Clinical Factors of Spinal Cord Injury

Question 1

Neurogenic bladder definition

Answer 1

Bladder dysfunction caused by neurologic damage
Reduced ability to sense the full bladder
Overactivity of detrusor and external sphincter

Question 2

Detrusor external sphincter dyssynergia

Answer 2

Loss of coordination between the detrusor and the sphincter

Question 3

Complications of neurogenic bladder

Answer 3

Common: UTIS, blocked catheter, incontinence

Long term: renal dysfunction, detrusor hypertrophy, stones, increased risk of cancer

Question 4

Neurogenic bowel usually results in…. (4)

Answer 4

Prolonged bowel transit time
Altered sphincter control
Constipation
Incontinence (including overflow)

Question 5

Pressure ulcer

Answer 5

Localized injury to the skin and/or underlying tissue usually over a boney prominency as a result of pressure or pressure in combo with shear/friction
Common, but often preventable

Question 6

Neuropathic pain in SCI

Answer 6

Burning, tingling, cold pain
Often below level of injury
Check for contributing factors (ex: UTI)

Question 7

Spasticity

Answer 7

Velocity dependent
Increases in tonic stretch reflexes (muscle tone)
From hyper-excitability of the stretch reflexes
One component of the upper motor neuron syndrome

Question 8

5 positive signs of UMN syndrome

Answer 8

Spasticity
Rigidity
Hyperreflexia
Primitive reflexes
Clonus

Question 9

3 negative signs of UMN syndrome

Answer 9

Lack of strength
Lack of motor control
Lack of coordination

Question 10

How to deal with spasticity

Answer 10

Non-pharm: stretching (in the morning especially), positioning
Meds: baclofen
Injections (botulinum toxin)
Surgical (intrathecal baclofen pump)

Question 11

What is the typical BP for a tetraplegic?

Answer 11

SBP 90-110

Question 12

Orthostatic hypotension

Answer 12

Decrease in SBP of at least 20 mmHg
Or a reduction in DBP of at least 10 mmHg
When changing from lying down to sitting up

Question 13

Autonomic dysreflexia

Answer 13

Medical emergency
Sudden rise in BP in response to a noxious stimuli (>20mmHg SBP)
At risk if your SCI is T6 or higher (above the major splanchnic outflow)
Can result in complications, including stroke/death

Question 14

Signs and symptoms of autonomic dysreflexia

Answer 14

Pounding headache
Change in HR (usually bradycardia)
Flushed skin above level of injury
Sweating above level of injury
Anxious feeling
Blurred vision
Nasal congestion
Piloerection above level of injury
Pale skin below level of injury

Question 15

What is the most common cause of AD

Answer 15

Bladder causes!

Question 16

Treatment for AD

Answer 16

Take BP in patients with SCI and know baseline
Sit up (reduce cranial blood flow), loosen tight clothing, check bladder function
Continue to monitor
Consider treating pharmacologically