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L12 SCI Assessment Flashcards

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1
Q

progression of SCI care

A

acute care: stabilize pt, place vent if needed
Inpt rehab: SCI program to teach function, b&b, psychosocial
outpt rehab: includes day care, clinic, ambulatory therapy

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2
Q

functional training for SCI should include:

A

positioning
mobility: WC or gait
bed mobility
transfers: car, bathroom, shower
pressure relief
equipment: for gait, WC

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3
Q

exercise for SCI should include:

A

strengthening
endurance
trunk stability
lengthening
shortening: tenodesis for C6

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4
Q

OT role in SCI

A

splinting
adaptive equipment for ADLs: shower bench, feeding, etc
self care: dressing, feeding

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5
Q

medical management of SCI includes

A

ileus
pneumonia
pressure ulcer
DVT
orthopedic: fracture or spinal surgery
Neuro: TBI/LOC
resp: weaning vent or pneumothorax
urologist: evaluate bladder and kidney function

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6
Q

Factors indicating/predicting outcomes and recovery in SCI

A
  1. incomplete vs complete injury: incomplete has better prognosis and recovery
  2. neuro level vs motor level: if they match
  3. ASIA level: what levels are 1/5
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7
Q

timeline of spinal shock

A

resolves in 48 hours
end of flaccid period

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8
Q

signs of resolved spinal shock

A

return of bulbocavernosus reflex
checked by tug on foley catheter triggering anal sphincter contraction

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9
Q

sacral sparing

A

sensation at S4-5 perianal region

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10
Q

incomplete SCI

A

motor and/or sensory function below neurological level including motor/sensory at S4/5 - sacral sparing

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11
Q

complete SCI

A

no sensory or motor function in lowest sacral segments/no sacral sparing

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12
Q

zone of partial preservation

A

a pt that has motor or sensory function below neurological level but not sacral sparing
areas of preserved motor and/or sensory function below neuro level are zones of partial preservation

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13
Q

neurological level of injury

A

most caudal level of spinal cord with normal motor and sensory function on both L and R sides of body

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14
Q

motor level

A

test 10 key muscle groups BL on ASIA
lowest myotome with key muscle grade of at least 3 with all levels above this at MMT 5

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15
Q

sensory level

A

tested with light touch and pinprick BL
normal/impaired/absent
most caudal level with normal light touch/pinprick

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16
Q

ASIA classification of different types of SCI

A

complete
sensory incomplete
motor incomplete
five levels A-E

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17
Q

ASIA grade A

A

complete injury
no motor or sensory function

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18
Q

ASIA grade B

A

incomplete
sensory preserved below level of injjury but not motor function

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19
Q

ASIA grade C

A

incomplete
motor function preserved but majority of key muscles below neuro level are <3 grade

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20
Q

ASIA grade D

A

incomplete
motor function preserved but majority of key muscles below neuro level are >3 grade

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21
Q

ASIA grade E

A

normal
motor and sensory functions are normal

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22
Q

10 muscle groups of ASIA

A

elbow flexors
wrist extensors
elbow extensors
finger flexors
finger abductors
hip flexor
knee extensor
ankle DF
long toe extensors
ankle PF

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23
Q

MMT outside of ASIA for SCI should be performed by:

A

positioning in std position or supine modified
stabilize limb
manual pressure of one joint
palpation for grades <3
use powder board to remove resistance in gravity reduced

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24
Q

Why do we test MMT outside of ASIA

A

measure progress/regression
test every muscle around area of injury

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25
cauda equina syndrome
injury below L1 severe stabbing back pain radiating along dermatomal patterns often UL, can be BL
26
cause of cauda equina
injury or infection disc herniation 45% hematoma tumor
27
tethered cord
SC gets stuck can be from growth spurt causes radicular pain w B&B dysfunction peripheral nerve injury from compression at T12-L1 similar to sciatica
28
s/s of cauda equina
areflexic B&B saddle anesthesia dermatomal radiating pain sensory and motor neuropathy/radiculopathy in LEs urinary disturbance more asymmetrical than conus medullaris
29
conus medullaris
UMN and LMN presentation due to compression of conus medullaris at end of spinal cord
30
cauda equina treatment
surgical decompression, most effective if completed in 24 hours
31
outcomes of cauda equina syndrome
48% complete recovery 18% ongoing sciatica 8% low back pain 50% had altered sensation or urinary difficulties one year later
32
conus medullaris injury etiology
spinal fracture SCI
33
conus medullaris s/s
abnormal sensations weakness B&B dysfunction BL and severe symptoms more symmetric than cauda equina
34
why is bladder management impacted in SCI
neurogenic bladder causes flaccid or spastic bladder control of bladder from S2-4 sympathetic control of bladder from thoracic sympathetic chain parasympathetic control of bladder relaxation from L2-S4
35
sympathetic control over bladder does:
suppresses bladder contraction
36
T spine injury impacting sympathetic control causes what bladder symptom?
increased pressure from contracting bladder causes backflow into ureters and kidneys hydronephrosis
37
sacral reflex does what for bladder?
relax external sphincter contract bladder relax internal sphincter
38
spastic bladder is caused by:
overactive sacral reflex loss of thoracic spine sympathetic control with injury above T12 which normally suppresses the sacral reflex
39
spastic bladder
bladder contracts regardless of urine amount present
40
flaccid bladder
sacral reflex is underactive or absent with injury below T12 so bladder does not contract to expell urine, leading to retention and overflow
41
indwelling catheter
goes into bladder need high water intake to reduce bladder or kidney stones
42
foley catheter
urethral cath held in place by inflated balloon and empties into bag
43
suprapubic catheter
surgically inserted into abdominal wall and bladder less problems with leaking in females
44
clean intermittent catherization
self catherterization so pt doesn't have to wear a bag and has a schedule to empty bladder
45
C3 SCI impacts diaphragm with what nerves?
bulbospinal axons phrenic nerve
46
What SCI levels results in diaphragm paralysis?
C3 and above has complete paralysis C4/5 may be partial
47
What SCI levels result in respiratory muscles?
T5 and above injuries resulting in intercostal and abdominal muscle paralysis
48
C5 respiratory management
diaphragm weakness lacking cough no intercostals poor lung volumes frog breathing
49
C6-8 breathing adaptations
use accessory muscles pec major/minor
50
T1-4 breathing adaptations
intercostals support inspiration/expiration reduced cough efficacy from expiratory weakness
51
T5-12 breathing adaptations
progressive improvement with descending lesion levels minimal CV disruption below T6
52
T12 injury breathing
comparable to able bodied person
53
is it easier to breathe in supine or upright?
supine, gravity reduced
54
AD to help with respiration in SCI
abdominal binder to compensate for abdominal laxity
55
cardiac function affected at what levels of injury?
cardiac function regulated by sympathetic NS in T1-4 injury T1 and above will not have supraspinal sympathetic control T1-4 will have partial preservation
56
pressure ulcer in SCI: prevention
nutrition: maintain protein to prevent muscle atrophy and promote collagen formation avoid moisture on skin: sweat and incontinence should be managed with skin checks and hygiene smoking cessation: nicotine limits oxygenation and blood flow
57
tonal issues in spinal cords
flexor spasm: flexor withdrawal mechanism triggered with sensory triggering without supraspinal dampening touch sets off spinal reflex which isn't perceived by brain but sets of spinal cord excitatory process
58
denervation of motor units leads to these changes in muscle
fibrosis atrophy decreased elasticity leading to ROM losses CT accumulates contractile properties become tonic/hyperactive
59
examination of SCI should focus on what areas based on spinal cord level (cervical, thoracic, lumbar)
C: CV, diaphragm, cough, autonomic T: autonomic function, diaphragm L: ambulation
60
contractures
develop secondary to prolonged shortening of structures around joint limit motion involve muscle changes along with capsular changes lack of active muscle function eliminates reciprocal inhibition of surrounding structures spasticity increases contracture risk
61
types of pain in SCI
upper limb pain: tetraplegia, aching, overuse from transfers, posture, WC propulsion neuropathic: below injury level, widespread and burning injury pain: severe and persistent, early onset
62
camber
tilted wheels allowing tighter turns on a wheelchair decreases tipping and falls decreased energy cost
63
rigid vs folding WCs
rigid have better manuverability and removable wheels folding can be easier to transport
64
risk factors for skin breakdown
weight loss/loss of muscle mass - less cushioning weight gain - more pressure smoking - decreased circulation extreme heat/cold skin moisture
65
first signs of skin compromise
reddening, discolored area skin is warm and hard to the touch non blanchable, area should blanch then go back to normal color within 1-5 seconds if redness doesn't go away in 10-30 min, its a stage 1 pressure ulcer
66
gel cushion pros/cons
pro: good pressure relief, shock absorption, can be countoured cons: heavier, hard to transport, makes WV heavier
67
air cushion pro/cons
pro:excellent pressure relief, lightweight, cons: requires regular maintenance, hard to perform transfers on this pad
68
hybrid cushion pro/cons
pro: gel support for pressure relief, thigh contours, decreased shear

529 Neuro 2 (16 decks)

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