Midterm

Question 1

More than half of all SCI occur among those who are how old?

Answer 1

16-30

Question 2

How long is the average LOS in acute care and rehab for SCIs now?

Answer 2

Acute care: 11 days
Rehab: 25 days

Question 3

Which direction do sensory and motor impulses travel?

Answer 3

sensory impulses travel up the spinal cord and motor impulses travel down the spinal cord.

Question 4

What are afferent vs. efferent impulses?

Answer 4

Afferent are sensory impulses and efferent are motor impulses.

Question 5

What are the types of afferent tracts and what impulses do they carry?

Answer 5

-Dorsal Column: position sense, vibration, 2 point discrimination, deep touch
-Spinothalamic Tract: Pain and temperature

Question 6

What is the type of efferent tract and what impulses does it carry?

Answer 6

Corticospinal tract: skilled movement of extrimities

Question 7

What is the type of efferent tract and what impulses does it carry?

Answer 7

Corticospinal tract: skilled movement of extremities

Question 8

What is the difference between white matter and grey matter?

Answer 8

The grey matter is where all the synapses occur and the white matter is the “highway system” that connects the different parts of grey matter to each other.

Question 9

What are the 3 horns of the grey matter and what type of synapses occur there?

Answer 9

-Anterior horn: motor
-Posterior horn: sensory
-Lateral horn: Autonomic nervous system

Question 10

What is Central Cord Syndrome and what does it affect?

Answer 10

It is an incomplete lesion where the center of the spinal cord is the only thing injured due to hyperextension or narrowing of the spinal canal. UEs are most affected and ambulation is possible for many patients.

Question 11

What is Tetraplegia?

Answer 11

Paralysis in the upper and lower parts of the body.

Question 12

What is Paraplegia?

Answer 12

Paralysis in the lower parts of the body

Question 13

What is Quadriparesis?

Answer 13

Weakness in all 4 limbs

Question 14

What is Paraparesis?

Answer 14

Weakness in lower extremities

Question 15

What does the ASIA Impairment Scale do?

Answer 15

It determines the severity of a spinal cord injury by assigning it a grade.

Question 16

What are the ASIA Impairment Scale grades? Which is best? Which is worst?

Answer 16

The grades are A-E. A is the most severe. E is the best.

Question 17

What are the ASIA key muscles for UEs and LE’s?

Answer 17

C5- Elbow flexors
C6- Wrist extensors
C7- Elbow extensors/wrist flexors
C8- Finger flexors
T1- Finger abductors
L2- Hip flexors
L3- Knee extensors
L4- Ankle dorsiflexors
L5- Big toe extensors
S1- Ankle plantar flexors

Question 18

When does spinal shock occur and how long can it last for?

Answer 18

It occurs 20-60 minutes after trauma and can last from 24 hours to weeks

Question 19

What happens with spinal shock?

Answer 19

Muscle flaccidity

Question 20

What are to types of medical management for an SCI and what are their sub-catagories?

Answer 20

-External Stabilization
-Crutchfield tongs
-Halo traction
-Cervical collars
-Jewett brace
-TLSO
-Surgical Interventions
-Laminectomy (for stenosis)
-Spinal fusion (for pressure relief and stabilization)
-Harrington rod (to stabilize a fracture)

Question 21

What are the 5 stages of grief and depression?

Answer 21

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Adaptation

Question 22

What causes Autonomic Dysreflexia?

Answer 22

A noxious (painful) stimuli below T6 or the level of the lesion.

Question 23

These are all symptoms of what in a SCI patient?
-Hypertension
-Severe headache
-Vasoconstriction increases BP
-Baroreceptors in heart respond to slow HR
-Vasodilation then occurs above the level of the lesion, and slowing of HR
-Profuse sweating, goose bumps
-Blurred vision

Answer 23

Autonomic Dysreflexia

Question 24

What should you do if your patient is showing signs of Autonomic Dysreflexia?

Answer 24

-Look for the source of the noxious stimuli
-Lower BP by sitting or standing the patient

Question 25

What is the difference between sympathetic and parasympathetic nervous systems?

Answer 25

-Sympathetic: responsible for fight or flight responses -Parasympathetic: responsible for rest and digest reponses

Question 26

What level lesion would require an SCI patient to need a ventilator to breathe?

Answer 26

C3 or above

Question 27

Which nerve roots control the diaphragm?

Answer 27

C3-C5

Question 28

What should BP not go below for SCI patients?

Answer 28

70/40

Question 29

What are the 3 types of spasticity?

Answer 29

-Extensor spasm: rigid knees and PF -Flexor withdrawal: UEs flexed -Clonus: a rhythmic oscillating stretch reflex

Question 30

What are the pharmacological treatments for spasticity?

Answer 30

-Muscle relaxers: Valium -Anti-spasmatics: Baclofen (most effective when given intrathecally) -Botulinum toxin A

Question 31

What are the surgical treatments for spasticity?

Answer 31

-Neurectomy: nerve removal -Tenotomy: tendon incision -Rhizotomy: spinal root incision

Question 32

How can PTs treat spasticity?

Answer 32

-E-stim -ROM -Positioning -Orthotics

Question 33

What is Neurogenic Heterotopic Ossificans?

Answer 33

Abnormal Bone Growth

Question 34

How often should a patient weight shift when in a wheel chair?

Answer 34

Every 15-20 minutes

Question 35

What is a Spastic Bladder vs. a Flaccid Bladder?

Answer 35

-Spastic Bladder: will empty itself when it reaches a certain level of fullness or when it is stimulated -Flaccid Bladder: requires manual emptying at predetermined times

Question 36

What kind of activities are focused on in the Acute phase of SCI rehab?

Answer 36

Positioning, ROM, stretching

Question 37

What kind of activities are focused on in the Intermediate phase of SCI rehab?

Answer 37

Progression to functional activities, transfers, how to use a wheelchair, head/hip and relationship

Question 38

What kind of activities are focused on in the Advanced phase of SCI rehab?

Answer 38

Gait training, balanced standing, KAFO use to stabilized legs for ambulation, and appropriate gait patterns

Question 39

What level spinal lesion makes walking possible with the use of a KAFO?

Answer 39

T1-T4

Question 40

What are Service Based Codes?

Answer 40

Codes which can only be used once per Tx no matter how long it took

Question 41

What are the Service Based Codes?

Answer 41

-PT eval/re-eval -Hot packs -E-stim

Question 42

What is the 8 Minute rule?

Answer 42

It is a rule for Medicare patients which states that you must perform a treatment for at least 8 minutes to bill for it and every 15 minutes after that is an additional unit.

Question 43

What happens if a patient has a low WBC value?

Answer 43

They will have trouble fighting off infection

Question 44

Why would a patient have a high WBC value?

Answer 44

Their body is fighting an infection or reacting to some sort of stress

Question 45

Why would a patient have a low Hgb value?

Answer 45

From blood loss

Question 46

What happens if a patient has a high Hgb value?

Answer 46

They may experience dehydration, kidney/heart/lung dx, or shock-like symptoms (tachycardia, hypotension, sweating, HA, bruising)

Question 47

What is Hematocrit?

Answer 47

The percent of RBC in the blood

Question 48

What would you expect to see in a patient with low Hct values?

Answer 48

Fatigue, decreased endurance, edema, decreased BP, dyspnea, fainting, tachycardia

Question 49

What is the worry for patients with low PLT values?

Answer 49

Bleeding out

Question 50

What is the worry for patients with high PLT values?

Answer 50

Blood clots

Question 51

Do patients with hypo or hyperglycemia have a high risk for developing ketoacidosis?

Answer 51

Hyperglycemia

Question 52

What type of burn is classified by... -cell damage to the epidermis only -skin appears red -surface is dry without blisters

Answer 52

Superficial burn

Question 53

What type of burn is classified by... -epidermis is destroyed along with the papillary layer of the dermis -there will be intact blisters -extremely painful -heals within 7-10 days with minimal to no scarring

Answer 53

Superficial Partial Thickness burn

Question 54

What type of burn is classified by... -Epidermis is destroyed and the dermis down to the reticular layer -most of the dermal layers are destroyed: hair follicles, nerve endings, sweat ducts -appear mix red or white and waxy -heals withing 3-5 weeks with scar formation

Answer 54

Deep Partial Thickness burn

Question 55

What type of burn is classified by... -All epidermis and dermis layers are destroyed completely -damage to underlying tissue (fat, muscle, nerves, bone, etc.) -characterized by eschar formation

Answer 55

Full Thickness burn

Question 56

What do 1st, 2nd, and 3rd degree burns mean?

Answer 56

1st = Superficial burn 2nd = Partial Thickness burn 3rd = Full Thickness burn

Question 57

Rule of 9's from head to toe

Answer 57

Entire head = 9% Anterior thorax = 9% Posterior thorax = 9% Anterior abdominal region = 9% Posterior abdominal region = 9% Genital region = 1% 1 UE = 9% Anterior LE = 9% Posterior LE = 9%

Question 58

What does FCE stand for in terms of Industrial Rehabilitation?

Answer 58

Functional Capacity Evaluation

Question 59

What are the 4 major components of an FCE and what are they for?

Answer 59

-Weighted activities: to see how much weight you can safely move through differing ROM -Tolerances: to see how long a client can withstand different postures or activities -Participation levels: to see how compliant or cooperative the client is with his/her duties -Postural examination: to analyze the client's posture during work related activities

Question 60

What is the FCE for?

Answer 60

To evaluate clients doing tasks similar to tasks they do at their job

Question 61

What is the difference between work conditioning and work hardening?

Answer 61

-Work Conditioning: involves the PT/OT, is 2-4 hrs/day, and simulates job tasks -Work Hardening: is much more intense, involves a mulit-disciplinary team, is 4-8 hrs/day, and involves specific job simulation tasks

Question 62

Arterial vs. Venous wounds

Answer 62

-Arterial wounds: lateral ankle/dorsum of foot, round, smooth defined edges, deep, blood cannot get to the area -Venous wounds: medial malleolus, irregular shaggy edges, shallow, pink or red, blood is not flowing back to the heart