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PTA II (Lecture) > Chapter 5. Neuro Rehab for Spinal Cord Injuries > Flashcards

Chapter 5. Neuro Rehab for Spinal Cord Injuries Flashcards

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1
Q

What are the most common level for injury

A
  • C1, C2, and C5-7

- T12-L2 (most trunk rotation)

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2
Q

Injuries named are named according to the ___ of fracture

A

vertebral level

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3
Q

*Injuries in the CERVICAL area become _____ and injires in the THORACIC area become ____
Injuries below L1 have ___

A
  • quads/tetraplegia
  • para
  • cauda equina syndrome
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4
Q

*Most common (4) types of forces (mechanisms of injury) are:

A
  1. Cervical rotation flex: (head side to side) transection of SC
  2. Hyperflexion: tear of anterior spinal artery= leading to ANTERIOR CORD SYNDROME
  3. Cervical Hyperextension
  4. Compression (ex.diving into shallow pool)
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5
Q

What leads to an ANTERIOR CORD SYNDROME ?

A

trauma; hyperflexion of your neck causing a tear of the ANTERIOR SPINAL ARTERY

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6
Q

*What is meant by COMPLETE when speaking about SCI subtypes

A

complete transection of motor and sensory tracts

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7
Q

**What are the 4 incomplete syndrome for INCOMPLETE SCI?

A
  1. Central Cord Syndrome
  2. Anterior Cord Syndrome
  3. Posterior Cord Syndrome
  4. Brown Sequard Syndrome
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8
Q

What does the Glasgow Coma state (neurologic examination) test?

A

level of consciousness

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9
Q

What are 6 neurologic exams for SCI?

A
  1. motor strength
  2. sensation
  3. Diaphragm
  4. Reflexes (ex. plantar reflex)
  5. Sacral sparing (ex. incontinence)
  6. Level of consciousness
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10
Q

**What are the Key myotomes (C5-T1)

A 
C5-deltoid
C6-biceps/wrist extensors
C7-triceps
C8-thumb extensors/finger flexors
T1-fingers abd/add
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11
Q

**What are the key myotomes for L2-S1

A 
L2-hip flexors
L3-quads (on the top)
L4-dorsiflexors
L5-big toe extensor 
S1-plantarflexion
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12
Q

*What is the different between Upper vs. Lower Motor neuron weakness

A
  • (UMN) Myelopathy=Spinal cord process

- (LMN) Radiculopathy= Nerve root process

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13
Q

*What are 3 differences between UMN and LMN?

A

UMN: -spasticity

  • tone increases
  • no fasciculations (spontaneous contraction)

LMN:-paresthesias (“pin+needles”)

  • tone decrease
  • fasciculations
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14
Q

**What does ASIA Impairment scale stand for

and what does ‘A’ and ‘E’ stand for (the extremes of the scale)?

A

(American Spinal Cord injury)
A: Complete
E: Normal

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15
Q

What is a Spinal shock?

A

loss of motor and sensory after trauma

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16
Q

Neurogenic shock involves the ___ chain and is associated with __ instability

A
  • sympathetic

- autonomic

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17
Q

Best timing of exam for Spinal/Neurogenic shock for prognosis is?

A

72 hours

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18
Q

What does a COMPLETE cord (impairment) consists of? (3)

A
  1. No sensation
  2. Flaccid Paralysis
  3. Initially areflexia(no normal reflexes)
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19
Q

What is Central Cord Syndrome caused by and what are 3 symptoms?

A
  • Hyperextension injuries
    1. Plegia of arms (UE > LE)
    2. Posterior (back) column spared; 3. Sacral sparing (sensation in sphincter control: are continent)
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20
Q

*Brown – Sequard Syndrome is caused by what?

A
  • trauma (only through gunshot)

- Tumour

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21
Q

What are some Brown – Sequard Syndrome?

Study These Flashcards
A
  • ipsilateral (one-side) motor paralysis
  • ipsilateral hyperanesthesia (excessive sensitivity)
  • contralatera (opp. side) loss of pain and temp.
22
Q

What spinal level is the Conus Medullaris? (cone-shaped end of spinal cord)

23
Q

What spinal level is the Cauda equina?

What part of the spine is injured, which causes which deficiencies?

Study These Flashcards
A
  • Spinal cord ends at: L2

- lumbosacral roots: problems with sensation in LE (ex. Bowel/bladder deficits)

24
Q

If ___ disc is pinched for longer than ___, than it is permanent

Study These Flashcards
A
  • herniated

- 24-48 hours

25
What is APOPTOSIS?
after cells die body goes to “programmed cell death"- (locally all cells die)
26
In the Acute rehabilitation phase the percentage of people having Pressure ulcers is __ and is most common over the ___
- 25% | - sacrum
27
Other than pressure ulcers what other deficits are common in the ACUTE rehab?
- pneumonia - DVT - Autonomic dysreflexia (excessive high blood pressure) - UTI (infection)
28
**What is the leading cause of death for SCI from highest to lowest (4)?
1. Pneumonia 2. PE (pulmonary embolism) 3. Heart disease 4. Sepsis (infection of blood)
29
If appearance of ____ within the cord, there is an unfavorable recovery
-hemorrhage
30
???*What is the difference between Autonomic Dysreflexia and Autonomic Hyperflexia?
Dysreflexia: high blood pressure due to problem to autonomic nervous system Hyperreflexia: LIFE THREATENING-exagerated blood pressure in response to pain (below the level of spinal cord injury)- cuz no sensation
31
How can you manage Autonomic Hyperreflexia- since it is caused by painful stimuli?
- place in sitting positiong (decrease intracranial pressure) - check for painful stimulus (where is pain) - minimize all noxious stimuli
32
* Neuropathic spinal results from______and is reported in ___ to __ % of patients - evaluation must look for other __ of __ (ex. other new conditions such as renal stones)
>changes in neuronal function and increased sponatenous activity > 6-50% >causes of pain
33
3 types of treatment for Neuropathic Spinal Pain
- Physio Therapy (electro) - anticonvulsants - antidepressants
34
***Patients without initial position sense of the _______ will likely not regain ____ (peeing) in a SCI
- great toes | - volitional voiding (peeing)
35
What is Hypertrophic Bone formation? | Treatment?
- formation of new bone in soft tissue planes surrounding a joint; most commonly in HIPS - Irradiation (radiation), ROM
36
What are 2 positive points on spasticity and 2 negative points
POS: -if you have at least a little bit of spasticity you can do transfers (after SCI) -assists mobility NEG:- interferes with positioning -spasms are painful
37
What are 2 ways to treat spasticity?
- muscle stretching=PNF inhibition, joint ROM - Botulinum Toxin:blocks release of ACh (TEMPORARY TREATMENT:effects lasts approx. 3 months=collateral sprouting of axon)
38
***What is one type of medication for Spasticity?
Baclofen
39
What are the extreme scores of the Muscle Testing for SCI?
0=total paralysis | 5=active movement, against full resistance
40
What is the minimal score needed to set functional goals with a specific level of injury on the Muscle test?
3=active movement against gravity
41
What is a functional goal for C!-C3?
- have control over shoulder elevation | - puff wheelchair (uses ventilator)
42
Those with a C4-T1, what is crucial to teach them as their functional goal?
-teach diaphragmatic breathing
43
How many degree of Lateral rotation do you need to have in the for dressing?
45 degrees
44
If cervical instability no more than 90 degrees of: | If lumbar instability no more than 90 degrees of:
- Glenohumeral flex/abd | - Hip flexion
45
When needing to exercises but not ready to go against gravity what can you do?
-lie down on back
46
How do you modify if no finger flexors are present? What level of innervation is this?
- Velcro | - C8
47
What can be donned (put on) to assist with preventing low BP?
Abdominal Binder
48
**What are 5 EARLY treatment exercises for SCI?
1. Mat activites (teach to INDEPENDENTLY roll to prevent pressure sores) 2. Prone- Scapular stregnthening (prone on elbows) 3. Supine-onto elbows to the longsitting position 4. Long sitting: pushup with hands 5. Transfers
49
*What are 5 Intermediate Treatment exercises?
1. Self ROM 2. Transfers (w/c to flor/floor to w/c) 3. Advanced wheelchair skills 4. Ascend/Descend curbs 5. Aquatic Therapy
50
*What are 4 Advanced Treatment exercises? How long is this treatment? What do you need to have to be able to do these ex.?
1. ambulation training 2. standing (with KAFO: KNEE ANKLE FOOT ORTHOTIC) 3. Forearm crutch gait activities 4. How to get up from floor - 2-3 months - C8 (abdominal control)

PTA II (Lecture) (13 decks)

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