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Year 2: Neuromuscular II > Test 1: SCI > Flashcards

Test 1: SCI Flashcards

1
Q

Describe DCML

A

ascending

in posterior SC

processes info about conscious proprioception, vibration, and fine touch

crosses at medulla

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2
Q

describe spinothalamic tract

A

ascending

in anterior/lateral part of SC

processes info about sharp pain, temp, crude touch

crosses at anterior commissure of SC

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3
Q

describe the corticospinal tract

A

descending

motor signals

in lateral portion of SC

crosses at medulla

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4
Q

somatotopy of the SC from medial to lateral

A

UE to LE

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5
Q

etiology/common characteristics of SCI/SCI pts

A

17000 new cases annually in US

80% males

most common between 15-29 years old or over 65

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6
Q

common mechanisms of SCI from most to least common

A

MVAs (38%)

Falls

violence

sports related (9%)

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7
Q

mechanisms that can mean a NON TRAUMATIC SCI

A

arterial venous malformation

thrombus, embolus, hemorrhage to arterial supply of SC

infection of cord (i.e. IV drugs)

tumor

MS with lesions in SC

ALS

spinal stenosis

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8
Q

what characteristics determine life expectancy in those with SCIs

A

incomplete injury = longer life expectancy than complete

paraplegia longer than tetra

lower cervical tetra longer than higher cervical (less involved levels)

mortality rate is highest in 1st year post injury

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9
Q

what is spinal shock

A

occurs immediately following SCI

~24 hr period of areflexia (no refelxes/flaccid)

reflexes gradually return over 1-3 days

can have hyperrelfexia for 1-4 weeks following return

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10
Q

when to do asia

A

after 24 hours but before 72

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11
Q

SCIs are named by what 3 characteristics

A

spinal level of injury

anatomical location of injury in cord

completeness of injury

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12
Q

What is the ASIA/ISNCSCI

A

American Spinal Cord Association (ASIA) created International Standard for Neurological Classification of SCI (ISNCSCI) to determine SCI level

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13
Q

what does ASIA look at

A

motor level of injury

sensory level of injury

neuro level of injury

complete or incomplete

zone of partial preservation

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14
Q

when naming a SCI by level of injury, what does this mean

A

names by the level of function NOT the vertebrae; nerve involvement is what determines level

i.e. can have a C8 lvl injury w/o C8 vertebrae

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15
Q

what is interesting about cauda equina with SCI

A

this is where SC transforms to spinal nerves

UMN transitions to LMN

can have both UMN and LMN symptoms

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16
Q

ASIA A

A

complete

no motor or sensory preserved in sacral segments S4-S5

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17
Q

ASIA B

A

incomplete

Sensory but not motor is preserved below neuro level and includes sacral segments s4-s5

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18
Q

ASIA C

A

incomplete

motor function is preserved below neuro level

MORE THAN HALF key muscles below neuro level have a mm grade of LESS THAN 3

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19
Q

ASIA D

A

incomplete

motor function preserved below neuro level

AT LEAST HALF of key muscles below neuro level a mm grade of 3 OR MORE

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20
Q

ASIA E

A

normal motor and sensory function

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21
Q

what is motor level of injury and how do you determine it

A

lowest myotome that has a grade of at least a 3 if the one above it is a 5

determined by testing 10 key muscles on R and L side of body

graded on scale 1-5

can differ on L and R

may differ from sensory level of injury

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22
Q

what is sensory level of injury and how do you determine it

A

most caudal level with normal light touch and pinprick sensation

determined by light and pin prick on R and L sides

3 point scale: 0 = absent, 1 = impaired, and 2 = normal

can differ L to R

can differ from motor level of injury

23
Q

what is neurologic level of injury

A

most caudal level of SC with normal motor and sensory function both R and L sides of body

24
Q

what is zone of partial preservation

A

dermatimes and myotomes caudal to the sensory or motor level that remain partially innervated

used to only apply to complete (ASIA A) injuries but now can include incomplete motor with absent voluntary anal contraction or incomplete sensory with absent deep anal pressure

25
sensory incomplete complete ASIA level
ASIA B sensory but not motor preserved at sacral segments
26
motor incomplete ASIA levels
ASIA C ASIA D
27
posterior cord syndrome
usually due to hyperextension injury common with falls or in MVAs w/o headrest motor is generally intact due to location of tracts B loss of DCML
28
anterior cord syndrome
usually due to hyperflexion injury may have an intact DCML still often lose motor and pain/temp B loss of CST and STT
29
central cord syndrome
usually due to hyperextension injury with people who have stenosis more UE involved than lower (somatotopy) tetraplegia common carying degrees of sensory impairment sacral sparing
30
brown sequard syndrome
one half SC affected DCML and corticospinal tract involvement = ipsilateral S&S spinothalamic involvement = contralateral S&S rare unless pt is stabbed or shot
31
cauda equina S&S
LMN flaccid paresis saddle anesthesia
32
below what level of injury is most likely LMN or mixed S&S
T12
33
LMN characteristics
generally below T12 hyporefelxive, flaccid, decreased tone/spasticity negative UMN signs flaccid bowel/bladder psychogenic responses for sexual function
34
UMN characteristics
generally above T12 hyperreflexia, increased tone/spasticity positive UMN signs spastic or hyper retentive bladder and bowel reflexogenic arcs for sexual function
35
describe acute care setting, when SCI pt may be here, and general focus of PT
i.e. ICU/floor 1-3 weeks getting upright tolerance and basic mobility
36
describe acute rehab setting, when SCI pt may be here, and general focus of PT
4-12 weeks learn ADLs, mobility, WC training, and bracing
37
describe LTACH, what SCI pts go here
usually with pts with higher SCI or on vents also could be after flap sx
38
what is outpatient PT for with SCI pts
community integration MSK injury prevention sports
39
secondary complications of SCI for the cardio/pulm system
pneumonia aspiration diaphragmatic/respiratory mm impairement PE/DVT BP management
40
secondary complications of SCI related to ANS
autonomic dysreflexia - can be fatal (T6 and above) BP management sweating response unopposed parasympathetic drive with injuries above T6
41
S&S of autonomic dysreflexia
HTN bradycardia HA profuse sweating increased spasticity vasodilation above lvl of injury (flushing) constricted pupils nasal congestion pilierecition (above lvl injury) blurred vision dry/pale skin (vasoconstrict below lvl)
42
secondary neurologic complications following SCI
tone/spasticity changes neuropathic pain sensory loss
43
secondary complications following SCI involving MSK system
motor loss osteoporosis secondary overuse injury heterotopic ossification osteomyelitis (in setting of pressure injury)
44
secondary psychological complications for SCI
adjustment to trauma/loss high depression rates high psychiatric illness dx post injury higher health care utilization for psychiatric dx
45
GI/GU secondary complications following SCI
UTI (leading type of infection following SCI) reflexive bowel/bladder (UMN) flaccid bowel/bladder (LMN)
46
SCI pts have high risk of pressure injury due to
decreased sensation, mobility, and blood flow as well as increased potential for incontinence
47
stages of a pressure injury
1 = intact skin but non blanchable 2 = partial thickness looks like blister/scrape 3 = full thickness, into subcutaneous fat layer stage 4 = full thickness, involving muscle or bone
48
what is a deep tissue pressure injury
persistent and non blanchable discoloration with dark wound bed due to prolonged pressure or shear may evolve to stage 3 or 4 pressure injury
49
PT management/focus in acute care
early mobility once stable focus of exam: sensory/motor, respiratory function, skin integrity, PROM, BP fluctuation intervention: -PROM/prevent contracture -BP management with position change -Respiratory fxn -pt edu -upright positioning -basic mobility
50
PT management/focus in acute rehab
PT exam: ROM, strength, outcome measures, functional mobility levels interventions: -aerobic -skin integrity/management -ADLs/functional mobility -pain/spasticity management -edu -strength -DME, WC, bracing
51
LTACH PT management/focus
mobility with pt as able exam focus: sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations interventions: -PROM/contracture prevention -Skin prevention or treatmetn -BP management with positioning -respiratory function -edu -upright positioning -basic mobility
52
PT management/focus for outpatient
exam focus: MSK/neuro/cardio pulm/skin integrity; knowledge of SCI and level of independence PT intervention: -community reintegration/navigation -goal directed activities (i.e. childcare, return to work) -prevent overuse MSK injury -overall strengthening -CV endurance -pain management
53
considerations for durable medical equipment with SCI pts
padded shower chair custom WC bracing walker/mobility device adaptive equipment ramps grab bars tach supplies O2
54

Year 2: Neuromuscular II (18 decks)

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