CV and Pulm PT Considerations in SCI Patients

Question 1

What spinal levels innervate the sympathetic nervous system?

Answer 1

T1-L2/3

Question 2

What spinal levels innervate the parasympathetic nervous system?

Answer 2

Some cranial nerves
S2-S4

Question 3

The cardiac system is primarily innervated by what spinal levels?

Answer 3

Vagus nerve - Para
T1-T5 - Symp

Question 4

Physiological action of the parasympathetic nervous system on the heart

Answer 4

Decreases HR below 100 and decreases contractility

Question 4

Physiological action of the sympathetic nervous system on the heart

Answer 4

Increase HR over 100 BPM and increase contractility

Question 5

If cardiac sympathetic control is lost in an SCI, how is the HR and CO impacted during activity?

Answer 5

Blunted. Will have trouble going over 100 BPM

Question 6

Vascular sympathetic nervous control is innervated by what spinal levels? What is the physiologic action?

Answer 6

T1-L2
Smooth muscle contraction (vasoconstriction)

Question 7

Vascular parasympathetic nervous control is innervated by what spinal levels? What is the physiologic action?

Answer 7

Trick question. There is no vascular parasympathetic innervation.

Question 8

Sympathetic innervation of the sweat glands. What is the physiologic action?

Answer 8

T1-L2
Cools body off

Question 9

T/F there is no parasympathetic innervation to the sweat glands.

Answer 9

True

Question 10

Upper body, head and neck, and hear vascular SNS innervation:

Answer 10

T1-T5

Question 11

Lower body vascular SNS innervation:

Answer 11

T6-L2

Question 12

Diaphragm innervation:

Answer 12

C3-C5

Question 13

Intercostals innervation:

Answer 13

T1-T11

Question 14

Abdominals innervation:

Answer 14

T6-L1

Question 15

What is the first reflex to reapper after spinal shock starts to subside?

Answer 15

Bulbocavernosus reflex

Question 16

Management of spinal shock

Answer 16

Hyper-drive BP (via medications) for spinal cord perfusion

Question 17

PT implications of spinal shock

Answer 17

Monitor for changes

Question 18

Inotropic effect

Answer 18

Increased HR

Question 19

Vasopressor effect

Answer 19

Increased BP

Question 20

Three medications appropriate for acute bradycardia:

Answer 20

• Parasympatholytic (inhibit PNS)
• Inotropic
• Vasopressor

Question 21

Management for acute bradycardia

4 items

Answer 21

• ECG monitoring
• Medications
• IV fluids
• Pacemakers

Question 22

Management for Low exercise tolerance

4 items

Answer 22

• Early mobilization/fxnl training
• Aerobic exercise
• Energy conservation
• Adaptive equipment

Question 23

5 risk factors for CVD:

Answer 23

• Physical inactivity
• Dyslipidemia
• BP irregularities
• Abnormal glycemic control
• Chronic inflammation

Question 24

Causes for acute and chronic orthostatic hypotension

Answer 24

* Acute: neurogenic shock * Chronic: Loss of SNS and active muscle pump

Question 25

Management of orthostatic hypotension | 5 items

Answer 25

* Pharm (midodrine) * Early mobilization/fxnl training * Compression garments * FES w/ exercise * Tilt table progression

Question 26

PT implications for exercise induced hypotension | 3 items

Answer 26

* Compression garments * Longer cool-down * Exercise in cool environments (minimize vasodilation)

Question 27

What causes exercise induced hypotension?

Answer 27

Loss of SNS to increase HR and PVR

Question 28

Management of DVT and PE | 4 items

Answer 28

* Anticoagulants * Compression garments / SCD * IVC filter (greenfield filter) * Mobilization, AROM and exercise

Question 29

Autonomic dysreflexia occurs in people with an SCI above what level?

Answer 29

T6

Question 30

# Identify: Defined as a sBP increase of 20-30 mmHg above RESTING BP (which is often lower than normal).

Answer 30

Autonomic dysreflexia

Question 31

What causes autonomic dysreflexia in SCI patients?

Answer 31

Noxious stimuli below the LOI

Question 32

Management of autonomic dysreflexia | 5 items

Answer 32

* Sit Pt upright * Loosen clothes * Identify and resolve irritant * If still elevated, pharmacological management * **Patient education and prevention is KEY**

Question 33

Three most common causes of autonomic dysreflexia:

Answer 33

* Bowel * Bladder * Pain

Question 34

At rest, inhalation is controlled by what?

Answer 34

The diaphragm and intercostals

Question 35

At rest, expiration is controlled by what?

Answer 35

Atmospheric pressure

Question 36

During exercise, inhalation is controlled by what?

Answer 36

Diaphragm, intercostals, accessory inspiratory mm

Question 37

During exercise, expiration is controlled by what?

Answer 37

Abdominals, intercostals, accessory expiratory mm

Question 38

SCM innervation

Answer 38

Spinal accessory n. and C2-3

Question 39

Trapezius innervation

Answer 39

Spinal accessory n. and C3-4

Question 40

Scalenes innervation

Answer 40

C3-C8

Question 41

Pectoralis major innervation

Answer 41

C7-T1

Question 42

Quadratus lumborum innervation

Answer 42

T12-L3