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Exam 2–SCI Flashcards

(58 cards)

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1
Q

C1-3: Possible movements

A

Neck flexion, Extension, & Rotation.

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2
Q

C1-3: Patterns of weakness

A

Total paralysis of trunk, UEs, LEs, & dependent on ventilator.

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3
Q

Functional Expectations of a C1-C3 injury

A

Respiratory: Ventilator dependent.

ADLs: Dependent.

Wheelchair mobility:
* Independent with power WC with alternative control (sip n puff & proportional chin control)
* Dependent with manual WC (tilt in space WCs to assist with weight shifts for pressure ulcers).

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4
Q

C4: Function gained from C1-3

A

Scapular elevation & better inspiration.

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5
Q

C4: Muscles innervated

A

Upper traps; diaphragm; cervical paraspinal muscles

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6
Q

C4: Patterns of weakness

A

Paralysis of trunk, UEs, LEs, inability to cough, endurance & respiratory reserve low secondary to intercostals.

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7
Q

C4: Functional expectations

A

Respiratory: MAY be able to breathe independently (no coughing)

ADLs: Dependent.

WC Mobility:
* Independent with power WC & alternative controls (sip n puff & proportional ching control).
* Dependent with manual WC (tilt in space, assisting with weight shifting for pressure ulcers

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8
Q

C1–C4: Therapy Focus

A

Pt Education: Teach pt how to direct own care (turning, weight shifting, bowel & bladder mgmt, routines)

Caregiver Training: Training others the proper techniques for dressing, hygiene, WC positioning & maintenance.

Ordering & training use of appropriate equipment for pt & caregivers

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9
Q

Equipment for C1–C4

A

Tilt-in-space Manual WC: Useful for brand-new injuries (still dependent).
* Allows weight shifting off of ischial tuberosities (pressure ulcers).

Tilting shower commode chair available for this population

Transportation
* Lowered-floor minivan
* Full-size van with raised roof: lowering powered ramp.
* EZ lock tie-down system.

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10
Q

C5: Function gained from C4

A

Deltoids
Biceps

Hand to mouth pattern ability

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11
Q

C5: Patterns of weakness

A

Elbow extension
Pronation
Wrist & hand movement

Total paralysis of Trunk & LEs

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12
Q

C5: Functionally relevant muscles innervated:

A

Deltoid
Biceps
Brachialis
Brachioradialis
Rhomboids
Serratus anterior (partially innervated)

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13
Q

Functional Expectations of C5

A

Respiratory: Independent breathing, weak cough = assistance clearing secretions.

ADLs:
* Feeding: Setup
* Grooming: Partial to total assist
* Dressing:
– UE: Partial assistance
– LE: Total assistance
* Toileting: total assistance
* Bathing: total assistance

WC Mobility:
* Independent with Power WC
* Some may self-propel Manual WC (unless terrain)

Transportation:
* Some may drive independently with highly specialized equipment (most don’t)

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14
Q

Adaptive Equipment for C5

A

U-Cuff: W/ deltoid & bicep but no wrist movement.
Button-hook zipper pull.

Plate Guard: Push food to it rather than off the plate.
Mobile arm support: Deltoid & bicep support. Helps strengthen C5 muscles appropriately, avoiding development of compensatory movements (shoulder hiking).

Due to inability to operate standard joystick on a power WC:
* Goal post handle
* Ball handle

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15
Q

C6: Functionally relevant muscles innervated

A

Clavicular pectoralis supinator
Extensor carpi radialis longus & brevis (Radial wrist extension)***
Serratus anterior (Scapular protraction)
Latissimus dorsi (Horizontal adduction)

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16
Q

C6: Movements possible, gained from C5

A

Scapular protraction
Some horizontal adduction
Forearm supination
Radial wrist extension***
– Allows for Tenodesis Grasp

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17
Q

C6: Patterns of weakness

A

Wrist flexion
Elbow extension
Hand movement

Total paralysis of trunk & lower extremities

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18
Q

What is the most important concept for a C6?

A

Ability for Radial Wrist Extension = Tenodesis Grasp.
* Stretching: Don’t overstretch flexor tendons
* Splinting: Maintain thumb opposition

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19
Q

C6: Functional expectations

A

ADLs:
* Feeding: Partial assist to independent
* Grooming: Partial assist to independent
* Dressing:
–UE: Independent
* LE dressing, Bowel & Bladder Management: Partial assist (some may achieve independence)

WC Mobility:
* Power WC independence
* Manual WC: Partial assist to independent with custom setup

Transportation:
* Independent: may transfer or drive from WC

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20
Q

C6: Adaptive Equipment

A

Built-up handle utensils, e.g. rocker knife (Tenodesis grasp)

(or educate them how to use utensils using Tenodesis grasp)

Driving Equipment: Spinner knob, tri-pin for steering wheel.

Bathing: (Always padded) tub transfer bench, rolling shower commode chair (for roll-in shower)

Manual WC:
* Rigid frame: Light-weight & sturdy
* Folding frame: (easier to get into car)

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21
Q

C7–C8: Movements possible

A

Elbow extension
Wrist extension (ulnar side)
Finger flexion & extension
Thumb flexion, extension, & abduction

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22
Q

C7–C8: Patterns of weakness

A

Paralysis of trunk & LEs
Limited grasp release & dexterity secondary to intrinsic muscles of the hand

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23
Q

C7–C8: Functional expectations

A

ADLs:
* Feeding: Independent
* Grooming: Independent
* Dressing:
– UE: Independent
* UB Bathing: Independent.
* LE dressing, LB bathing, Bowl & Bladder management: Partial assist to independent.

WC Mobility:
* Manual WC: Independent indoors (not if terrain)

Transportation:
* Independent with specialized equipment

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24
Q

T1–T9: Functionally relevant muscles innervated

Study These Flashcards
A

Intrinsics of the hand
Lumbricals
Pollicis muscles (^^full independence in UEs)
Intercostals (increased endurance)
Erector spinae (upper/partial trunk stability)

25
T1–T9: Movement possible
UEs full functioning Limited upper trunk stability (erector spinae) Endurance increased secondary to intercostals
26
T1–T9: Patterns of weakness
Lower trunk paralysis Total paralysis of LEs
27
T1–T9: Functional expectations
ADLs: Independent WC: Independent Transportation: Independent in driving, including loading & unloading WC
28
T10–T11: Functionally relevant muscles innervated
External obliques Rectus abdominis Intact intercostals
29
T10–T11: Movement possible
Good trunk stability
30
T10–T11: Patterns of weakness
Paralysis of LEs Good trunk stability emerges here (external obliques, rectus abdominis)
31
T10–L1: Functional expectations
(muscles gained: external obliques, rectus abdominis, & intact intercostals = Good trunk stability & possible standing!) ADLs: Independent WC: Independent Transportation: Independent including loading & unloading WC. Standing/ambulation: Supervision to independent using bracing (crutches or walker)
32
L2–S5: Movement possible
Gooder trunk stability Partial control of LEs
33
L2–S5: Patterns of weakness
Partial paralysis of LEs
34
L2–S5: Functional expectations
ADLs: Independent WC: Independent Transportation: Independent including loading & unloading WC Standing/Ambulation: * Standing: Independent * Ambulation: Independent to some assist
35
When does feeding & grooming independence emerge?
C6 (Partial/setup assist to Independent)
36
When does manual WC independence emerge?
C6: partial to independent C7–C8: Independent indoors
37
When does the hand-to-mouth pattern emerge?
C5 (deltoid & bicep functiion)
38
When does full independence in all ADLs emerge?
T1–T9
39
When does respiratory independence emerge?
C4 (may require assistance clearing secretions)
40
When does driving independence emerge?
C5 (with highly specialized equipment–stay in chair using tie-down system)
41
When does FULL driving independence emerge?
T1–T9 (including loading & unloading) – Full-hand functioning – Limited trunk stability (erector spinae)
42
ASIA A
Complete = No motor or sensory function is preserved in sacral segments S4–5.
43
ASIA B
Incomplete: Sensory intact but no motor function preserved below neurological level.
44
ASIA C
Incomplete: Motor preserved below neurological level, more than half of key muscles below level of injury are muscle grade of <3.
45
ASIA D
Incomplete: Motor preserved below neurological level, more than half of key muscles below level of injury are muscle grade of >3.
46
ASIA E
Normal sensory & motor return.
47
ASIA Sensory Grading
0 – Absent 1 – Altered 2 – Normal
48
ASIA Muscle Grading
0 – Total paralysis 1 – Palpable or visible contraction 2 – Active movement, full ROM with gravity eliminated 3 – Active movement, full ROM, against gravity 4 – Active movement, full ROM, against gravity, providing some resistance 5 – Active movement, full ROM, against gravity, providing normal resistance
49
Decubitus: what/why? prevention?
What: ulcer from constant pressure in a static position without shifting. Prevent by shifting weight: –Seated: one minute/hour – In bed: change position every 2 hours
50
Central cord SCI
Most common Incomplete = sacral sensory sparing Caused by falls (common in older people) Greater weakness in UE than LE Results in cervical stenosis.
51
Brown-sequard SCI
Incomplete Damage to half the cord = Ipsilateral proprioception & motor loss Contralateral loss of sensation Common cause is knife or gunshot wound
52
Anterior cord SCI
Incomplete All motor functions absent below injury level Proprioception & sensation remain.
53
Conus medullaris
Injury to the Sacral Cord = flaccid paralysis of LEs
54
Cauda equina
Injury to lumbosacral nerve roots in the spinal canal Areflexic bladder & bowel; paralysis or weakness of LEs
55
Tetraplegia vs. Paraplegia
Tetraplegia: Injury to the cervical spinal cord = Impaired UE, LE, & trunk function Paraplegia: Impaired LE function & possibly trunk
56
Common tests related to SCI?
ROM MAS: Modified Ashworth Scale (spasticity) SCIM: Spinal Cord Independence Measure. GRASSP: Graded Redefined Assessment of Strength, Sensibility & Prehension – Measures hand function (designed for patients with Tetraplegia)
57
Common tests related to SCI?
ROM MAS: Modified Ashworth Scale (spasticity) SCIM: Spinal Cord Independence Measure. – Questionnaire for functional independence. GRASSP: Graded Redefined Assessment of Strength, Sensibility & Prehension. – Measures hand function (for pts with tetraplegia)
58
Complications of SCI?
*Autonomic Dysreflexia (find & eliminate the cause–bladder, drainage obstructions. Have pt maintain upright position) *DVT: Deep Vain Thrombosis (blood clot, usually in leg–anticoagulants) *Heterotrophic Ossification (bones forming where they shouldn't) *Orthostatic Hypotension (lay back down) *Pressure ulcers (decubitus ulcers) *Pain *Spasticity *Temperature Regulation (educate neutral temperatures)

Adult (4 decks)

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