Spinal Cord Injury - Part 2 Flashcards
What is…
- spinal shock = ?
- signs = ?
- Spinal shock: A period of areflexia immediately following SCI with loss of reflexes below the level of lesion.
- Usually lasts about 24 hours, with gradual return of reflexes within 1-3 days.
- Signs:
- Absence of reflex activity, autonomic reflexes like bladder and bowel control, and hypotension.
- Autonomic Dysreflexia (AD) = ?
- Symptoms = ?
Autonomic Dysreflexia: A life-threatening emergency due to an uncoordinated autonomic response to a noxious stimulus below the lesion in SCI above T6.
Symptoms: Pale skin below lesion, flushing and sweating above lesion, reduced heart rate, and increased blood pressure.
What triggers Autonomic Dysreflexia?
- Triggers:
- bladder retention
- rectal distention
- pressure sores
- bladder infections, and other noxious stimuli.
- Anoxious stimuli below the level of lesion elicits sympathetic over activity thatconstricts blood vessels (of viscera and skeletal muscles) below the level of lesion –abrupt increase in blood pressure
- Normally, sympathetic facilitation (through neurons conveying signals regardingnoxious stimuli) is balanced by inhibitory signals descending from the brain –normal blood pressure is maintained; lesion above T6 level prevent most of thespinal cord to receiving signals from the brain that inhibit sympathetic activity
What is the treatment for Autonomic Dysreflexia?
Bring patient upright, loosen clothing, drain the bladder, and call for emergency assistance.
What is….
- Spasticity = ?
- Common triggers = ?
- How is it managed = ?
a) Increased muscle tone and hyperactive reflexes occurring below the level of the lesion after spinal shock.
b) Common triggers: Tight clothing, kidney stones, UTI, emotional stress, and fecal impaction.
c) Managment: Medications like Baclofen, selective stretching, weight-bearing, and ROM exercises.
What is the main method of bladder management after SCI?
Intermittent catheterization, performed every 4 hours.
What is the difference between a spastic and flaccid bladder in SCI?
- Spastic bladder empties in response to filling pressure (UMN).
- Flaccid bladder has difficulty emptying (LMN).
What is the leading cause of death in SCI patients?
Pulmonary complications such as pneumonia.
Injuries occurring at which cervical levels require ventilator support?
- C1-C2 injuries require ventilator support
- C3-C4 injuries may require partial ventilator support
What is the management goal for pulmonary impairments in SCI?
Improved ventilation, effective coughing, and prevention of chest tightness.
What are common exercises for pulmonary function in SCI?
- diaphragmatic breathing
- assisted cough
- respiratory muscle training
What are pressure ulcers?
Lesions of the skin and underlying tissue caused by prolonged immobilization.
What is the main prevention strategy for pressure ulcers?
Frequent repositioning, proper wheelchair and bed positioning, and skin inspections.
What is orthostatic hypotension?
A sudden drop in blood pressure when moving to an upright position, common in SCI above T6.
What are the symptoms of orthostatic hypotension?
Lightheadedness, low blood pressure, and fainting.
What interventions are used for orthostatic hypotension?
Gradual progression to upright positions, use of tilt tables, and compressive stockings.
What is neurogenic shock?
A condition in SCI where blood pressure (SBP below 100) and heart rate drop (HR below 80), causing circulation problems.
What is tenodesis?
A grasping technique used by people with C6 or C7 tetraplegia, using wrist extension to passively flex the fingers.
What is the difference between nociceptive and neuropathic pain in SCI?
Nociceptive Pain: Pain caused by musculoskeletal injuries, often due to overuse or poor posture.
Neuropathic Pain: Pain caused by injury to the central or peripheral nervous system, often described as burning or shooting.
What are risk factors for developing neuropathic pain in SCI?
Nerve impingement, compression, or damage related to the lesion.
What interventions are used for neuropathic pain?
- Non-pharmacological: massage, TENS
- Pharmacological: Gabapentin, Amitriptyline.
What is the 6-minute arm test?
A submaximal endurance test using an arm ergometer for people with SCI.
What is the recommended CV training for SCI patients?
- 3-5 days per week
- 20-60 minutes of activity like arm ergometry
- At 50%-80% of peak HR
What are the symptoms of cardiovascular impairments in SCI?
Hypotension, bradyarrhythmias, orthostatic hypotension, and deconditioning.
What are…
- Signs of DVT in SCI patients = ?
- Interventions = ?
- rapid onset of swelling
- increased temperature of the limb
- pain
Interventions: Monitoring for early signs, compression stockings, and possibly anticoagulants.
What is the main rehabilitation goal for SCI patients with osteoporosis?
Prevention of fractures through weight-bearing exercises and use of bisphosphonates.
What are…
- Contractures in SCI = ?
- How can they be prevented = ?
- Contractures develop secondary to prolonged shortening of structures across and around a joint, resulting in limitation in motion
- A consistent and concurrent program of range of motion (ROM) exercises, positioning, and splinting is important to maintain joint motion and prevent contracture.
- 65% of people w/sci will have at least 1 contracture within 1 year and 70% of people with tetraplegia will have a loss of shoulder ROM
Pressure ulcer wound assessment
- Stage 1 = ?
- Stage 2 = ?
- Stage 3 = ?
- Stage 4 = ?
- Stage I: Intact skin with non-blanchable redness of a localized area usually over a bonyprominence
- Stage II: A superficial ulceration that extends into the dermis
- Stage III: An ulcer that extends into the subcutaneous tissue but not into muscle
- Stage IV: Deep ulceration that extends through muscle tissue down to the underlying bony prominence
