SCI Flashcards
C1-C3 functions
- need respirator/ventilator
- limited head and neck movement
- Able to use “sip and puff” wheelchair, eye gaze
- Completely dependent in ADLs and transfers
C4 functions
- full mobility of the head and neck
- no respirator, ADL/transfer dependent
- Possibility of autonomic dysreflexia
- “Sip and puff” mouthstick power wheelchair required
C5 functions
ELBOW FLEXION
- Supination, no finger/wrist movement
- mobile arm support
- Electric wheelchair with hand control may be used
C6 functions
WRIST EXTENSORS
- Independent in transfers from toilet to wheelchair
- can reach forward.
- splint to promote wrist tenodesis.
- Able to do some ADLs : shaving, dressing UB
- Assistance for LB dressing & transfer from bed to wc
C7 functions
TRICEPS for elbow extension
- partial intrinsic hand muscles
- wrist flexion, finger extension (reduced grasp)
- I: self care, transfers
- Mod I: feeding, bathing, grooming, toileting
- Mod I to min: Dressing
- some assistance for bowel/bladder care
- manual wc with wc pushups for pressure relief (depression relief techniques)
C8-T1 functions
- Full UE control, including fine coordination and
grasp - I: personal care (few hours of homemaking assistance each day after d/c)
- Mod I: ADLs, mobility and communication
T6 functions
- Increased endurance
- Larger respiratory reserve
- Pectoral girdle stabilized for heavy lifting
- ADLs Independent (No assistive devices)
- Uses braces with great difficulty for ambulation
T12 functions
- Improved endurance and trunk control.
- ADLs/IADLs independent
- long leg braces and crutches, wc for energy conservation
L4 functions
- Independent in all activities plus ambulation
- involuntary bowel and bladder control
How should sensation testing be conducted in a SCI?
- Tested proximal to distal
- Vision occluded
- Test uninvolved side first
At what SCI level can a person use a universal
cuff?
C5
what stage does tenodesis occur?
C6
What is spinal shock?
can start 30 min after injury, lasts 4-8 weeks
- acute physiological loss or depression of spinal cord function following a spinal cord injury
- Associated loss of sensorimotor function and flaccid paralysis lasting several days
- all reflex activity gone below level of injury
- transitions to spasticity
- cannot evaluate deficit until spinal shock ends
ASIA E
NORMAL motor & sensory function
ASIA D
INCOMPLETE
50% of muscles more than grade 3
Can raise arms or legs off of bed
ASIA C
INCOMPLETE
50% of muscles less than grade 3
Can’t raise arms or legs off of bed
ASIA B
INCOMPLETE
sensory only, no motor
ASIA A
COMPLETE
no motor, no sensory, no sacral sparing
what is the tone of muscles after a SCI?
initially flaccid below level of injury then become spastic
- hyperactive sympathetic functions
- sensory loss below LOI
orthostatic hypotension
low BP while upright
- lean client back/help them lie down to return to normal
- leg wraps to prevent
autonomic dysreflexia
headache, sweating, congestion, high BP, bradycardia
- sit client UP, remove restrictive clothing
- check catheterization (bladder voiding)
- T6 and above
- causes: irritants that would normally cause pain to area below injury, bladder irritants, skin irritants, sexual activity, heterotopic ossification, skeletal fx, appendicitis
- immediately discontinue sesion to allow client to stabilize and recover
what are some driving adaptations for SCI?
- palmar cuff and spinner knob to steer wheel single handedly
- pedal extensions for acceleration/braking for limited LE reach
- hand controls for acceleration/braking (all levels with paraplegia)
AE for SCI
C1-C3: eye gaze, sip & puff
C4: sip & puff
C5: mobile arm support for feeding, universal cuff, wrist cock-up splint
C6: tenodesis splint, built-up handles, sliding board, transfer board for transfers
C7: hook & loop straps
in which SCI level are wrist extensors?
C6
in which SCI level are triceps?
C7
in which SCI level are finger flexors, extensors, intrinsics?
C8
C8 functions
FINGER FLEXORS, EXTENSORS, INTRINSICS
- at risk for heterotopic ossification
- independent car transfers
- same functions as C7
- independent bladder function with intermittent catheterization
what approach is used with SCI (acute phase)?
top down approach
how often do weight shifts occur?
every 30-60 min
stage 1 pressure ulcer
- NO OPEN WOUND or tear in skin
- red
- NO BLANCHING
- Warm
- Surrounding area may feel either firmer or softer
- May report PAIN
Stage 2 pressure ulcer
- Partial thickness skin loss
- Exposed dermis
- Open wound (scrape, blister, tear)
- pain & tenderness
- Warm
- Localized EDEMA
stage 3 pressure ulcer
- Full-thickness skin loss
- Open wound (crater)
- Wound extends into fat layer
stage 4 pressure ulcer
- Full-thickness tissue & skin loss
- Open wound, visible muscle, tendon, bone
- Tunneling or undermining present
unstageable pressure ulcer
- Full thickness skin & tissue loss
- Wound completely covered by eschar or slough
hollow back is
lumbar lordosis
round back is
kyphosis
lateral curvature of the spine is
scoliosis
sciatic pain
nerve trapped by herniated disc
compression fracture
vertebral osteoporosis
spinal stenosis
narrowing of intervertebral foramen (disc)
spondylolysis
Stress fracture through pars interarticularis of lumbar vertebrae
spondylolisthesis
Vertebrae slipping out of position (forward due to pars fracture instability)
causes of low back pain
Poor physical fitness, obesity, reduced muscle strength, poor endurance
osteopenia
- REVERSIBLE weakening of bone, precursor to osteoporosis
- Risk factors: inadequate calcium intake, estrogen deficiency, and a sedentary lifestyle
UMN damage
- CNS
- CVA, TBI, SCI (cortex, brain stem, corticospinal tracts, spinal cord)
- HYPERTONIA: velocity dependent
- flexor/extensor muscle spasms
- NO voluntary movements: dyssynergic patterns, obligatory synergies
LMN damage
- PNS
- polio, Guillain-Barre, PNI, peripheral neuropathy, radiculopathy
- SC: anterior horn cell, spinal roots, peripheral nerves,
- CN: cranial nerves
- LOW TONE: not velocity-dependent
- Involuntary muscle twitching
- Voluntary movements weak/absent if nerve interrupted
windswept deformity
Pelvis rotated laterally to one side, resulting in the spine, trunk, and thighs moving to the opposite side
cauda equina
LMN lesion
- Loss of long nerve roots at or below L1 level (lost sensation, movement)
- no spinal reflex activity, areflexic bowel/bladder, loss of sensation
- nerve regeneration: often incomplete, slows/stops within a year- may become paralyzed
conus medullaris/tethered SC syndrome
- Injury of sacral cord & lumbar nerve roots, L2 lesions
- LE motor & sensory loss, weakness, pain, bowel/bladder issues
- PRESERVED: reflexes if lesion is in sacral segments
- children: lesions, fatty tumors, hairy patches, dimples on LB
posterior cord syndrome
least frequent, injury to posterior columns
- LOST: PROP
- preserved: pain, touch, temperature, motor function to varying degrees