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Clinical Medicine - OT > Week 2 - Spinal Cord Disorders > Flashcards

Week 2 - Spinal Cord Disorders Flashcards

1
Q

What is a spinal cord injury?

A

Damage to the spinal cord that results in a loss of function such as mobility or feeling.

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2
Q

What can cause SCI?

A

Fracture
Dislocation
Penetration
Non-traumatic

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3
Q

A tumour is an example of what type of cause of SCI?

A

Non traumatic

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4
Q

What is the mechanism of injury for SCI?

A

Direct trauma
Compression
Ischemia

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5
Q

How long is hypoxia in SCI for injury to occur?

A

1-3 minutes

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6
Q

True or false, hypoxia for longer than 1-3 minutes causes disruption to ascending and descending nerve pathways?

A

True

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7
Q

What 3 types of impairment can SCI cause?

A

Motor
Sensory
Autonomic

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8
Q

What motor impairment can be seen with SCI?

A

Paralysis

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9
Q

What 4 sensory impairments can result from SCI?

A

Temperature
Touch
Pain
Proprioception

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10
Q

What 4 autonomic impairments can result from SCI?

A

Bowel
Bladder
Sexual function
Vasomotor

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11
Q

How many people are affected by spinal injury in Australia?

A

12,000

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12
Q

What is the highest cause of SCI?

A

Transport related injuries

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13
Q

True or false, SCI affects more females than males?

A

False, 84% are male, 16% female

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14
Q

What age group has the most frequent number of spinal cord injuries?

A

15-24 years

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15
Q

How is SCI diagnosed?

A

Imaging

Clinical assessments

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16
Q

What imaging can be used to diagnose SCI?

A

CT
MRI
X-ray

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17
Q

What clinical assessments can be used to diagnose SCI?

A

ASIA impairment scale

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18
Q

What does ASIA stand for?

A

American Spinal Injury Association

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19
Q

What does the ASIA impairment scale diagnose?

A

Neurological level and complete/incomplete injury

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20
Q

True or false: Neurological level of injury is at the same level as the vertebral level or injury/

A

False. Spinal cord segments may not arise at the same level of vertebral segment.

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21
Q

What 3 areas do we assess as practitioners for SCI?

A

Motor function
Sensory Function
Autonomic function

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22
Q

What is a complete class A on the ASIA Impairment Scale?

A

No motor or sensory function is preserved in S4/S5

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23
Q

What is an incomplete class B on the ASIA Impairment Scale?

A

Sensory but not motor function is preserved below the neurological level and includes S4/S5

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24
Q

What is an incomplete class C on the ASIA Impairment Scale?

A

Motor function is preserved below the neurological level and more than half of key muscles below the neurological have a muscle grade less than 3

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25
Q

What is an incomplete class D on the ASIA Impairment Scale?

A

Motor function is preserved below the neurological level and at least half of key muscles below the neurological level have a muscle grade of 3 or more

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26
Q

What is a normal class E on the ASIA Impairment Scale?

A

Motor and sensory function are normal

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27
Q

What is a complete injury?

A

The spinal cord is completely severed

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28
Q

What is an incomplete injury?

A

There are zones of partial preservation

29
Q

What are zones of partial preservation?

A

Some functions for several segments below injury, nil below this level.

30
Q

What is lateral preservation?

A

One side with partial sparing or at a different level

31
Q

What are the 3 points of diagnosis for SCI?

A
  1. Level of injury
  2. ASIA classification
  3. Completeness
32
Q

What is tetraplegia AKA?

A

Quadriplegia

33
Q

What segments of the spine are affected in a quadriplegic SCI?

34
Q

True or false, Quadriplegia and Paraplegia affect the upper and lower limbs?

A

False. Paraplegia affects lower limb only

35
Q

What segments of the spine are affected in a paraplegic SCI?

A

T1 and below

36
Q

Ture or false, bowel, bladder and sexual function are affected in both quadriplegia and paraplegia?

37
Q

What are the functional outcomes for injuries above T12/L1?

A

Upper motor neurone issues and reflex activity

38
Q

What are the functional outcomes of injuries below T12/L1?

A

Lower motor neurone issues and flaccid paralysis

39
Q

What is central cord syndrome?

A

Caused by hyperextension injury
Impairment greater to upper limbs
The majority are incomplete injuries

40
Q

What are the outcomes of central cord syndrome?

A

Ambulant
Bowel and bladder control
Poor hand function

41
Q

What is Brown-Sequard syndrome?

A

A unilateral injury (one side) caused by fracture/dislocation, tumour or penetrating injury

42
Q

What are the signs of Brown-Sequard?

A

Ipsilateral (Same side) loss of motor function, touch and proprioception
Contralateral (opposite side) loss of pain, temperature and touch sensation

43
Q

What is Anterior Cord syndrome?

A

Caused by flexion injury which compromises the anterior spinal artery, injuring the anterior cord and sparing the lateral and posterior cord.

44
Q

What are the signs of anterior cord syndrome?

A

Pain, temperature and touch sensation affected, intact proprioception.

45
Q

What is conus medullaris syndrome?

A

Injury to sacral and lumbar nerve roots.

46
Q

What are the signs of conus medullaris?

A

Lower limb motor impairment
LL sensory impairment
areflexic bladder
Areflexic bowel and lower extremities.

47
Q

What is Cauda equina syndrome?

A

Injuries below L2 damage spinal roots.

48
Q

What are the signs of Cauda equina syndrome?

A

Flaccid paralysis with variable prognosis

49
Q

What is spinal shock?

A

All nerve cells below the level of lesion do not function
Nil reflexes and limbs flaccid
The higher the level the more severe and persisting the shock is

50
Q

How long does it take for spinal shock to subside?

A

24 hours to 6 weeks

51
Q

What causes spinal shock?

A

Bleeding or oedema within spinal cord
Other injuries
Neurogenic shock
Complications from lying in bed

52
Q

What is early phase spinal injury management trying to achieve?

A

Avoiding neurological deterioration
Enhancing recovery
Achieving biomechanical stability

53
Q

Why would surgery be required for SCI?

A

To remove fluid, tissue, disc, bone or foreign objects pressing on the cord
To stabilise vertebra
Spinal traction for anatomical realignment

54
Q

What are the treatment goals of respiratory management?

A

Improve gas exchange and ventilation, and making sure people are getting air in and out of their lungs

55
Q

True or false, people with SCI are at high risk of respiratory infection and sleep apnoea?

56
Q

What bladder complications can SCI cause?

A

UTI, Sepsis and renal impairment

57
Q

What is Autonomic Dysreflexia?

A

T6 Lesion or above, life threatening condition that is a vascular reflex in response to a noxious stimulus.

58
Q

What are the signs and symptoms of Autonomic Dysreflexia?

A

Sweating
Blotchiness above lesion
Elevated blood pressure
Throbbing headache

59
Q

What causes Autonomic Dysreflexia?

A

Over distension of bladder or bowel
skin conditions
disorders of internal organs
musculoskeletal eg fracture

60
Q

What is the treatment for Autonomic Dysreflexia?

A

Elevate legs and lower head
remove stimulus
antihypertensive drugs if no relief
ring ambulance

61
Q

True or false, 48% of people with an injury at T6 or above will have Autonomic Dysreflexia?

62
Q

What are secondary complications of SCI associated with immobility?

A 
Oedema
Muscle shortening
contractures
scoliosis
osteoporosis
pain
respiratory complications
63
Q

What are secondary complications of SCI associated with sensory loss?

A 
Skin abrasions
burns
pressure injuries
posture and seating issues
pain
64
Q

What are secondary complications of SCI associated with autonomic function?

A

Autonomic Dysreflexia
Temperature regulation (Hyper/hypothermia)
Bladder (incontinence, UTI, renal problems)
Bowel (incontinence, constipation, haemorrhoids)

65
Q

What is the aim on SCI rehabilitation?

A

Minimise primary impairment from the SCI
Prevent secondary complications
retrain activity
promote participation

66
Q

What is the role of OT in SCI rehabilitation?

A 
Optimise independence in self-care, productivity and leisure
Self care retaining
Assessment and treatment of UL
Home assessment and equipment selection
Domestic retraining
Transport
Community living skills
Leisure skills
Vocational skills
67
Q

True or false, in most cases SCI causes are not preventable.

A

False, most causes are preventable

68
Q

True or false, SCI results in reduced life span

A

True, SCI exacerbates the aging process

Clinical Medicine - OT (35 decks)

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