Traumatic Spinal Cord Injury Flashcards by sophia carrasco

What is the average age** for injury for a traumatic SCI

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What race and gender is more common for SCI

Male and slightly higher among nonwhites

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What kind of injury is common with SCI

Incomplete tertraplegia

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What is the highest level of injury where the UEs are fullly innervated

Any above T1 is considered tetraplegia

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What are associated injuries with a SCI

– Fractures
– Loss of consciousness
– Pneumo/hemothorax
– TBI

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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

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What is the highest cause of death from a SCI

Pneumonia and respiratory system disease

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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

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What is the life expectancy for a paraplegia ASIA (A,B,C) and what about ASIA D

14 years less
6 years less

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– 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

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What are the primary SC damages

direct
acutal shearing , crushing

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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

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The SCIM is more responsive to change than ___

FIM

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What is the spinal cord injury falls concern scale modified from

FES (falls efficaicy scale)

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Are teh FES and ABC scale useful for people who cant walk

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The Transfer assessment Instrument tests function and safety of transfer in what 4 phases

– Wheelchair set-up
– Body set-up
– Flight
– Assistive technology

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The transfer assessment instrument assesses risk of what

Injury and overuse

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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

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What is the difference in tone between UMN and LMN lesion

UMN has spasticity and LMN has flaccisity

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At which level is the conus medullaris typically located at

L1/L2

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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

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What marks the ending of spinal shock

Return of anal and bladder reflexes signals the end of spinal shock

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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

1. Orthostatic hypotension 2. Decreased vital capacity 3. Atelectasis 4. Pneumonia 5. DVT 6. 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 **a****cute 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

1. Bedside treatment 2. Upright tolerance 3. Mat activities 4. Transfers 5. Basic WC skills 6. Power building & conditioning ex 7. Advanced WC skills 8. Gait 9. 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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