Test 3 - SCI Flashcards
neurologic level
lowest level on the spinal cord where key muscles test at least 3/5 and sensation intact for this level dermatome
functional level
lowest segment which strength of key muscles graded at 3+/5 or higher and sensation intact
central SCI
A lesion to the centrally located structures of region, that produces sacral sparing and greater weakness in the upper limbs than in the lower limbs.
Brown-sequard Syndrome
Hemisection of the cord which produces ipsilateral (same-sided) proprioceptive and motor loss and contralateral (other side) loss of pain and temperature.
Posterior cord syndrome
Rare, results from compression by tumor or infarction of the posterior spinal artery. Proprioception, stereognosis, two point discrimination, and vibration sense are lost below the lesion.
Anterior Cord Syndrome
A lesion that produces variable loss of motor function and of sensitivity to pain and temperature, while preserving proprioception, touch and vibration.
Conus Medullaris
SyndromeInjury of the sacral cord (conus) and lumbar nerve roots within the neural canal that usually results in nonreflexive bladder, bowel and lower limbs. Sacral segments may occasionally show preserved reflexes (bulbocavernosus and micturition reflexes).
Cauda Equina Syndrome
Injury to the lumbosacral nerve roots within the neural canal resulting in nonreflexive bladder, bowel and lower limbs.
Mm and movement at C1, C2 and C3
Max A x 2 paralysis of - arms body and legsMuscles Innervated sip and puff ventilator required secretion assistance
Sternocleidomastoid
Cervical paraspinal
Neck accessory
Movement
Neck flexion
Neck extension
Neck rotation
goals: communication and w/c mobility
Mm and movement at C4
Max A Have : head and neck weak : shoulder sip and puff secretion assistance
Muscles Innervated Upper/Lower trapezius Diaphragm Cervical paraspinal muscles Levator scapulae
Movement Neck flexion Neck extension Neck rotation Scapular elevation Inspiration
goal: feeding independence
Mm and movement at C5
May assist with dressing Full head and neck movement good shoulder movement ELBOW FLEXION hand control w/c secretion assistance
Muscles Innervated Deltoid Biceps Brachialis Brachioradialis Rhomboids Serratus anterior Teres minor/major
Movement Shoulder flexion Shoulder abduction Shoulder extension Elbow flexion Supination Scapular adduction & abduction
goals: independence with eating, drinking, face washing, tooth brushing, face shaving, and hair care, after assistance in setting up specialized equipment.
Maybe - driving
Mm and movement at C6
WRIST EXTENSION passive key grip (tenodesis) hand control/manual w/c variable bed to chair A self-feeding secretion assistance UE dressing Writing
Muscles Innervated Pectoralis Supinator Extensor carpi radialis longus and brevis Latissimus dorsi
Movement Scapular protraction Horizontal adduction (some) Forearm supination Radial wrist extension
goals: functional goals include greater ease and independence in feeding, bathing, grooming, personal hygiene and dressing. Some individuals may also independently perform bladder and bowel management, ight housekeeping duties, transfer, do pressure reliefs, turn in bed, and drive using adaptive equipment.
Mm and movement at C7 & C8
Wrist Flexion and partial finger flexion independent transfer : bed to chair , chair to car drive with AE secretion assistance B & B independent Ind. UE dressing and bathing simple meal prep
Muscles Innervated Sternal pectoralis Triceps Pronator quadratus Extensor carpi ulnaris Flexor carpi radialis Flexor digitorum profundus and superficialis Extensor communis Pronator/flexor/extensor/abductor pollicus
Movement Elbow extension Ulnar wrist extension Wrist flexion Finger flexion & extension Thumb flexion, extension, & abduction
goals: wheelchair, greater ease in performing household work and transferring, ability to do wheelchair pushups for pressure reliefs, and the need for fewer adaptive aids in independent daily living.
Mm and movement at T1-T4
Full UB use manual w/c transfers feeding I in personal care NORMAL communication
Muscles Innervated
Intrinsics of hand including thumb
Internal and external intercostals
Erector spinae
Movement
Upper extremity
Limited trunk stability
Increasing lung capacity
C8-T1 -Functional goals include living independently without assistive devices in feeding, bathing, grooming, oral and facial hygiene, dressing, transferring, bladder management and bowel management.
T2-T6 - increasing the use of ribs and chest muscles, or trunk control.
T10-L1
Muscles Innervated
Fully intact intercostals
External obliques
Rectus abdominus
Movement
Trunk stability
For injury levels between T7 and T12, there is the added motor function of increased abdominal control. Functional goals for individuals within the six levels of injury may include improving cough effectiveness and increasing ability to perform unsupported seated activities
L2-S5
Individuals with motor function in the hip flexors, or Iliopsoas, are classified L2;
those with motor function in the knee extensors, or Quadriceps femoris, are classified L3;
ankle dorsiflexors, or Tibialis anterior, is classified as an L4 level of injury
long toe extensors, or Extensor hallucis longus, are classified L5. To be classified at any of these levels, the person must score 3 or better on the classification form at that level.
Muscles Innervated Full abdominals Full trunk musculature Hip flexors, extensors, abductors Knee flexors & extensors Ankle dorsiflexors Plantar flexors
Movement
Trunk stability
Partial to full control of LE
Walking can be a viable functional goal for some people with the help of specialized leg and ankle braces. The level of injury is also a factor. Individuals with lower levels of injury will walk with greater ease with the help of assistive devices
To classify an individual with an S1 level of injury, motor function of the ankle plantar flexors, specifically the Gastrocnemius, must score 3 or better on the classification form
goals: increased ability to walk with fewer or no supportive devices. Depending on the level of injury, there are also various degrees of return of voluntary bladder, bowel and sexual functions. Greater improvements in function occur the lower the level of injury.
damage to the central SC will lead to what pattern?
bilateral loss of pain and temperature b/c that is what the central tract carries
What levels would be associated with quadriplegia?
C1-C8
What levels would be associated with paraplegia?
T1 and below
At what levels does autonomic dyreflexia occur?
T6 and above
resulting in acute, uncontrolled hypertension
an imbalanced reflex sympathetic discharge, leading to potentially life-threatening hypertension
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Key levels for determining levels of lesion
Elbow flexors (biceps flexes forearm) C5 Wrist Extensors (cock-up wrist) C6 Elbow Extensors (triceps straightens elbow) C7 Finger flexors (flex fingers to grip) C8
Small finger abductors (spreads fingers) T1
Hip Flexors (flexes hip) L2 Knee Extensors (quadriceps straightens knee) L3 Ankle dorsiflexors (bends ankle up and lifts foot) L4 Long toes extensors (lifts big toe) L5
Ankle plantarflexors (calf muscles push foot down) S1
What is spinal shock?
How long does it typically last?
Complete loss of neurological function
- Diminished reflex activity below level of injury
- Affected area
- Decreased sensation
- Decreased deep tendon reflex
- Decreased blood pressure
- Flaccid muscle function
Frequent loss of bowel & bladder control
Lasts 1 day to 6 weeks
acute management
Positioning/Deformity Control
Skin integrity
Initial ADL skills
Education but action is primary feature
Start upright tolerance
Building blocks * think about what are the skills you will need them to have in order to complete ADL’s*
Strengthening/ROM- this also helps to start acclimating them to their body
Initial inpatient rehabilitation
Upright tolerance Deformity control Skin issues become more directive ADL’s Strengthening/ROM Learning body in space skills Functional mobility Spinal shock resolves Education
outpatient/ home health
Finishing what you started ROM/Strengthening Body in space ADL skills Functional mobility skills Community access Training family
autonomic dyreflexia prevention
Lesions T6 and above
Treatment
Elevate to sitting position
Take blood pressure in both arms – remember systolic BP can be in 90 – 110 mmHg range normally
Check for blockage/kinks in bladder & bowel system
Check for areas of restriction – tight clothing
Relieve urinary pressure
Seek medical attention
Stages of pressure sores 1-4
1 - red patch
2 - through epidural
3- Mm
4 - bone
