Spinal Cord Injury - Part 2 Flashcards

1
Q

What is…

  • spinal shock = ?
  • signs = ?
A

- 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.
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2
Q
  • Autonomic Dysreflexia (AD) = ?
  • Symptoms = ?
A

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.

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3
Q

What triggers Autonomic Dysreflexia?

A

- 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
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4
Q

What is the treatment for Autonomic Dysreflexia?

A

Bring patient upright, loosen clothing, drain the bladder, and call for emergency assistance.

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5
Q

What is….

  • Spasticity = ?
  • Common triggers = ?
  • How is it managed = ?
A

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.

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6
Q

What is the main method of bladder management after SCI?

A

Intermittent catheterization, performed every 4 hours.

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7
Q

What is the difference between a spastic and flaccid bladder in SCI?

A
  • Spastic bladder empties in response to filling pressure (UMN).
  • Flaccid bladder has difficulty emptying (LMN).
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8
Q

What is the leading cause of death in SCI patients?

A

Pulmonary complications such as pneumonia.

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9
Q

Injuries occurring at which cervical levels require ventilator support?

A
  • C1-C2 injuries require ventilator support
  • C3-C4 injuries may require partial ventilator support
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10
Q

What is the management goal for pulmonary impairments in SCI?

A

Improved ventilation, effective coughing, and prevention of chest tightness.

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11
Q

What are common exercises for pulmonary function in SCI?

A
  • diaphragmatic breathing
  • assisted cough
  • respiratory muscle training
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12
Q

What are pressure ulcers?

A

Lesions of the skin and underlying tissue caused by prolonged immobilization.

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13
Q

What is the main prevention strategy for pressure ulcers?

A

Frequent repositioning, proper wheelchair and bed positioning, and skin inspections.

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14
Q

What is orthostatic hypotension?

A

A sudden drop in blood pressure when moving to an upright position, common in SCI above T6.

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15
Q

What are the symptoms of orthostatic hypotension?

A

Lightheadedness, low blood pressure, and fainting.

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16
Q

What interventions are used for orthostatic hypotension?

A

Gradual progression to upright positions, use of tilt tables, and compressive stockings.

17
Q

What is neurogenic shock?

A

A condition in SCI where blood pressure (SBP below 100) and heart rate drop (HR below 80), causing circulation problems.

18
Q

What is tenodesis?

A

A grasping technique used by people with C6 or C7 tetraplegia, using wrist extension to passively flex the fingers.

19
Q

What is the difference between nociceptive and neuropathic pain in SCI?

A

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.

20
Q

What are risk factors for developing neuropathic pain in SCI?

A

Nerve impingement, compression, or damage related to the lesion.

21
Q

What interventions are used for neuropathic pain?

A
  • Non-pharmacological: massage, TENS
  • Pharmacological: Gabapentin, Amitriptyline.
22
Q

What is the 6-minute arm test?

A

A submaximal endurance test using an arm ergometer for people with SCI.

23
Q

What is the recommended CV training for SCI patients?

A
  • 3-5 days per week
  • 20-60 minutes of activity like arm ergometry
  • At 50%-80% of peak HR
24
Q

What are the symptoms of cardiovascular impairments in SCI?

A

Hypotension, bradyarrhythmias, orthostatic hypotension, and deconditioning.

25
Q

What are…

  • Signs of DVT in SCI patients = ?
  • Interventions = ?
A
  • rapid onset of swelling
  • increased temperature of the limb
  • pain

Interventions: Monitoring for early signs, compression stockings, and possibly anticoagulants.

26
Q

What is the main rehabilitation goal for SCI patients with osteoporosis?

A

Prevention of fractures through weight-bearing exercises and use of bisphosphonates.

27
Q

What are…

  • Contractures in SCI = ?
  • How can they be prevented = ?
A
  • 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
28
Q

Pressure ulcer wound assessment

  • Stage 1 = ?
  • Stage 2 = ?
  • Stage 3 = ?
  • Stage 4 = ?
A

- 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