Module 1 Flashcards
1
Q
A spinal cord injury usually begins with a _ _ _ to the _ that _ or _ vertebrae and destroys _.
A
A spinal cord injury usually begins with a SUDDEN TRAUMATIC BLOW to the SPINE that FRACTURES or DISLOCATES vertebrae and destroys AXONS
2
Q
What are the three top three things that lead to a spinal cord injury?
A
Motor vehicle accidents
Falls
Violence
3
Q
An _ can be used to determine what happened to the spine? What two types of imaging is used to determine what happened to the soft tissue?
A
An X-RAY- spine
CT scan and/or MRI- soft tissue
4
Q
The _ _ is the caudal end of th spinal cord. The _ _ is distal to the _ _.
A
The CONUS MEDULLARIS is the caudal end of the spine. The CAUDA EQUINA is distal to the Conus Medullaris
5
Q
What is the most common part of the spine to see a spinal cord injury? Most common level?
A
Cervical spine
C5
6
Q
SCI’s to the thoracic usually require _ _ and are usually _ with a decreased chance of?
A
Usually require EXTREME FORCE and are usually COMPLETE
With a decreased chance of motor or sensory return
7
Q
Lumbar spine SCI’s are usually?
A
Usually Incomplete
8
Q
In general spino refers to? Spinal?
A
Spino- sensory
Spinal- motor
9
Q
Two examples of secondary tissue destruction? Due to?
A
Ischemia and inflammation
Due to further compression on the spine and nerves
10
Q
_ _ is a transient phenomenon that occurs after trauma to the spinal cord during which the spinal cord temporarily ceases to function below the level of the lesion. Typically?
A
SPINAL SHOCK
Typically resolves within 6 weeks
11
Q
The neurological level of injury cannot be accurately determined until? However you should?
A
Cannot be accurately defined until the shock is resolved
However you should still evaluate and continue to assess and reassess
12
Q
_ _ is the resumption of voluntary motor function or sensation that has been lost due as a result of SCI
A
NEUROLOGICAL RETURN
13
Q
Return of _ _ is not neurological return. Because it is not?(2)
A
Return of REFLEXIVE FUNCTIONING is not neurological return
Because it is not: voluntary or reproducible
14
Q
How should you answer the question ‘ Will I be able to walk again?’ How should you not? Depends on?
A
Should- let’s see what we can do to work toward that today, and we will get a better picture as you progress
Should not- give a yes or no answer
Depends on the patients motivation
15
Q
What do you do if a patient has an “unrealistic goal”?
A
Try to redirect with helping them to establish shorter term goals
16
Q
With _ _ _, most damage to the cord is caused by the sequelae of initial trauma. Lasts from? Destruction can progress?
A
With SECONDARY TISSUE DAMAGE most damage is. . .
Lasts from several days to weeks
Destruction can progress up or down the cord from the site of injury
17
Q
15-30 seconds of _ can lead to irreversible damage
A
15-30 seconds of ANOXIA can lead to irreversible damage.
18
Q
What are the five grades of classification for SCI? Which is most severe? Least severe? Incomplete?
A
A-E
Most severe: A (complete)
Least severe: E (normal)
Incomplete: B, C, D
19
Q
What classification grade is being described: No motor or sensory function is preserved in the sacral segments S4-S5?
A
Complete- A
20
Q
What classification is being described: sensory but not motor function is preserved below the neurological level and includes the sacral segments (S4-S5). They can _ but _ _ bowel movements.
A
Grade B- Incomplete
They can FEEL but CAN’T CONTROL bowel movements
21
Q
What level of the spine, if damaged will effect bowel movements?
A
S4- S5
22
Q
Which classification is being described: Motor function is preserved below the neurological level and more than half of the key muscles below the neurological level have a muscle grade of less than 3.
A
Grade C- Incomplete
23
Q
In the grade C- Incomplete classification: greater than _ of key muscles have a less than / MMT grade.
A
Greater than 50% of key muscle have a less than 3/5 MMT grade
24
Q
Which classification is being described: Motor function is preserved below the neurological level and at less half the key muscles below the neurological level have a muscle grade of 3 or more.
A
Grade D- incomplete
25
With classification Grade D: 50% of key muscles _ _ or _ _ 3/5 MMT grade.
50% of key muscles GREATER THAN or EQUAL TOO 3/5 MMT grade.
26
The grade E classification: motor and sensory function _ _. Only valid for?
Motor and sensory function ARE NORMAL.
Only valid for people who have had a spinal cord injury and progressed to 'normal'
27
_ is paralysis of all 4 extremities and trunk resulting from cervical spine lesion
QUADRIPLEGIA (TETRAPLEGIA)
28
_ is paralysis of part of trunk and both lower extremities from thoracic, lumbar, or Cauda Equina lesion.
PARAPLEGIA
29
How do you classify the motor level? Sensory level? Neuro level?
Motor- most caudal level of spinal cord with normal muscle function BILATERALLY
Sensory- " " " " " " " normal sensory function "
Neuro- " " " " " " " normal motor and sensory function bilaterally
30
What is the exception for classifying a neurological level: SCI's that are within levels _ _ using _ (in this case levels are presumed to be _ to _ level).
SCI'S that are within levels NOT TESTABLE using MMT (in this case levels are presumed to be EQUAL TO SENSORY level)
31
Which levels are not readily tested with MMT? (3 sections)
C1-C4
T2-L1
S2- S5
32
What is used as a reference point for sensory testing?
Cheek
33
Key Muscles: C5? C6? C7? C8? T1?
```
C5- biceps brachi
C6- Extensor carpi Radialis longus (ECRL)
C7- triceps
C8- Flexor digitorum profundus
T1- Abductor digiti minimi
```
34
Key muscles: L2? L3? L4? L5? S1?
```
L2- Iliopsoas
L3- quadriceps
L4- tibialis anterior
L5- Extensor hallucis longus
S1- Gastroc/ Soleus
```
35
A complete injury is no _ or _ _ in the _ _ _. An incomplete injury is?
A complete injury is no SENSORY OR MOTOR FUNCTION in the LOWEST SACRAL SEGMENTS
An incomplete injury is sensory and/ or motor function below the neurological level including sensory and/ or motor of S4-S5
36
_ of _ _ are sensory and/ or motor function below the neurological level excluding S4-S5
ZONES OF PARTIAL PRESERVATION are sensory and/ or motor function below the neurological level excluding S4-S5
37
With zones of partial preservation- _ and _ caudal to neurological level that remain _ _. Only applies to?
DERMATOMES AND MYOTOMES caudal to the neurological level that remain PARTIALLY INNERVATED.
Only applies to COMPLETE INJURIES
38
Which syndrome is being described: loss of motor function below the level of the lesion, loss of pain and temperatures below the level of lesion? _ is preserved. Usually due to?
ANTERIOR CORD SYNDROME
PROPRIOCEPTION is preserved
Usually due to FLEXION INJURY
39
Posterior cord syndrome: loss of _ and _ _ _ (aka _) below the level of the lesion, and a _ _ _ _ pattern is typical.
Loss of PROPRIOCEPTION and 2 POINT DISCRIMINATION (aka EPICRITIC) below the level of the lesion, and a WIDE-BASE STEPPAGE GAIT pattern is typical.
40
Posterior cord syndrome: preservation of _ _, sense of _ and _ _. Example? It is _, damage occurs to the _ _ _.
Preservation of MOTOR FUNCTION, sense of PAIN and LIGHT TOUCH.
Example: CEREBELLAR TUMOR
It is RARE, damage occurs to the POSTERIOR SPINAL INJURY
41
Which syndrome is being described: Lesion involving the center of the spinal cord, sacral sensory sparing, greater motor weakness in UE than LE. Variations in sensory loss below the level of the lesion.
CENTRAL CORD SYNDROME
42
Central cord syndrome is more predominant in the _ _, usually caused by _ injury. Ex: _ _ from prolonged restriction of _.
More predominant in the OLDER POPULATION, usually caused by HYPEREXTENSION injury.
Ex: CERVICAL STENOSIS from prolonged restriction of NERVES.
43
In central cord syndrome patients will have _ _, most commonly _ _.
Patients will have BLADDER DSYFUNCTION, most commonly URINARY RETENTION.
44
_ _ syndrome has the opposite symptoms of _ _ syndrome.
ANTERIOR CORD syndrome has the opposite symptoms of POSTERIOR CORD syndrome.
45
_ _ syndrome is most often caused by a penetration injury (gun shot, knife, wound, MVA).
BROWN SEQUARD syndrome
46
Brown Sequard syndrome- Ipsilateral symptoms include: _ loss in corresponding _ _; severe _ and _ deficits; _ below the lesion; lack of _ _ (has _ and positive _ sign); loss of _, _, and _ sense.
- SENSORY loss in corresponding DERMATOME LEVEL
- severe MOTOR AND PROPRIOCEPTIVE deficits
- SPASTICITY below the level of lesion
- lack of SUPERFICIAL REFLEXES (has CLONUS and positive BABINSKI sign)
- loss of PROPRIOCEPTION, KINESTHESIA, and VIBRATORY SENSE
47
Brown Sequard Syndrome- contralateral symptoms: severe loss of sensitivity to _ _ and _; loss of _ and _ in _ _ _ below the level of the lesion.
- Severe loss of sensitivity to PIN PRICK and TEMPERATURE
| - Loss of PAIN and TEMPERATURE in SEVERAL DERMATOME SEGMENTS below the level of the lesion
48
Of the various syndromes which are most likely to walk? (2)
Posterior Cord Syndrome
Central Cord Syndrome
49
Which syndrome is being described: flaccid paralysis of LE, areflexic bowel and bladder, sacral reflexes may or may not be retained. Has high patient _.
Conus Medularis
Has high patient VARIABILITY
50
Which syndrome is being described: flaccid paralysis of LE, and areflexic bowel and bladder.
Cauda equina syndrome
51
Both _ _ and _ _ have flaccid paralysis of LE, and areflexic bladder and bowel.
Both CONUS MEDULLARIS and CAUDA EQUINA have flaccid . . .
52
Most spinal injuries are a combination of _ and _.
Combination of UMN AND LMN
53
Features of UMN injury: muscle _ and _; _ reflexia ; _; _ sign; possible _ _.
- Muscle WEAKNESS and ATROPHY
- HYPER reflexia
- CLONUS
- BABINSKI sign
- possible SPASTIC PARALYSIS
54
LMN features: _ _; profound muscle _; muscle _; absent _; _ on EMG.
- FLACCID PARALYSIS
- profound muscle ATROPHY
- muscle FASICULATIONS
- absent REFLEXES
- FIBRILLATIONS on EMG
55
As spinal shock resolves there will be _ initially followed by _.
As spinal shock resolves there will be FLACCIDITY initially followed by SPASTICITY.
56
_ is more common in cervical, upper thoracic lesions and incomplete injuries. Is _ _; _ syndrome. What scale is most commonly used?
SPASTICITY is more common in cervical, upper thoracic lesions and incomplete injuries.
Is VELOCITY DEPENDENT, UMN syndrome.
Modified Ashworth scale is most commonly used to measure spasticity
57
Benefits of spasticity: helps maintain _ _, increases muscle _, increases _ _, can assist with _/_, strengthens _/ _ and reduces risk for _. Can help with _ _.
```
Helps maintain MUSCLE BULK
Increases muscle TONE
Increases METABOLIC REQUIREMENTS
Can assist with BOWEL/ BLADDER
Strengthens BONE/ MUSCLE and reduces risk for OSTEOPORSIS
Can help with FUNCTIONAL MOBILITY
```
58
Problems with spasticity: causes _, disrupts _, interferes with _-_, limits voluntary _ _, affects _ and _, contribute to _ _, and trigger unwanted _/ _ _.
```
Causes PAIN, disrupts SLEEP
Interferes with SELF- CARE
Limits voluntary JOINT MOVEMENT
Affects POSTURE AND BALANCE
Contribute to SKIN BREAKDOWN
Can trigger unwanted BOWEL/ BLADDER RELEASE
```
59
What is the PT goal for patients with spasticity?
Improve Quality of life (QOL)
60
A _ _ encourages and increase in weight bearing and helps reduce spasticity. Can also help increase _ _, increases _ _, and can help with _ _.
A TILT TABLE encourages and increase in . . . .
Can also help increase BONE DENSITY, increases SOCIAL INTERACTION, and can help with PERCEPTUAL IMPROVEMENTS
61
When using modalities as a treatment for spasticity you need to keep _ in mind. Will it _ _, is it _?
You need to keep GOALS in mind.
Will it INCREASE FUNCTION, is it MEASURABLE
62
Daily _ and _ will only affect in short term, with limited carryover.
Daily ROM AND STRETCHING will only affect short term with limited carryover.
63
What is the first line of intervention to help with spasticity? Second line (2)?
Pharmaceuticals:
- 1st line: BACLOFEN
- 2nd line: GABAPENTIN and BENZODIAZEPINES (Valium)
64
Why is baclofen the most commonly used drug for spasticity? Indicated for spasticity of _ _.
Because it INTERFERES LEAST with DAILY FUNCTION
Indicated for spasticity of SPINAL ORIGIN
65
Weakness, sedation, confusion, hypotension, nausea, and dizziness are _ _ of _.
. . . Are ADVERSE EFFECTS of BACLOFEN
66
Seizures, fevers, hallucinations and spasticity are _ _ _ from baclofen. Therefore PT should?
Are SUDDEN WITHDRAWAL SYMPTOMS from baclofen.
PT should have conversation with Doctor if patient starts to wean themselves off or quitting
67
Gabapentin is beneficial with both _ and _ _.
Beneficial with both SPINAL and CEREBRAL SPASTICITY
68
Benzodiazepines can be combined with _, can cause _ and _. Can be used with _ _ _ and _ _.
Can be combined with BACLOFEN, can cause SLEEPINESS and DROWSINESS.
Can be used with SPINAL CORD INJURY and MULTIPLE SCLEROSIS
69
What is a common method of administration of with seizure medication? Is a _ of medicine on the _ of the _. Medicine is pumped through a _ _ _ directly to the fluid surrounding the _ _.
INTRATHECAL pump
Is a RESERVOIR medicine on the OUTSIDE of the BODY
Medicine pumped through a SMALL CATHETER TUBE directly to the fluid surrounding he SPINAL CORD.
70
Disadvantages of intrathecal pump: requires _, is _, and the tubing can become _ or _. Risks? (4)
Requires SURGERY
Is EXPENSIVE
And the tubing can become KINKED OR DISCONNECTED
Risks (I POW)
-infection, pump dsyfunction, overdose, and withdrawal symptoms
71
Advantages of the intrathecal pump: medicine is sent directly to _ _ (more _ than oral dosage), dosage can _ _, _ medication is needed which can _ _, reservoir can be _ _ as needed.
- Medicine is sent directly to NERVE CELLS (more DIRECT than oral dosage)
- dosage can BE ADJUSTED
- LESS medication is needed which can DECREASE SIDE-EFFECTS
- Reservoir can be REFILLED EASILY as needed.
72
What are 4 options to help with spasticity if Baclofen doesn't work?
COAT
- contracture release
- osteotomy (remove small wedge from a bone to reposition/ shape)
- arthrodesis
- tendon transfer (moves the attachment point of a spastic muscle)
73
Other than drugs what is the most common optional treatment that is used to treat spasticity?
Tendon transfer
74
Dorsal root rhizotomy, neurectomy, and myelotomy are neurologic surgical options that are used to control _ when _ aren't _.
Surgical options that are used to control PAIN when DRUGS AREN'T EFFECTIVE.
75
Sensory dsyfunction can cause _ and _ _ _ which increases the potential for _. Especially in?
Can cause DISCOORDINATION and IMPAIRED BODY AWARENESS which increases the potential for INJURY.
Especially in DIABETIC PATIENTS
76
The ability to breath and cough depend on function of _ _, which are influenced by _ of _.
Depend on function of VENTILATORY MUSCLES which are influenced by LEVEL OF LESION.
77
Lesions _ _ influence innervation to diaphragm, accessory muscles, intercostals and abdominal muscles. Even if?
Lesions ABOVE T12 influence innervation . . .
Even if C3-C5 IS STILL INTACT
78
During _ _, goal is to teach the patient _ _ patterns, strengthen _ muscles, preserve _ _ _, optimize _, provide _ support and assisting with clearance of _.
During RESPIRATORY REHAB, goal is to:
- teach the patient EFFICIENT BREATHING patterns
- strengthen VENTILATORY muscles
- preserve THORACIC CAGE MOBILITY (ribs mobilization)
- optimize POSTURE
- provide ABDOMINAL support and assist with clearance of SECRETIONS (postural drainage)
79
Secondary complications of Bladder dysfunction include _ and _ _/ _ and _ failure.
Include KIDNEY and BLADDER STONES/ INFECTION and RENAL FAILURE
80
_ _ with SCI is seen with lesions above the conus medullaris, and _ _ is seen with conus medullaris and Cauda equina lesions.
SPASTIC BLADDER - above conus medullaris
FLACCID BLADDER- with conus medullaris and Cauda equina lesions.
81
_ is very common with SCI, _ is the commonly associated symptom. _ _ is commonly used for hyper/ hypo reflexive bladders.
UTI is very common with SCI, LETHARGY is the commonly associated symptom.
INTERMITTENT CATHETERIZATION is commonly used for . . .
82
Timed voiding, pelvic floor exercises, biofeedback, crede method, bladder tapping and vasalva maneuvers are all examples of?
Example of INCONTINENCE TREATMENTS
83
The crede method applies _ pressure to _ _ (with _). Valsalva maneuvers can assist with a more complete _ of the _.
Crede method applies MANUAL pressure to LOWER ABDOMEN (with HANDS)
Vasalva maneuver can assist with a more complete EMPTYING of the BLADDER.
84
What is the innervation for the detrusser muscle?
S2-S4
85
_ _ _ results from a lesion above the conus medullaris (T11-12). _ _ _ results from a lesion affecting the parasympathetic cell bodies in the conus medullaris, Cauda equina, or pelvic nerve.
UMN BOWEL SYNDROME results from a lesion above the conus medullaris.
LMN BOWEL SYNDROME results from a lesion . . . .
86
Training program, digital stimulation, suppositories/ laxatives, and colostomy or ileostomy are all _ _ _.
Are all BOWEL MANAGMENT TREATMENTS
87
What are 2 important steps that can be taken to help improve bowel managment?
HH
- HIGH FIBER DIET
- HYDRATION (at least 8 glasses of water per day)
88
_ _ occurs when SCI blocks communication between the brain stem and the thoracic spinal cord. Sympathetic input to the _ is _ and parasympathetic input _, which results in bradycardia, bradyarrhythmias, hypotension and orthostatic hypotension.
CARDIOVASCULAR DYSFUNCTION occurs when SCI blocks . . .
Sympathetic input to the HEART IS LOST and parasympathetic input REMAINS, which results in bradycardia . . . .
89
In an SCI patient if the cardiovascular system is affected, control _ _ _ to _. Response to _ is _ (decreased _ _ and _ induced _).
Control DOES NOT RETURN to NORMAL
Response to EXERCISE IS IMPAIRED
- decreased EXERCISE TOLERANCE
- EXERCISE induced HYPOTENSION
90
Thermoregulation dsyfunction occurs with SCI lesions _ _, patients are unable to _ or _ below the level of the lesion. Temperature regulation mechanisms can _ over _.
Occurs with lesions ABOVE T1, patients are unable to SWEAT or SHIVER below the level of the lesion.
Temperature regulation mechanisms can IMPROVE OVER TIME
91
Orthostatic Hypotension (OH) is caused by loss of sympathetic control of _ _ _, loss of _ _ and _ _, and prolonged _ _. What can help?
Is caused by loss of sympathetic control of PERIPHERAL VASOCONSTRICTOR ACTIVITY, loss of MUSCLE TONE and MUSCULOSKELETAL PUMP, and prolonged BED REST.
TILT TABLE can help
92
Abdominal _, _ _, gradually implementing _ _, adequate _, and pharmacological interventions can all help with OH symptoms.
Abdominal BINDERS, COMPRESSION STOCKINGS, gradually implementing UPRIGHT TOLERANCE, and pharmalogical interventions can all help with OH symptoms.
93
_ _ is a pathological autonomic reflex that typically occurs in SCI lesions above T6 where there is a loss of centrally mediated control of sympathetic responses.
AUTONOMIC DYSREFLEXIA
94
autonomic dysreflexia is an? Commonly occurs from?
An uninhibited response to noxious stimuli below the level of the the injury.
Commonly occurs from the CATHETER (full or kinked)
95
Autonomic dysreflexia can happen _ _, but typically _ _ _ _ of injury. Needs to be treated as a _ _, because of the _ in _.
Can happen AT ANYTIME, but typically OCCURS WITHIN 6 MOS. of injury
Needs to be treated as a MEDICAL EMERGENCY, because of the INCREASE IN BP
96
Risk factors for AD include lesions _ _, and _ injuries. _ of those at risk will have an episode in the _ _ after injury.
Risk factors include:
- lesions ABOVE T6
- INCOMPLETE injuries
80% of those at risk will have an episode in the FIRST YEAR after injury
97
4 common signs associated with AD?
HH TB
- hypertension (sudden increase in systolic and diastolic)
- headaches (usually bilateral, back of head/ eyes)
- temperature dysregulation (chills above the level of injury)
- bradycardia (decreases HR to compensate for increase in BP)
98
AD may also by _, meaning _ or _ symptoms, other than _ and _.
May also be SILENT, meaning MINIMAL OR NO symptoms, other than HYPERTENSION and BRADYCARDIA
99
With AD (above T6 level SCI), the _ is in charge above the level of the lesion, and the _ is in charge below.
PARASYMPATHETIC NS in charge ABOVE
SYMPATHETIC NS in charge BELOW
100
If you suspect a patient has AD you should _ _ to _, and then keep them _ _ if patient is experiencing anything other than _ _ because _ _ will increase _ and exacerbate the problem.
You should INITIATE CALL TO 911, and then keep them IN SITTING (or get them to sitting position) if patient is experiencing anything other than ORTHOSTATIC HYPOTENSION because LYING DOWN will increase BP and exacerbate the problem.
101
What are the 3 precipitating factors associated with AD and their percentages?
Urologic- 90%
Gastrointestinal- 8%
Other- 2%
102
You should consider sending patient to ER/ ambulance if AD does not change once _ _ is _, cause _ be _ within _ _, or if there is a suspicion of _ complication.
- Does not change once NOXIOUS STIMULI is REMOVED
- Cause CANNOT BE DETERMINED within 90 SECONDS
- Or if there is a suspicion of OBSTETRICAL complication.
103
What are the 3 interventions for AD?
PAP
- prevention
- advocacy
- patient education
104
Peripheral vasodilation, loss of musculoskeletal pump, predisposition for hyper coagulation after trauma, loss of negative intrathroacic pressure that would assist with venous return, and development of hematomas due to trauma are all?
Are all causes of DVT
105
The key to prevention of DVT is _ _ with _ _. What are the recommendations?
Key to prevention is EARLY MOBILIZATION WITH ANTICOAGULANT MEDICATIONS
Recommended after patient has been medicated for at least 4 hours, some facilities recommend 8-12 hours
106
Risk factors for DVT: _ (slightly higher), _ injuries, and _. Risk is highest _ _ to _ _ _ injury.
Risk factors: MALE, COMPLETE injuries and PARAPLEGIA
Risk is highest 72 HOURS TO 2 WEEKS POST injury
107
What is a common warning sign of DVT in patients with incomplete injuries? Description.
Positive Homan's sign
| - Dorsiflexion or squeezing of calf reproduces symptoms
108
Chest pain, SOB, tachycardia, sweating, fever, and apprehension are all symptoms of? Can result in?
Symptoms of PULMONARY EMBOLISM
Can result in DEATH
109
Treatment for PE's includes: _ _, _ medications, _ _ and _ _, and in some places _ _ devices (_).
Includes:
- COMPRESSION HOSE
- ANTICOAGULANT medications
- EARLY MOBILIZATION AND PASSIVE EXERCISES
- And in some places SEQUENTIAL COMPRESSION devices (SCD)
110
Up to 80% of individuals with SCI will have a _ _ during their lifetime, 30% will have _ _ _.
Up to 80% will have PRESSURE SORE during their lifetime, 30% will have MORE THAN ONE.
111
Typical repositioning guidelines to prevent pressure sores from developing (seated and supine)?
Seated: reposition every 15-30 minutes
Supine: reposition every 2 HOURS
112
Pressure ulcers typically develop on _ _. Stage range?
Typically develop on BONY PROMINANCES
Stage 1-4
113
_% of all pressure sores are preventable.
95%
114
Falling backward, any jerking motion, and overly aggressive ROM can cause _ _.
Can cause UNSTABLE SPINE
115
Warning signs of an unstable spine: sudden onset of _/_ near _ site, sudden loss of _ or _, or increasing _ _ (problems _, _)
- Sudden onset of PAIN/ TENDERNESS near FRACTURE SITE
- Sudden loss of SENSATION or STRENGTH
- increasing DIAPHRAGM WEAKNESS (problems COUGHING, SOB)
116
_ _ are ectopic bone formations in the connective tissue outside of the skeleton.
HETEROTOPIC OSSIFICATION
117
Heterotopic ossifications usually occur in _ _ (_, _, _), always occur _ the level of the lesion, and may occur in the _/_ of high tetraplegics and those with accompanying TBI.
Usually occur in LARGE JOINTS (HIPS, KNEES, ELBOWS)
Always occur BELOW the level of the lesion
May occur in the SHOULDER/ ELBOWS of high tetraplegics and those with accompanying TBI
118
_% of adults with SCI have HO. Most commonly develops _-_ _ post injury (peak incidence at _ _), however _ _ can occur _ after injury.
50% of adults with SCI have HO
Most commonly develops 1-4 MONTHS post injury (peak incidence at 2 MONTHS), however LATE ONSET can occur YEARS after injury.
119
Advanced age, complete injuries, male gender, pressure ulcers and spasticity are all?
Are all risk factors for HO development
120
HO can present with _ _, _ and _ of unknown origin. _ _ is the best test after ruling out bone fx, joint infection, and DVT with X-Ray. In lab results _ _ will be elevated.
Can present with LOCALIZED SWELLING, WARMTH and FEVER of unknown origin.
BONE SCAN is the best test after ruling out bone fx, joint infection and DVT with an X-Ray.
In lab results PHOSPHATASE LEVELS will be elevated.
121
Which stage of HO is being described: may begin 11-20 days after injury; symptoms include fever, soft tissue swelling, pain, local warmth and redness; no detectable change is seen on an X-Ray, and ROM may be slightly limited.
Stage 1 HO
122
What stage of HO is being described: symptoms include fever, soft tissue swelling, local warmth and redness near joint, ectopic bone now visible on X-Ray, and ROM may be slightly limited.
Stage 2
123
With stage 3 HO: _ and _ subside, X-Ray shows _ _, and ROM is _ _.
SWELLING AND REDNESS subside
X-Ray shows CONTINUED CALCIFICATION
ROM is INCREASINGLY LIMITED
124
Stage 4 HO: occurs _-_ _ after onset, X-Ray shows _ _, and _ _. Complications include _ and _ _.
Occurs 2-4 WEEKS after onset
X-Ray shows EXTENSIVE CALCIFICATION
JOINT ANKYLOSIS
Complications include CONTRACTURES AND PRESSURE SORES
125
PT treatment for HO: _ _ after acute inflammatory phase.
GENTLE STRETCHING after acute inflammatory phase.
126
_ is caused by loss of calcium and collagen from bones, result of venous stasis, and loss of muscular action and weight bearing. Complications include _.
OSTEOPORSIS is caused by . . . .
Complications include FRACTURES
127
Motor complete injuries, paraplegia, Caucasian, female and increased time since injury are all?
Risk factors for osteoporosis
128
With Osteoporosis treatment _ _, and includes _ _ _ and _/ _ (PT treatments).
Treatment MINIMIZES EFFECTS
Includes: FUNCTIONAL ELECTRIC STIMULATION and AMBULATION/ STANDING
129
PT treatments for acute and chronic pain in SCI patients includes: _ and other _, proper _ in _ and _, _ and _ exercises, and _ education and _ techniques. These same treatments are also used for patients with?
- TENS and other MODALITIES
- Proper POSITIONING in BED and W/C
- STRENGTHENING and STRETCHING exercises
- POSTURAL education and COMPENSATORY techniques
Also used for patients with TBI
130
If TBI and SCI occur together the treatment should focus on?
Treatment should focus on which ever issues are having the greatest effect
131
With SCI- TBI patients therapy approach must be _ to _ _ and facilitate _ _ through established _, _/_ and _ learning strategies.
Approach must be INDIVIDUALIZED to PATIENTS DEFICITS and facilitate NEW LEARNING through established ROUTINE, REPITITION/ PRACTICE and ERRORLESS learning strategies.
132
When working with SCI- TBI patients tasks demanding simultaneous attention to multiple variables and/ or rapid processing become difficult, resulting in _ _, inconsistent _, _, _ and _.
Resulting in COGNITIVE OVERLOAD, inconsistent PERFORMANCE, STRESS, FATIGUE, and IRRITABILITY
133
General guidelines for SCI evaluation: assess the "_ _", obtain _ and _ clearance for therapy, identify the impact of the SCI on _ _ _, identify what the patient _ _ and _ it is _, and identify patients _ _.
- assess the 'WHOLE PICTURE'
- obtain ORTHOPEDIC AND MEDICAL clearance for therapy
- identify impact of the SCI on PATIENTS' LIFE ROLES
- identify what the patient CAN DO and HOW IT IS ACCOMPLISHED
- identify patients FUNCTIONAL LIMITATIONS
134
General guidelines for SCI evaluation: identify the impairments interfering with patients _ to _ _, assess the _ the patient will be _ _, and identify the patients _ _ and _ system
- identify the impairments interfering with patients ABILITY TO COMPLETE ACTIVITIES
- assess the ENVIRONMENT the patient will be RETURNING TO
- identify the patients COPING STRATEGIES and SUPPORT SYSTEM
135
During patient history taking, need to ask about _ and _ of _ in _ as part of precautions/ activity restriction.
Need to ask about:
- BRACING
- # of HOURS IN WHEELCHAIR
136
When taking medical history it is important to know about type of _/ _, etiology of _ to _ _, associated _, changes in _ _, and _ findings.
Know about:
- type of INJURY/ SURGERY
- etiology of DAMAGE TO SPINAL CORD
- associated INJURIES
- changes in NEUROLOGICAL STATUS
- DIAGNOSTIC findings
137
When asking about prior level of functioning it is important to discuss _, _ of _, and _ and incorporate that into your treatment plan.
Important to discuss OCCUPATION, LEVEL of INDEPENDENCE and LIFESTYLE and incorporate that into your treatment plan.
138
During subjective exam ask the patient about his/ her: _ for _ and _ _, _ status, any _ _, _ or _, and his/ her _ of injury.
- GOALS for REHAB and AFTER REHAB
- EMOTIONAL status
- any COPING STRATEGIES, CONCERNS, FEARS
- his/ her UNDERSTANDING of injury
139
How should you assess BP in a patient with a SCI? Be aware of possibility of _.
Should be assessed in both SUPINE (first) and then in SITTING (second)
Be aware of possibility of OH
140
When assessing cognition you should look at: are they _ and _; how is their ability to _ _, what is their _ _, and how are their _ _ skills.
Are they ALERT AND ORIENTED
How is their ability to FOLLOW DIRECTIONS
What is their ATTENTION SPAN
How are their PROBLEM SOLVING skills
141
When evaluating SCI patient do not assume that _ _ above the level of the lesion _ _ _ and that _ _ is _ below. Be aware of muscle _ and _ weakness. Be sure to distinguish _ _/_ from _ _ function.
- Do not assume that ALL MUSCLES above the level of the lesion HAVE NORMAL FUNCTION and that MOTOR FUNCTION IS ABSENT below.
- Be aware of muscle SUBSTITUTION and TRUNK weakness
- Be sure to distinguish ABNORMAL TONE/ SPASTICITY from VOLUNTARY MOTOR function.
142
During sensory assessment be sure to test _ _ _ on _ _. Be aware of _ _.
Be sure to test ALL KEY POINTS on BOTH SIDES
Be aware of SENSORY SUBSTITUTION
143
Muscle tone assessment provides information regarding _ _. Need to rate severity of _ and it's _ on _. Indicate if _ is _ or _ with activity/ stimuli.
Muscle tone assessment:
- provides information regarding MEDICAL STATUS
- need to rate severity of SPASTICITY and it's EFFECT ON FUNCTION
- indicate if SPASTICITY is CONSTANT OR FLUCTUATES with activity/ stimuli
144
What are 2 common scales used to evaluate spasticity?
MS
- modified Ashworth scale
- spasm frequency score
145
Range of Spasm frequent score? Level 0 and 1 description?
Range is: 0-4
Level 0: no spasms
Level 1: mild spasms induced by stimulation
146
Spasm frequency score 2: _ _ spasms occurring less than _ per _.
INFREQUENT FULL spasm occurring less than ONCE PER HOUR
147
Spasm frequency score that is being described: ten or more spasms per hour or continuous contraction
Score of 4
148
Spasm Frequency score 3: spasms occurring _ than _ per _.
MORE than ONCE per HOUR
149
Skin integrity assessment should include _ _ and _. Pressure ulcers _ _ be _.
Should include VISUAL OBSERVATION and PALPATION (for skin breakdown sites)
Pressure ulcers NEED TO be STAGED.
150
_ tolerance should also be assessed
SITTING TOLERANCE
151
_ status and _ mobility also need to be assessed during evaluation.
RESPIRATORY STATUS
FUNCTIONAL MOBILITY
152
What is a common test used to assess activity tolerance? Balance? (2)
Activity tolerance: 6 MIN WALK TEST
Balance: BERG BALANCE test and BALANCE SCALE
153
During assessment need to identify _; _ _, _ _, and _ goals; _ _.
Need to indentify:
- PROBLEMS
- SHORT TERM, LONG TERM and PATIENT goals
- REHAB POTENTIAL
154
Short term goals should be for _ _ _ or specific _ of _. Must be _, _ and _.
Should be for SHORT TIME SPAN or specific NUMBER OF TREATMENTS
Must be MEASUREABLE, FUNCTIONAL, and REALISTIC
155
Long term goals are for the _ of _ or _ of _; are based on _ _; must be _, _ and _; _ provides direction, focus, and structure for therapeutic programs.
- Long term goals are for the LENGTH OF STAY or DURATION OF PRESCRIPTION
- are based on FUNCTIONAL POTENTIAL
- must be MEASUREABLE, FUNCTIONAL, and REALISTIC
- WORDING provides direction, focus, and structure for therapeutic programs
156
Rehab potential is based on _ _ and _ _ of _; includes _ and _ _.
Rehab potential:
- is based on OBJECTIVE FINDINGS and ESTIMATED LENGTH OF STAY
- includes BARRIERS and FACILITATING FACTORS
157
During ROM testing be sure to note any _ and _; check _ and _ (if _ injury don't _ _ _)
During ROM testing:
- be sure to note any LIMITATIONS AND MEASURE
- check DORSIFLEXION and SLR (if LUMBAR injury don't MOVE PAST 90)
158
ROM testing is also important for _ and to guide you in _ of _ program
Also important for BRACING and to guide you in CREATION OF STRETCHING program
159
According to the ADA requirements: what is the minimum clearance for door width is _", with _" for hinged doors.
36" minimum clearance
32" for hinged doors
160
What is the requirement for handrail/ grab bar height? Max Counter height?
Handrail/ grab bar: 34-38"
Counter height: 34" max
161
Check recording for additional information on . . . .
ADA REQUIREMENT SLIDES
162
Muscle Strengthening for SCI patients: strengthen _ _ muscles used in _ _ even if they have a _/_ _.
Strengthen ALL INNERVATED muscles used in FUNCTIONAL ACTIVITIES even if they have a 5/5 STRENGTH
163
What are the 4 key muscle groups to target for strengthening in the UE?
SSS E
- scapular depressors and protractors
- shoulder flexors
- shoulder horizontal adductors
- elbow extensors and flexors
164
What are the 4 key muscle groups to strengthen in the LE?
HH AK
- Hip flexors and extensors
- Hip abductors
- Knee flexors and extensors
- Ankle dorsi flexors
165
_ _ muscles should be included in strengthening program.
ALL TRUNK muscles should be included . . .
166
Movement strategies for balance: find new _ of _(_) for _ or _; improve dynamic balance in __ and _ _ or _; improve _ _ for _ in all directions.
Balance movement strategies:
- find new CENTER OF GRAVITY (STATIC) for SITTING or STANDING
- improve dynamic balance in SHORT and LONG SIT or STANDING
- improve PROTECTIVE REACTIONS for FALLING in all directions.
167
Conditioning strategies: improve overall _ _; physiologic adaptations of _ and _ _ needs to be considered: need to factor in _ and _ _ changes, and _.
Improve overall MUSCLE ENDURANCE
Physiologic adaptations of CARDIOVASCULAR and PULMONARY SYSTEMS needs to be considered
Need to factor in METABOLIC and BODY COMPOSITION changes and OSTEOPENIA
168
Aerobic training/ exercise prescription: Target heart rate = 20-30 beats _ _ _ _; duration should be _ minutes of _ aerobic exercise on _-_ times/ week.
- Target Heart Rate (THR)= 20-30 beats ABOVE RESTING HEART RATE
- duration should be 30 minutes of CONTINUOUS aerobic exercise 2-3 TIMES/ WEEK
169
Types of aerobic activities that can be incorporated into treatment (if available): arm _; _ ergometer/ treadmill, _ aerobics, _, and _ _ training.
Types of aerobic activities:
- arm ERGOMETER
- WHEELCHAIR ergometer/ treadmill
- SEATED aerobics
- SWIMMING
- CIRCUIT RESISTANCE training
170
Anaerobic training: intensity is generally _-_ of _ _; duration is _-_ sets of _ reps _ _ per week.
Intensity is generally 50-80% of 1 RPM
Duration is 2-3 sets of 10 reps, TWO TIMES per week
171
Examples of anaerobic training types: _ stations, _ _ and _.
WEIGHT stations, FREE WEIGHTS, and THERABAND
172
Functional treatment guidelines: _ _ the functional activity into _; make the task _; learn the skill _ _; preserve the patients capacity to perform _ _ by preserving _ _.
- BREAK DOWN the functional activity into PARTS
- Make the task EASIER
- learn the skill IN REVERSE
- preserve patients capacity to perform FUNCTIONAL SKILLS by preserving BENEFICIAL TIGHTNESS (Tenodesis)
173
Treatment precautions for cervical instability: avoid shoulder _/ _ of greater than _ _; avoid _ _ of shoulder muscles.
Avoid shoulder FLEXION/ ABDUCTION of greater than 90 DEGREES
Avoid STRONG CONTRACTIONS of shoulder muscles
174
Treatment precautions for lumbar stability: avoid hip _ greater than _ _, limit _ to less than _ _; avoid _ _ of hip muscles.
Avoid hip FLEXION greater than 90 DEGREES
Limit SLR to less than 60 DEGREES
Avoid STRONG CONTRACTIONS of hip muscles
175
Treatment precautions: _-_ precautions; be careful when treating _/_; take _ _ during functional activities and of _ _.
WEIGHT BEARING precautions
Be careful when treating OSTEOPOROSIS/ FRACTURES
Take SKIN PRECAUTIONS during functional activities and of VULNERABLE AREAS.
176
What are 2 important BP precautions?
Orthostatic hypotension
Autonomic dysreflexia
177
Preserve Tenodesis grasp/ appropriate shortening of long finger flexors with _ or _. Prevent _ of _ _ with less than _/_ _.
Preserve Tenodesis with C7 OR HIGHER
Prevent OVERSTRETCHING of WRIST EXTENSORS with less than 3/5 STRENGTH
178
Treatment precautions with Low back: maintain _ _ in _; _ _ should be avoided if _ is not _ _.
Maintain PROPER POSITION in WHEELCHAIR
LONG SITTING should be avoided if SLR is not 90 DEGREES
179
Up to 75% of _ _ develop _; and 49-73% develop _ _ _.
Up to 75% of WHEELCHAIR USERS develop PAIN and 49-73% develop CARPAL TUNNEL SYNDROME
180
_-_ % of wheelchair users have _ _, and 65% with pain have _ _ _ or _.
5-31% have ELBOW PAIN, and 65% with pain have ROTATOR CUFF TEARS or TENDONITIS
