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NMSK II - Exam 1 > Intro to SCI > Flashcards

Intro to SCI Flashcards

(68 cards)

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1
Q

What is SCI?

A

Gamage to the spinal cord resulting in symptoms below the level of injury

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2
Q

How many cases annually of SCI happen in the USA?

A

-18,000 new cases annually in the USA

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3
Q

What is the most common age does SCI happen?

A

Between ages 16-30 with most being 19

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4
Q

What is the percentage of men and women that get SCI?

A

Men: 80%
Women: 20

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5
Q

What is the mechanism of injury with traumantic SCI? (in order)

A
  1. MVA: 38%
  2. Falls 32%
  3. Violence: 14%
  4. Sport related injuries: 9%
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6
Q

What is the mechanism of injury for non traumatic SCI?

A

-Arterial venous malformation
-Thrombus, embolus, or hemorrhage to arterial supply of the spinal cord
-Infection of the cord (common in setting og IV drug abuse)
-MS with lesions to spinal cord
-ALS
-Spinal stenosis

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7
Q

What is the life expectancy of incomplete SCI?

A

INcomplete is longer than complete

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8
Q

What is the life expectancy of paraplegia SCI?

A

Paraplegia is longer than tetraplegia

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9
Q

What is the life expectancy of lower cervical tetraplegia SCI?

A

Lower cervical tetraplegia longer than higher cervical tetraplegia

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10
Q

When is mortalitiy rate the highest?

A

Highest in the first year after injury

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11
Q

When does spinal shock occur?

A

Happens immediately after SCI

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12
Q

How long does areflexia happen agfter a SCI?

A

Around 24 hours

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13
Q

When doe reflexes gradually return after SCI?

A

Over 1 to 3 days

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14
Q

When would you perform the ASIA exam after SCI?

A

Between 1 to 3 days when reflexes gradually return?

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15
Q

How long can a patient have after SCI?

A

About 1 to 4 weeks

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16
Q

How are SCI named?

A

Spinal level of injury
Anatomical location of injury in cord
Completeness of injury

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17
Q

What are the AISA and ISNCSCI used for?

A

Looks at motor and sensory levels bilateral as well as sacral tone and sensation to determine:
1. Motor level of injury
2. Sensory level of injury
3. Neurological level of injury
4. Complete or incomplete
5. Zone of partial preservation

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18
Q

What is ASIA level A?

A

Complete
No motor or sensory function is preserved below the neurological level and includes

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19
Q

What is ASIA level B?

A

Incomplete
Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4 to S5

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20
Q

What is ASIA level C?

A

Incomplete
Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3

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21
Q

What is AISA level D?

A

Incomplete
Motor function is preserved below the neurological level of injury, and more than half of key muscles below the neurological level have a muscle grade of 3 or more

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22
Q

What is ASIA level E?

A

Normal
Motor and sensory function is normal

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23
Q

How is motor level of injury determined?

A

Determined by testing 10 key muscles on the right and left side of the body
(the lowest myotome that has a grade of at least a three if the one above it is a 5

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24
Q

How is the sensory level of injury determined?

A

Determined nu light touch and pin prick on both right and left side of the body
(the most caudal level with normal light touch and pinprick sensation)

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25
What is the neurological level of injury?
The most caudal level of the spinal cord with normal motor and sensory function both the right and left side of the body
26
What is zone of patrial preservation?
Used to apply only to complete injuries (ASIA A) and defined as: Dermatomes and myotomes caudal to the sensory or motor level that remain partially innervated
27
What are the different types of spinal cord syndromes?
Anterior cord Central cord Brown sequard Posterior cord Conus medullaris syndrome Cauda equina syndrome
28
What is brown sequard syndrome?
Occurs from hemisection of the spinal cord (damage to one side) and is typically a penetration wound (gunshot or stab)
29
What happens on the ipsilateral and contralateral side of the body during brown sequard syndrome?
Ipsilateral: Loss of proprioception, light touch, and vibratory sense Contralateral: Loss of sense of pain and temperature
30
What tract is involved with the ipsilateral side of the body with brown sequard syndrome?
DCML and Lateral corticospinal tract
31
What tract is involved with the contralateral side of the body with brown sequard syndrome?
Spinothalamic tract
32
What is the cause of anterior cord syndrome?
Frequently related to flexion injuries of the cervical region with resultant damage to the anterior portion of the cord or vascular supply from the anterior spinal artery
33
What type of functions do you lose during the anterior cord syndrome?
Loss of motor function and loss of sense of pain and temperature below the level of lesion
34
What tracts are injured during anterior cord syndrome?
Bilateral loss of Corticospinal tract and Spinothalamic tract
35
What is the most common cause of central cord syndrome?
Occurs from hyperextension injuries to the cervical region Also associated with congenital, degenerative narrowing of the spinal canal
36
What are the symptoms of central cord syndrome?
UE's more affected than LE's, varying degrees of sensory impairment, sacral sparing
37
What are the symptoms of posterior cord syndrome?
Bilateral loss of DCML
38
What are the symptoms of conus medullaris?
Mixed LMN and UMN
39
What are the symptoms of cauda equina syndrome?
LMN, flaccid paresis, saddle anesthesia
40
Where are UMN injuries present?
Above the conus medullaris
41
Where are LMN injuries present?
Below the conus medullaris
42
What are the signs and symptoms present of LMN injuries?
Generally below T12 Hyporeflexia Flaccidity Decreased tone/spasticity Negative UMN signs Flaccid bladder and bowel Psychogenic responses for sexual function
43
What are the signs and symptoms present of UMN injuries?
Generally above T12 Hyperreflexia Increased tone/spasticity Positive UMN Signs (Babinski and Hoffmans) Spastic or hyperreflexive bladder and bowel Refleogenic arcs for sexual function
44
What are the general considerations for acute care settings?
ICU Floor 1 to 3 weeks Getting upright tolerance Basic mobility
45
What are the general considerations for acute rehab settings?
4 to 12 weeks Learning ADL's Mobility Wheelchair training Bracing
46
What are the general considerations for LTACH settings?
Usually patients with higher level SCI on vents Or after flap surgery
47
What are the general considerations for out-patient settings?
Community integration MSK injury prevention Sports
48
What are secondary complications for cardiovascular/pulmonary function?
Pneumonia (PNA) Aspiration Diaphragmatic/respiratory muscle impairment PE/DVT BP management (Orthostatic hypotension in T6 and above injuries
49
What are secondary complications to autonomic functions?
Autonmic dysreflexia - can be fatal (T6 ad above) BP management Sweating response Loss of descending control of ascending sympathetic reflexes Lack of inhibition from higher centers
50
What are symtoms of autonomic dysreflexia?
HTN (raise of 20-30 mmHg systolic) Bradycardia Headache (severe and pounding) Profuse sweating Increases spasticity Vasodilation above level of injury (leading to flushing) Constricted pupils Nasal congestion Piloerection Blurred vision Dry, pale skin due to vasoconstriction (below level of injury)
51
What are the secondary neurological complications?
Tone/spasticity changes (depends on LMN vs UMN Neuropathic pain Sensory loss
52
What are secondary musculoskeletal complication?
Motor loss Osteoporosis Secondary overuse injuries Heterotrophic ossification Osteomyelitis (in setting of pressure injuries)
53
What are secondary psychological complications?
Adjustment to trauma and/or loss Higher depression rates Higher psychiatric illness diagnoses post injury Higher care utilization for psychiatric diagnosis
54
What are the secondary GI/GU complications?
UTI (leading type of infection following SCI Reflexive bladder/bowel Flaccid bladder/bowel
55
What are secondary integumentary complications?
High risk for pressure injuries due to: -Decreased sensation -Decreased mobility -Decreased blood flow -Increased potential for incontinence
56
What is stage 1 for secondary integumentary complications?
Intact skin, non-blancheable
57
What is stage 2 for secondary integumentary complications?
Partial thickness, looks like blister or scrape
58
What is stage 3 for secondary integumentary complications?
Full thickness, into subcutaneous fat layer
59
What is stage 4 for secondary integumentary complications?
Full thickness involving muscle or bone
60
What are deep pressure injuries?
It is persistent, non-blanchable discoloration with dark wound bed due to prolonged pressure or shear May evolve rapidly to a stage 3 or 4 level
61
What is the PT management for acute care?
-Early mobility once medically stable -Focus exam on sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations
62
What are the (PT management) interventions for acute care?
PROM/contracture prevention Skin prevention BP management with change in position Respiratory function Education Upright positioning Basic mobility
63
What is the PT management for acute rehab?
ROM, strength, outcome measure, functional mobility level
64
What are the (PT management) interventions for acute rehab?
Aerobic capacity Skin integrity/management ADL's/functional mobility Pain/spasticity management Education Strengthening DME, w/c, and bracing needs
65
What is PT management for LTACH?
Mobility as able Focus exam on sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations
66
What are the (PT management) interventions for LTACH?
PROM/contracture prevention Skin prevention or treatment BP management with change in position Respiratory function Education Upright positioning Basic mobility
67
What is PT management for out patient?
MSK, neuro, CV, Pulm, integumentary integrity Knowledge of SCI and level of independence
68
What are the (PT management) interventions for outpatient?
Community reintegration/navigation Goal-directed activities: return to sport, childcare, work, etc. Prevent MSK repetitive use injuries Overall strengthening CV endurance Pain management

NMSK II - Exam 1 (4 decks)

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