above S2

56
Q

areflexic/flaccid bowel

A

incontinence due to flaccid sphincters; feces may become impacted. SCI S2-4 or cauda equina/peripheral nerves. Ongoing release of feces.

57
Q

management of bowel dysfxn

A 
Prevent constipation and impaction
Promote regular BMS
Manual removal of stool
Digital stimulation of the rectum/sphincter
Suppository
Abdominal massage
High fiber diet – fruits and vegetables 
Meds, stool softeners, laxatives
58
Q

sexual fxn - impaired

A

impaired sensation and genital fxn. physical mvmts hard, fear of incontinence, anxiety

59
Q

male erection

A 
Psychogenic reflex (thoughts): T12 –L3 and S2-S4
Reflexogenic (genital stimulation): intact reflex arc in S2-S4
60
Q

male ejaculation

A

Greater ability in LMN lesions (S2-4) and in incomplete injuries
Difficult in lesions above T12

61
Q

male orgasm

A

Cerebral event (not physiological)
Varies with level and extent of injury
More likely with incomplete injury and those below T12

62
Q

erectile fxn is greater in ___ and ___

A

UMN and incomplete

UMN = lesion above S2-S4

63
Q

Female UMN lesion sexual fxn

A

reflex arc intact so sexual arousal components (vaginal lubrication, clitoral erection) will occur. Psychogenic response is lost LMN lesion- psychogenic responses will be preserved but reflex responses lost

64
Q

fertility - men

A

Decreased fertility (erectile dysfunction/ impaired ejaculation/ low sperm count/ low motility)
Retrograde ejaculation
Physical aids for erectile dysfunction
Electro-ejaculation or by penile vibration

65
Q

fertility - women

A

Fertility unchanged
Menstruation stops post injury, but resumes after 6 mths- 1 yr
Can become pregnant , carry baby full term and deliver vaginally
Risks of pregnancy: Autonomic dysreflexia, DVT, can go into labor without realizing it
Additional concerns: incontinence, spasms, respiratory problems

66
Q

osteoporosis

A
  • most bone loss seen in 1st six months after injury
  • kidney stones can be caused from calcium lost into urinary system
  • imbalance of calcium deposition and reabsorption
67
Q

heterotopic ossification s/s

A

swelling, warmth, decreased ROM, low grade fever

68
Q

heterotopic ossification

A

associated with rauma UTI pressure sores

69
Q

Pt considerations for heterotopic ossification

A

gentle ROM, avoid resistance ex, active mvmts in pain free ROM ok

70
Q

DVT is most common when

A

in acute phase

71
Q

normal BP for tetraplegia

A

90/60

72
Q

normal BP for paraplegia

A

may be lower than that in those without SCI

73
Q

BP due to

A

lack of regulation of BP by SNS

lack of muscle contractions

74
Q

treatment for autonomic dysreflexia

A

if supine, sit up. loosen tight clothing, kinked catheter most commoncause, also noxious stimulus, pressure sore, UTI, bladder distention. monitor BP

75
Q

goal of PT

A

achieve max fxnl independence

76
Q

treatment should (3 things)

A

promote max physiologic capacity, provide compensation for paralysis deficits, provide education

77
Q

physiological capacity trtment includes what 4 thigns

A

muscle strengthening, improve respiratory capacity, endurance training, maintain ROM

78
Q

standardized measures for acute-subacute (3-6 mo) (5 tests)

A

1) FIM
2) Spinal cord independence measure
3) walking index for SCI
4) sickness impact profile
5) modified ashworth

79
Q

Spinal cord independence measure (SCIM)

A

Self-care, Respiration and sphincter mgt, bed mobility/transfers, mobility inside and out

80
Q

walking index for sci 2

A

20 item description of ambulation

Includes use of parallel bars, AD, orthotics, number of people assisting, all for 10 meters.

81
Q

sickness impact profile 68

A

behavioral depression scale

82
Q

standardized mearues chronic (4)

A

1) craig handicap assessment and reporting technique
2) sickness impact profile
3) WC skills test
4) WHO QOL BREF

83
Q

CHART

A

craig handicap assessment and reporting technique
Function in physical, cognitive, mobility, occupation, social integration, and economic self-sufficiency
Excellent assessment tool

84
Q

WC skills test

A

32 items of w/chair mobility in environment/obstacles

Speed, turns, ramps, ability to maneuver in environment

85
Q

WHO QOL BREF

A

26 items in domains of: physical health, psychological health, social relationships, and environment

86
Q

CHART is valid for what populations

A

SCI, CVA, TBI, MS, amputee, burn

87
Q

MMT considerations

A

Substitutions are done and often missed by the examiner!!
Fatigue gives the impression of less strength- do not do several repetition or exercise before MMT. Get grade correct the first time.
Check one level above and one level below the suspected level of ‘normal function’

88
Q

common muscle substitutions: tenodesis for

A

finger flexors

89
Q

common muscle substitutions: supination + gravity =

A

wrist extension

90
Q

common muscle substitutions: shoulder ER + sup + gravity =

A

elbow extension

91
Q

push ups in WC

A

Serratus anterior = used for sitting push-ups with lower trapezius (scapular protraction= functional lengthening of UE)
Deltoid takes over in the absence of serratus anterior = winging of scapula = reverse action in closed chain = lifting of the buttocks
Lower trapezius - reverse action = actively lifts lower trunk
Neck flexors take over in the absence of lower trapezius = drop the head, passive lifting of pelvis through spine and tight connective tissue

92
Q

T/F normal ROM may not be the goal

A

true

93
Q

ROM considerations - neck

A

don’t overstretch cervical extensors. avoid flexion. forward head interferes with breathing and blaance

94
Q

ROM trunk

A

don’t overstretch back extensors.

95
Q

fxn of tight lumbar fascia

A

provides passive trunk stability. helps with rolling and transfers

96
Q

loose low back =

A

kyphotic posture. interferes with breathing and casues sacral sitting

97
Q

ROM hamstrings - SLR of what degree needed for long sitting

A

110 degrees

98
Q

ankle DF - what degree needed for amublation

A

0 deg

99
Q

ROM shoulder

A

Stretch pectorals and encourage hyperextension (not in injuries higher than C4)
Sitting support (UE swung behind for support)
Supine on elbows- assist to sitting position
Hooking onto wheelchair handles
External rotation ROM important

100
Q

ROM elbow

A

Full elbow extension (especially if weak Triceps or spastic Biceps) & forearm supination-pronation
Required for all ADL skills

101
Q

ROM wrist

A

attain 90 deg extension for stability and wt bearing

102
Q

fingers ROM

A

Avoid stretching finger flexors with wrist extension
Fingers should flex with wrist extension and extend with wrist flexion = mild tightness
Avoid overstretching the thumb web space
Adequate enough to allow the hook grasp
But tight enough that the thumb is pulled in opposition by tenodesis

103
Q

info for WC prescription

A 
Goals of the patient
Environment in which wheelchair used
Changing conditions- wt, recovery
Type of WC may change as pt recovers 
Assistance required for transfers/propelling
Insurance
Physical characteristics of the owner
104
Q

C1-C4 WC recommendation

A

power WC w/ mouth stick activities

105
Q

C5 WC recommendation

A

electric WC w/ hand controls: manual SC w/ quad peg for short distances

106
Q

C6 and below WC recommendation

A

manual WC but consider long distances - may need power chair

107
Q

pre-gait activities

A

orthosis, start in parallel bars, strengthing, pelvic control, push ups for UE stregth

108
Q

factors that influence expected functional outcome

A 
Level and extent of injury
Psychological state (motivated/ anxious)
Body type (weight/ height)
Pre-existing medical conditions (DM/ HT)
Associated injuries (wounds/ fractures/ infections)
Secondary complications 
Resources (support systems)
Environment
109
Q

Peds - paraplegia in what age group

A

0-12

110
Q

Peds - quadriplegia more common I nwhat age group

A

13-21

111
Q

concerns for peds sCI

A

Neuromuscular scoliosis- occurs frequently. <12 y/o then 3.7 times more likely need spinal fusion
Hip subluxation-occurs in 100% of children injuried <5 y/o and 94% injuried <10 y/o.
Unable to detect autonomic dysreflexia or other symptoms (fever, change in spasticity, headache, sweating)
Decreased community participation and QOL compared to peers
Ongoing checks with growth
Education: child, caregivers, siblings, teachers
DVT are less common
Latex allergies

112
Q

Spinal cord injury w/o radiographic abnormality (SCIWORA)

A

Occurs in 64% of younger children
Bony structures of spine differ from adult until 8y/o
Facet joints more horizontally oriented and vertebral bodies more anteriorly wedged>decreased stability
Ligaments and capsules more elastic

113
Q

T/F SCI in kids can be delayed 30 min to 4 days after injury

A

true - occurs in 50% of kids with SCI

114
Q

measures for kids

A

May use Adult Spinal Cord Independence Measure (SCIM)
Pediatric Wee-FIM
Pediatric Evaluation and Disability Inventory (PEDI)
Pediatric Powered Wheelchair Screening Test
Pediatric AOL
School Function Assessment (SFA)

Semester 5 PMNM Exam 8 (2 decks)

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