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Exam 2 SCI Flashcards

1
Q

What controls bowel and bladder?

A

Conus medularis

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2
Q

Does spastic bladder occur above or below conus medularis? What about flaccid bladder?

A

Above

Below

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3
Q

Spastic bladder

A

Reflexively empty at certain point
Pull hair
Tap pubis
Stroke abdomen

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4
Q

Flaccid bladder

A

Valsalva to raise bp
Creed maneuver: above pubis curl stomach and push in and down
Catheterization intermittently

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5
Q

Timed voiding

A

Every x number of hours try and go to restroom, start 2 hr increments, use techniques, cathertize if need be

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6
Q

Other bowel and bladder programs

A

Meds
Bladder intermittent catherterization
Bowel, adult diapers

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7
Q

Do men have greater erection capacity above or below cm? What about lower capacity?

A

Above

Below

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8
Q

Erection type: reflexogenic

A

Occur in response to external physical stimulation of genitals
Must have intact reflex arch

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9
Q

Psychogenic erection type

A

Occur through cognitive activity

More difficult to attain

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10
Q

Ejaculation

A

More likely if below CM
Lower level vs. higher level
Incomplete
Spasm, so backdown prevents ejaculation

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11
Q

Children and sexual dysfunction

A

Generally spermatogenesis decrease
Ejaculation difficult: improve with vibration
IVF best option

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12
Q

Menstruation

A 
Interrupted for 1-3 months after injury
Conception unimpaired
Arousal and female sexual response occur if injury above CM
May not feel labor
Labor cause AD
C sections common
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13
Q

Osteogenesis

A

Soft tissues below level of spinal lesion (soft tissues ossify)

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14
Q

Heterotrophic ossification

A

Always extra articular
Always extra capsular
Occurs adjacent to large joints: hip knee and spine
Interventions:
Surgery meds PT for ROM for deformity and fxn limits

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15
Q

Pressure ulcers

A

Pressure and shearing forces
Delayed rehab, infection, and death
Develop over bony prominence
10-15 seconds pressure relief every 10 minutes

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16
Q

Cushion best for pressure relief

A

Air, adjustable, do not max fill

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17
Q

Conservative traction

A

Cervical subluxation

Fraction dislocation

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18
Q

Surgery for fx stability

A

Unstable fx
Gross malalignment
Cord compression
Deteriorating status

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19
Q

Minerva

A

Type of cervial brace provides stability in all planes for fx

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20
Q

Somis

A

Does not limit motion in all planes, provide some stability post up weeks
More for scoliosis patients

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21
Q

Miami J

A

1st rigid collar developed, not used much anymore, keeps Cspine from moving

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22
Q

Vista

A

Rigid collar, more comfort than Miami J, questionable stability, thermal plastic does prevent cspine motion, may eventually crack

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23
Q

Aspen

A

Most commonly collar used, extremely stable, more comfort than Miami J, for non displaced fx or dislocation without fx

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24
Q

Bathing collar

A

More stability as muscles get stronger, before just wet wipes before

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25
Soft collar
No stability at all, comfort for patient
26
TLSOs
Body jacket, need to be supine to don,Doff, graduate to the other one, flexible plastic, reminder to not bend, flex/extend spine
27
Jewett
For scoliosis, not as affective as TLSO for stability, OP tend to fx, this stops them
28
Early mobility contra
L spine Pelvic rotation SLR greater than 60 Hip flexion beyond 90 with knee extension C Spine Motion of head and neck Shoulder flexion and abduction greater than 90
29
Special skills
Tenodesis grip: c spine injuries, wrist extensors, so not stretch extensors! Make tighter SLR of >100 para
30
WC skills test
32 skills 3 levels of difficulty Indoor, community, and advanced Higher the score the better
31
Walking index for SC injury
Looks at AD and amount of assistance required for 10M walktest Scores range 0-20 Walking ability post spinal cord Traumatic or non
32
Spinal cord injury independence scale
``` 19 areas - FIM 15 Measures independence Sub categories: self care, respiration and sphincter management, mobility Score 0-100 Based off FIM, adjusted for WC ```
33
Neuromuscular recovery scale
Measures recovery not compensation Meant to target true recovery 14 items: 4 on body wt treadmill, 10 tested on ground No use of devices
34
What is the most common side effect of long term WC use?
Shoulder pain, strengthen RC muscles
35
NDT
Neuro-developmental treatment | Bobath
36
Concepts NDT
Facilitate Activate key muscles, create correct movements Inhibit Inhibit some muscles, to create movements Handling Clinically: hands used to support and assist movement from one position to another Application: use of hands, light touch, intermittent touch or form manual contact to guide and assist movements
37
How many cases of stroke SCI per year?
11,000
38
Who is most likely for SCI?
White male
39
Age of SCI?
1970 28 | 2005 38
40
What percent are tetra and para?
56% | 43%
41
Complete SCI?
1970 52% | 2008 44%
42
Life expectancy
``` Non SCI 78.6 Incomplete 72.6 Complete para 65.2 Low tetra 60 High tetra 55.7 ```
43
Traumatic injury
Result from an external force acting on the body
44
Most common causes of injury
MVA 40.4% Falls 27.9 Violence 15% Sports 8%
45
Non traumatic
Disease or pathological influence causing SCI | 39% of all SCI
46
Causes no trauma
``` Neoplasms Vascular dysfxn- SC stroke RA OA ALS MS infection ```
47
How many vessels supply spinal cord?
3- 2 posterior | 1- anterior
48
Neurological level:
most caudal level of SC with normal motor and sensory control bilaterally
49
Motor level:
Most caudal segment of SC with normal motor function bilaterally Test: MMT 6 pt scale
50
Sensory level
Most caudal segment SC with normal sensory function bilaterally Test: light touch and pin prick 0 absent 1 impaired 2 normal
51
Complete injury:
NO sensory or motor function is preserved in lowest sacral segment S4S5
52
Incomplete Injury
Motor and/or sensory function preserved below neurological level including sensory and motor S4S5 Some motor and sensory spared at S4S5
53
Zones of partial preservation
Areas of intact motor and/or sensory function preserved below neurological level but no motor or sensory at S4S5
54
Dorsal column
``` UE Sensory Proprio, vibration, deep touch, posterior column Medial and lateral Lemniscus Ascending ```
55
Spinothalamic, spinoreticular, | Spinotectal
Pain, temp, crude touch UE and LE the same Ascending sensory
56
Spinocerebellar
Unconscious proprioception | Ascending sensory
57
Medial and lateral reticulospinal
Unconscious automatic posture adjustment, balance and automatic gait related movements Descending motor UE LE c spine and lumbar same
58
Medial and lateral vesibulospinal
``` Only through CSpine Descending motor Lateral stays ipsilateral Medial does both Position of head and neck, posture and balance ```
59
Lateral corticospinal
“Pyramidal Tract” Descending motor Voluntary movement 85% cross after medulla
60
Anterior corticopsinal
Voluntary movement (limb) Descending motor Axial muscles
61
Rubrospinal
Movement of limbs Descending motor All movements in neuroplasticity unconscious
62
Anterior cord injury lose what?
Motor function
63
Spinal cord syndrome
1/5 of all incomplete fall with in brown sequard Anterior, posterior, central cord Cauda equine
64
Brown Sequard
``` Spinal cord trisected Tracts: spinothalamic both sides Cortical spinal and medial Lemnos is lateral side Impair: pain temp course touch bil Fine touch proprio motor ipsilateral ```
65
Anterior cord
Tracts: spinothalamic and descending motor Impair: pain, temp, and motor control Happen anywhere along cord MVA because forced flexion, fall over railing, compression, bladder incontinence
66
Posterior cord
Lose sensation can lose motor too depending on how far | Extremely rare because forced extension
67
Central cord
``` Hyper extension of c spine Over age 50 Only in c spine Tracts: ascending spinothalamic Lateral cortical spinal Impair: pain, temp, motor control Disrupts flow to anterior spinal cord Can return if just pinched off ```
68
Cauda Equina
Potential impact for all nerve roots below L2 Saddle Impair: loss sensation, loss motor, bowl and bladder loss Considered part of CNS Severe disc rupture in L spine Stenosis, tumor
69
ASIA
Scores are letter and number Grade A: complete Low enough to raise leg bil KfO use abs to move foot B: incomplete sensory preserved Not fxn walk, stand abs pull forward C: incomplete motor preserved below grade 3 Not fxn walk, walk for exercise WC primary mobility D: incomplete above grade 3 Fxn walk need bracing E: normal
70
ASIA for nerve root
``` C5 elbow flexion C6 wrist extension C7 elbow extensors C8 ginger flexors CT1 finger abductors L2 hip flexors L3 knee extensors L4 ankle df L5 long toe extensors S1 ankle pf ```
71
Spinal shock
Period or areflexia following SCI Autonomic regulation impaired Revolves 1-3 days Areflexia 24hrs
72
Autonomic dysreflexia
Lesions above T6 more common in Chronic and complete Cause: irritation below level of injury bladder distension or blocked catheter, pressure ulcer, kidney Malfxn, labor, estim, pain Symptoms: headache, sweat, increased spasticity, vasoconstrict below injury, blur vision, increase bp, constricted pupils
73
Interventions AD
``` Emergency! Monitor vitals Bring to upright posture Loosen any tight clothing Check source: bladder and bowels ```
74
Spastic hypertonia
65% individuals with SCI More common incomplete Up to 50% individuals report spasticity to problem for daily life Interventions: stretch, Meds, Botox, surgical procedures

Neuro 2 (2 decks)

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