Lecture 11/12 - SCI Flashcards
1
Q
Where is the conus medullaris
A
L1
2
Q
Describe the corticospinal tract
A
Provides voluntary motor function
3
Q
Describe the dorsal column medial lemniscus tract
A
Fine touch, 2-point discrimination, proprioception, and vibration
4
Q
Describe the spinothalamic tracts
A
Pain, temperature, noxious stimuli, crude touch
5
Q
What is an SCI, mechanisms of injury, level of involvement, and level of severity
A
5
Q
Compare parasympathetic and sympathetic locations in the ANS
A
Parasympathetic: Cervical and sacral
Sympathetic: Thoracic and lumbar
6
Q
Describe the SCI pathophysiology for a primary injury
A
7
Q
Describe SCI pathophysiology for a secondary injury cascade (describe the 3 phases)
A
8
Q
Describe spinal shock and if it ever resolves
A
9
Q
Describe transverse cord syndrome and areas it impacts
A
10
Q
Describe central cord syndrome and areas it impacts
A
11
Q
Describe brown-sequard syndrome and areas it impacts
A
12
Q
Describe anterior cord syndrome and areas it impacts
A
13
Q
Describe posterior cord syndrome and areas it impacts
A
14
Q
Compare conus medullaris and cauda equina syndrome
A
15
Q
Why is the average age of SCI’s increasing and who does it impact more men or women
A
Why: Life expectancies are higher, older people fall more and that’s the main cause of SCI’s -> less incidence in MVA’s due to safety measures put in place
16
Q
Social impacts of SCI
A
17
Q
Secondary complications following an SCI
A
18
Q
What are some psychosocial and respiratory complications following SCI
A
19
Q
Describe orthostatic hypotension, its signs/symptoms, and risk factors
A
20
Q
Describe autonomic dysreflexia
A
21
Q
Describe pallor and flushing in different skin tones
A
22
Q
How do we manage autonomic dysreflexia
A
23
Q
Describe why an SCI causes impaired temperature control
A
24
What are two main types of pain after SCI
25
Describe spasticity for SCI
26
Describe skin integrity and bone health for SCI
27
Describe neurogenic bladder and bowel complications for an SCI
28
Describe sexual dysfunction and function for an SCI
29
What is the INSCI Assessment
30
What does the INSCI look like?
31
How to determine level of SCI involvement (sensory and motor) and what are the different levels of severity
32
How to perform the sensory exam on the INSCI
33
How to perform the motor exam on the INSCI
34
What are the non-key muscles used in INSCI and what is the root levels respective myotomes
35
How to perform deep anal pressure and voluntary anal contraction
36
Describe the neurological level of injury
37
Describe the AIS scale
38
What is the zone of partial preservation (ZPP)
39
What are some key points about doing the INSCI
40
What is the motor level, sensory level, NLI, and AIS grade
41
What is the motor level, sensory level, NLI, and AIS grade
42
What is the motor level, sensory level, NLI, and AIS grade
43
What are some outcome measures to use for SCI
44
Describe the spinal cord independence measure (SCIM)
45
Describe the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP)
46
Describe the SCI Functional Ambulation Profile (SCI-FAP)
47
Describe the Standing and Walking Assessment Tool (SWAT)
48
Describe the Wheelchair Skills Test (WST)
49
Describe the mortality following SCI
50
Describe recovery following SCI
51
Describe prognosis following complete injuries
52
Describe prognosis following incomplete injuries
53
Describe ambulation prognosis following an SCI
54
Describe prognosis of anterior cord syndrome, central cord syndrome, and brown-sequard syndrome
55
Describe how we predict functional abilities following an SCI
56
Describe what muscles, movements, capabilities are affected and equipment needed for C1-C4 injury
57
Describe what muscles, movements, capabilities are affected and equipment needed for C5 injury
58
Describe what muscles, movements, capabilities are affected and equipment needed for C6 injury
59
Describe what muscles, movements, capabilities are affected and equipment needed for C7 injury
60
Describe what muscles, movements, capabilities are affected and equipment needed for C8 injury
61
Describe what muscles, movements, capabilities are affected and equipment needed for T1-T12 injury
62
Describe what muscles, movements, capabilities are affected and equipment needed for L1-L3 injury
63
Describe what muscles, movements, capabilities are affected and equipment needed for L4-S1 injury
64
What is the fall rate for SCI, its causes and consequences
65
Describe the neural control of gait (name and describe all the components)
66
What are central pattern generators
67
Describe the neural mechanisms of reactive balance
68
How do neural changes impact motor function
69
How does neuroplasticity change following SCI
70
Describe the Hebbian Theory (Functional Plasticity)
71
Describe structural plasticity in the CNS
72
Describe axonal regeneration and sprouting
73
How does rehab facilitate neuroplasticity
74
What are 2 treatment principles used in rehab for SCI
75
What are acute care priorities for SCI
76
What are early rehab/low function priorities for SCI
77
What are late rehab/high function priorities for SCI
78
Describe Activity-Based Therapy (ABT)
79
How do we treat sensory cues/afferent proprioceptive inputs for SCI (ABT)
80
How do we treat central excitability (neuromodulation) for SCI (ABT)
81
Describe functional electrical stimulation (FES) for SCI treatment (ABT)
82
Describe combining approaches (ABT)
83
Describe effectiveness of ABT
84
Describe locomotor training and name some types
85
What are the 4 locomotor training principles
86
Describe maximize WB (locomotor principle)
87
Describe optimizing sensory cues (LT principles
88
Describe optimizing kinetics (LT principles)
89
Describe minimizing compensation (LT principles)
90
Describe the effectiveness of locomotor training
91
Describe balance training for SCI
92
Describe interval vs external perturbations
93
Describe reactive balance training and are physio's assessing it?
94
Describe 3 reactive balance strategies for LE
95
Describe the impact of reactive balance training
96
Describe acute intermittent hypoxia as a treatment for SCI (emerging technique)
97
Describe vagus nerve stimulation for SCI (emerging technique)
98
What are the physical activity guidelines for SCI
99
Describe aerobic physical activity for SCI
100
Describe strength training for SCI
101
Describe flexibility training for SCI
102
1. Assisted low pivot transfer (2 ppl to 1 ppl transfer). Get him towards sliding board transfer. Build independence by being able to verbalize to care provider what he needs done for ADL's.
2. Impacts intercostal and accessory muscle use for breathing. May not be able to use abdominal muscles to effectively cough and increase work of breathing. Perform ACBT. We could use an AB Binder
3. INSCI, 4+1 assessment, IPPA, general strength and mobility
4. Grasping and propelling with a wheel chair, wrist extension exercises, apply hooks to wheel chair to help with propelling
103
1. Yes, she would be at risk for autonomic dysreflexia. She may still be in spinal shock but it is not resolved yet, so she would be at risk after that. Also above T6 = higher risk. Educate about noxious stimuli and to remove it to resolve symptoms. Signs and symptoms to expect so will be more sympathetic on top and parasympathetic below
2. Neuropathic. I would have her do nerve flossing. Electrical stimulation, gabapentin
3. INSCI, ROM, SCIM, 4+1 assessment,
4. Perturbations for trunk control (anticipated vs unexpected), gripping ball, reaching and grasping. High reps and task specific -> reaching and grasping for silk above head or out in front
104
1. Use screening questionnaire (PHQ-9 -> mental health), referring to member of multidisciplinary team
2. Send him cardiovascular guidelines (2 x a week for 20 minutes for strength and 3 x a week for 30 mins for aerobic exercise
3. 6/2-minute walk test, mini BEST test, SCIM
4. 3x a week with an RPE at moderate 6/10 , cycling to help with ankle ROM. FITT based on guidelines above and also perceived exhaustion during assessment. Strength: lat pull downs for upper and lower would be a weighted sit-to-stand. Focus more on sustained stretches (Hamstrings, gastrocs, soleus, hip flexors, abductors, adductors, pecs,
105
1. Female, age -> risk of osteoporosis. May have reduce bone density below lesion. Most likely to fracture distal femur and proximal femur usually below lesion area, may also wrist and foot.
2. Decreased speed, stride length. Hard time to recruit muscle during gait. Start with therapeutic ambulation to start and then work to community ambulation (discuss what community ambulation looks like for her).
3. INSCI, functional ambulation profile, evaluate UE strength, ROM, ADL's, SCIM -> go on resources to find for spastic issues or don’t up to you
4. Work on maintaining cardiovascular health, bodyweight support treadmill, FES, bike -> repetitive, sensory cues, environmentally specific, and what ever the 4th principle is
