Traumatic Spinal Cord Injury Flashcards
What is the average age** for injury for a traumatic SCI
42
What race and gender is more common for SCI
Male and slightly higher among nonwhites
What kind of injury is common with SCI
Incomplete tertraplegia
What is the highest level of injury where the UEs are fullly innervated
T1
Any above T1 is considered tetraplegia
What are associated injuries with a SCI
– Fractures
– Loss of consciousness
– Pneumo/hemothorax
– TBI
how has the the length of hospital stage for acute and IP rehab decreased
– Acute decreases from 24 to 11 days
– IP rehab decreases from 98 to 37 days
What is the highest cause of death from a SCI
Pneumonia and respiratory system disease
If a pt has a. Tretraplegia SCI injury (ASIA A, B , C) then what is their life expectancy ? what if they are ventilator depedent
20 years less
42 years less
What is the life expectancy for a paraplegia ASIA (A,B,C) and what about ASIA D
14 years less
6 years less
– Indirect
– Ischemic changes
– Metabolic changes
– Edema of cord or surrounding tissues
– Autodestructive processes over time
– Many times more devastating than primary
These are all what kind of types of SC damages
Secondary
What are the primary SC damages
- direct
- acutal shearing , crushing
What kind of injurys are a traumatic injury (4)
Hyperextension , most common in C spine
Compression
Flexion/rotation- usually results in fx dislocation , most common causes of neuro damage in thoracic region
Hyperflexion
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What are the 3 subscales for Spinal Cord Independence Measure (SCIM)
– Self-care
– Respiration/sphincter mgmt
– Mobility
The SCIM is more responsive to change than ___
FIM
What is the spinal cord injury falls concern scale modified from
FES (falls efficaicy scale)
Are teh FES and ABC scale useful for people who cant walk
No
The Transfer assessment Instrument tests function and safety of transfer in what 4 phases
– Wheelchair set-up
– Body set-up
– Flight
– Assistive technology
The transfer assessment instrument assesses risk of what
Injury and overuse
What are the 9 complication of SCI: neurological
UMN
LMN
Nerve root injury at level of injury
Spinal shock
Insufficient temperature regulation
Pain and dysesthesias
Bowel dysfunction
Bladder dysfucntion
Sex dysfucntion
What is the difference in tone between UMN and LMN lesion
UMN has spasticity and LMN has flaccisity
At which level is the conus medullaris typically located at
L1/L2
What is spinal shock
Transient, flaccid period
Cord ceases to function immediately post traumatic injury
Begins to resolve within 24 hours , lasting a few weeks
What marks the ending of spinal shock
Return of anal and bladder reflexes signals the end of spinal shock
What is a important prognostic indicator at the end of spinal shock
Motor and sensory function present
What is the spinal cord reflex center for bowel dysfucntion
S2-S4
If someone has a a UMN neurogenic (reflexive) bowel is the reflex center intacted or not and what is the bowel program
Intact
Suppository insertion followed by digital stim to reflexively empty
If someone has a LMN (Areflexive) bowel what is intact and not intact , and what bowel program do they do
Non intact reflex center
Intact abdominals
Manage diet , fluids , may need to manually evacuate
If some has a UMN lesion - neurogenic bladder what are they unable to do
Empty bowel
If someone has a LMN bladder issuee- flaccid bladder what happens
Bladder empties as it fill and u mange by timed voids and fluids monitored
How is the male and females sexual dysfucntion different
Males have extremely lower fertility rate while females fertility rate is unaffected
How is UMN and LMN lesions different for males for sexual dysfunctions
UMN: not be able to ejaculate
LMN: may not be able to get pp up
What is the skin rule for SCI patients in WC and bed
2 mins every 30 min in WC , turn in bed every 2-4 hours
What is key for skin issues in SCI patients
Prevention is key
What is the most common spots for skin issues of all SCI pressure sores during intial hospital stay
Sacrum and heel
What is the distribution of SCI grade 3 and 4 during hospital stay for pressure sores
Sacrum and heels .. fewer then all of the SCI people
What is the distribution of pressure sores for SCI grades 3 amd 4 2 years after injury
Ischium (1)
Trochanter (2)
Sacrum
Where is the SCI patient at highest risk for MSK contractures
Below level of lesion bc u cant move those mms
Where is heterotopic ossification for MSK for SCI
Below level of lesion
Where are the most common overuse injury related to MSK for SCI patient
Shoulders
What are the 6 compilations of SCI relating to cardiopulmonary/circulatory
- Orthostatic hypotension
- Decreased vital capacity
- Atelectasis
- Pneumonia
- DVT
- Autonomic dysreflexia
When does orthostatic (postural) hypotension occur
When pt is moved into vertical too quickly
What do u need to do if a patient experiences orthostatic hypotension
Lower head and raise feet ASAP
If a patient experiences orthostatic hypotension what will they required
Progressive program to build upright tolerance , not able to sit upright in WC
What equipment will u need for a patient with orthostatic hypotension
• Elastic hose and/or wraps
• Abdominal binders
• Tilt tables
• Neuro chairs/recliners
T/f: can u start vertical tolerance training by dangling at edge of bed for a patient with orthostatic hypotension
Non
T/F: autonomic dysreflexia is not life threatening
False it is
what SCI level of injury will autonomic dysreflexia occur in
Injuries below T5 or T6
What is released with autonomic dysreflexia
Release of norepinephrine at ganglia of sympathetic nervous system no longer under effective spinal cord control
What is autonomic dysreflexia triggered by
Visceral stimulus to autonomic nervous systems
T/F: if a patient has 1 episode of AD will they be more prone to have another
Yes
What are common causes of AD (6)
- full bladder
- kinked foley
- constipation
- positonion (males)
- restrictive clothing
- skin breakdown
What are symptoms of AD
- HTN
- pounding HA
- sweaty and red
- nasal obstruction
What is the response for AD
identify cause
What is the response for AD
- identify cause ( check for foley and positioning)
- create orthostatic hypotension
- call nursing or 911
50% of people with chronic SCI have ___
DM
Sooo
- decreased ability to exercise
- weight gain
- less mm mas and higher fat mass
If a SCI patient has a adynamic ileus what will happen
Prolonged bed rest
What are the acute abdominal problems with SCI patients
– Lack of sensation slows early diagnosis
– General “I don’t feel good.”
– Increased spasticity
– Fever
What are the stages of emotional adjustment
– Shock
– Denial
– Anger
– Depression
– Readjustment
What are the 2 most common psychological complications for SCI patient
Depression and anxiety
What are Gardner wells Tongs
Provides traction to minimize movement and decompress c spine
What is the Gardner-wells tongs used in conjunction with
Special bed
What does the halo vest provide and eliminate
Provieds traction
Eliminates movement of cervical spine
What does the halo vest allow
Early out of bed activities
What kind of collar is a semi Reggie foam collar that minimizes movement and can be removed for person hygiene while in bed and least restrictive
Philadelphia collar
How should the body jacket be made (TL injuries)
Custom made for maximum stability and comfort
Where does the body jacket go
Trunk from sternum to caudal to iliac crest
What kind of brace is a metal and leather frame contacting sternum , pelvis , and can have clavicle/scapula extensions to control flexion and extension
Taylor knight brace
What is the early PT mgmt for SCI pts
➢Respiratory training
➢ROM and flexibility
➢Strengthening
➢Functional training
What are some activities to increase chest expansion and keep airways clear for early PT mgmt
– Breathing exercises
– Assisted cough
– Glossopharyngeal breathing (for high
tetras)
– Suctioning
What kind of stretches should u avoid during early pt mgmt for SCI pts
- Shoulder flexion and abduction with c/o neck pain for
cervical injuries - SLR with c/o back pain for lumbar injuries
- No hip flexion > 90 for lumbar injuries
What kind of sitting should u avoid for early PT mgmt for a SCI pt
Long sitting position until at lease 90° passive unilateral SLR attained on body sides
Active and active resistive __ exercseis should be done ___ and ____ (acutely)
Shoulder
Bilaterally and symmetrically
should you do MMT beyond ASIS testing? Why or why not?
Yes bc its essential fror establishing
baseline & monitoring recovery &
effectiveness of exercise program.
During functional training for early PT mgmt for SCI patient what should u do
Progressive tolerance to vertical (closely monitor vital signs and skins)
- donning/doffing orthosis with log rolling
- bed mobility
- pressure relief weight shifts
- patient and caregiver training , emphasizing patients responsibility
What is the 9 general program progression for SCI
- Bedside treatment
- Upright tolerance
- Mat activities
- Transfers
- Basic WC skills
- Power building & conditioning ex
- Advanced WC skills
- Gait
- Pain management
75% of SCI patients have degenerative changes where
Shoulder
40% of SCI patients have what
CTS (carpal tunnel)
What levels are considered to be high tetraplegic
C1-C4
If there is a high and low pressure in a ventilator what does that mean
High: kink in tubbing ; bloackage
Low: disconnection
What are the 4 things for ventilator management
➢Know patient’s status before calling for
help.
➢Know facility’s procedures.
➢Know if patient is “in distress” or not
➢Battery management
When should u turn in bed for a SCI pt
Turn in bed every 2-4 hours
What are ways u can drive a independent power WC
– Proportional head control
– Head array
– Joystick with chin
– Sip-n-puff
– C5 joystick
When can u use a mobile arm support
If biceps are intact or present
Acts as a deltoid assist
What are therapeutic exercises for SCI patient
➢PROM
➢Scapular stabilization
➢Balance - edge of mat & control with
head
➢Tilt table, standing frames
➢Bed mobility
➢Breathing exercises
What is included with federal funding
– Social Security
– Medicare
What is included with state funding
– Medicaid (combined with federal)
– Health and Human Services (used to be DARS),
Texas Workforce Commission
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