SCI Flashcards
(119 cards)
1
Q
What is the leading cause of death for those w/SCI?
A
Pnemonia and septicemia (respitory illnesses)
With wound infections following closely
2
Q
From C1-C7, the nerve root exits ___ the vertebrae
A
Above the vertebrae
3
Q
From C8 and below, the nerve root exits ___ the vertebrae
A
Below the vertebrae
4
Q
Which nerves have no dorsal root or dermatome?
A
Coccygel nerve and C1
5
Q
Define thrombosis
A
Local coagulation or clotting of the blood
6
Q
Define embolus
A
A blood clot, air bubble, piece of fatty deposit, or other obj which has been carried in the bloodstream to lodge in a vessel and cause an embolism
7
Q
Define arteriovenous malformation
A
An abnormal connection between arteries and veins, usually in the brain or spine.
8
Q
What does ASIA stand for
A
American Spinal Injury Association
9
Q
What does ISNCSCI Stand for
A
International standards for neurological classification of SCI
10
Q
What does AIS stand for
A
ASIA impairment scale
11
Q
Define sacral sparing
A
The presence of sensory or motor function in the most caudal sacral segments as determined by examination (S4-S5 light touch or pin prick or presence of DAP)
12
Q
ASIA key mm for:
C5
A
Elbow flexors (biceps)
13
Q
ASIA key mm for:
C6
A
Wrist extensors
14
Q
ASIA key mm for:
C7
A
Elbow extensors
15
Q
ASIA key mm for:
Finger flexors
A
Middle digit flexion at the DIP
16
Q
ASIA key mm for:
T1
A
Little finger abduction
17
Q
ASIA key mm for:
L2
A
Hip flexors
18
Q
ASIA key mm for:
L3
A
Knee extensors
19
Q
ASIA key mm for:
L4
A
Ankle DF
20
Q
ASIA key mm for:
L5
A
Long toe extensors (big toe tested)
21
Q
ASIA key mm for:
S1
A
Ankle PF
22
Q
Which levels are there no key mm for ASIA testing?
A
C1-C4, T2-L1, S2-5
23
Q
What does a violation of the N0000N sign indicate?
A
Incomplete
24
Q
What is tenodesis grip?
A
A flexion contracture developed in the fingers so that when wrist extension is performed, the fingers will flex - allows for grip in individ w/o finger mm
25
T or F: More SCI injuries are female
False - 78% male
26
Race/Ethniciy of those affected w/SCI (High to low)
```
Non-hispanic white
Non-hispanic black
Hispanic
Asian
Other
Native American
```
27
Cause of SCI (High to low)
```
Vehicular
Falls
Violence
Sports
Med/Sx
Other
```
28
Extent of SCI (High to low)
Incomplete tetraplegia
Complete Paraplegia
Incomplete Paraplegia
Complete Tetraplegia
29
What is the average age of injury for SCI
43
30
How many cases per million in the US
54
31
How many people in US with SCI
296,000
32
Complete vs incomplete lesion
Loss of all sensation and motor function below the level of the lesion vs only partial loss below the level of lesion
33
Define tetraplegia
Impairment or loss of motor function and/or sensory function in the cervical segments of the SC due to damage of neural elements w/in the spinal canal
34
Define paraplegia
Impairement or loss of motor and/or sensory function in the thoracic, lumbar, or sacral (NOT CERVICAL) segments of the SC due to damage of neural elements within the spinal canal
35
Length of stay:
Acute care
Rehab
11 days
| 30 days
36
Which layer of the meninges is avascular
The arachnoid mater
37
Which type of SCI has the best prognosis?
Contusion because the SC is still intact
38
What is a contusion injury
Bruising of the SC following fx and dislocations of the vertebrae
39
Causes of compression injury
From fx and dislocations of vertebrae, tumors, disc herniation
40
What is the clinical presentation of a contusion
Initially severe symptoms but usually a relatively rapid return of function, dependent upon the severity of the injury
41
What is a laceration
SCI injury due to knife, gunshot, or other projectile/foreign object
42
What is the clinical presentation of a laceration injury
Partial to complete loss of function below level of lesion w/impairment dependent upon the extent of the lesion
43
What is a loss of vascular supply lesion
SCI from thrombosis, embolus, arteriovenous malformation or direct disruption of blood vessels
44
What is the clinical presentation of a loss of vascular supply lesion
Partial loss of SC fun below the level of the lesion in distribution of blood supply
45
At T6, what would you find in the PCML?
T6-S5 nerve information
46
What does damage below the level of L2 lead to?
Damage is to the nerve roots only due to the SC ending at L2 bony level
47
What does a hyperflexion injury cause?
Anterior Cord Syndrome
48
What does a hyperextension injury cause?
Posterior cord syndrome
49
What causes anterior cord syndrome
Loss of blood flow to anterior spinal cord artery, damage to the anterior 2/3 of SC, hyperflexion injury
50
What is anterior cord syndrome
Partial or full loss of bilateral ALS, lateral and anterior CST below level of lesion, but spared PCML bilaterally below level (preservation of light touch and joint position sense)
51
What is posterior cord syndrome
Loss of DCML sensory modalities below the level of lesion, preservation of ALS sensation, and partial or full preservation of CST motor function bilaterally
52
What is central cord syndrome
Central SC hemorrhage and necrosis with sparing of the peripheral areas of the SC - most often in the cervical region w/greater weakness in UE than LE
53
What is the most common clinical syndrome SCI
Central cord syndrome
54
What is Brown-Sequard Syndrome
Hemisection of the SC causing
IPSI DCML and CST loss (prop, vibration, fine touch, motoro control)
CL ALS loss (crude touch, sharp/dull, T, pain, tickle and itch)
55
What are the most common mechanisms of injury for Brown-Sequard
Traumatic SCI - penetrating injuries (Gunshot, knife wound) or a burst fx
56
What is cauda equina syndrome
Involves lumbosacral nn roots of cauda equina, causing LMN damage
57
Symptoms of Cauda Equina Syndrome
producing:
- flaccid paralysis of LEs
- areflexic bowel and bladder
- partial or complete loss of sensation
58
Difference b/t conus medullaris syndrome and cauda equina syndrome
Conus medullaris is more rostral in the SC (L1-L2)
59
What is conus medullaris syndrome?
Damage to the SC w/UMN and LME damage (Depending on level of injury) - typically more rostral than cauda equina
60
What is Acute Transverse Myelitis
SC lesion usually in the thoracic spine, where 1/3 recover complete, 1/3 partial, and 1/3 not at all
Initially presents w/fever, headache, nausea and vomiting, lethargy, and myalgias
61
What is a Complete Injury?
Loss of sensation and motor function below level of lesion w/absence of sacral sparing and 0s for light touch/pinprick (S4-5)
62
What is an incomplete injury?
Partial loss of sensation and motor fun below level of injury where Sacral sparing is present
63
What is AIS A
Complete SCI
| - No sensory or motor fun preserved in sacral segments S4&5, and often none below the level of injury
64
What is AIS B
Sensory Incomplete
- sensory, but not motor fun preserved @ most caudal segments (absent N0000N sign)
- NO MOTOR FUN preserved MORE THAN 3 levels below motor level
65
What is AIS C
Motor Incomplete
- Motor fun is preserved in the most caudal sacral segments (Voluntary anal contraction)
* > 1/2 of key mm fun below level of injury have mm grade <3
- some sensory fun at S4-5 (DAP, PP, or LT)
66
AIS D
Motor Incomplete
- At least 1/2 of key mm fun below single NLI have muscle grade >= 3
67
AIS E
Normal
- sensation and motor fun are graded normal in all segments
68
What is the use of non-key muscles in the AISA exam?
To differentiate b/t AIS B vs C w/non-key mm >3 levels below the motor level on each side
69
Pt presentation with:
| C2-C3
Ventilator dependent, total care
70
Pt presentation with:
| C3-5
Phrenic nn, independent breathing, off ventilator
71
Pt presentation with:
| C5
Can raise shldrs and flex arm to use joystick on power w/c - possibly manual w/c + adaptations
72
Pt presentation with:
| C6
Have wrist ext so weak, funct tenodesis grasp
73
Pt presentation with:
| C7
Have triceps and can preform P relief and transfers to help self prevent ulcers
74
Pt presentation with:
| Thoracic region
Adds postural stability and respiration function
75
Pt presentation with:
| T6-T12
abdominal function
76
Pt presentation with:
| L2
Hip flexion
77
Pt presentation with:
| S2-4
Sacral region is important for bowel/bladder/sexual function
78
What do you do w/acute SCI MGT
- check ABC
- Log roll (NEUTRAL SPINE)
- Immobilize
- Monitor BP & ECG
- X-ray, CT and/or MRI
79
Indications for Sx w/acute SCI
- Bone fragments and disk material in spinal canal
- Unstable fx
- Progression of neuro deficit
- Decompression due to edema, increased blood in area, etc
80
Goals of sx
1. Stabilize
2. Decompress Neural elements
3. Correct deformity and/or maintain alignment
81
What are harrington rods
Stainless steel rods w/hooks on either end placed on either side of injury
- away : traction
- towards : Compression
82
What is the most common approach for TL Sx?
Posterior approach
83
Where is an anterior approach more common?
Cervical spine
84
How long do you immobilize for
| - Stable fx w/o sx
6-12 weeks
85
How long do you immobilize for
| - Cervical Fusion
3-4 months using halo or SOMI
86
How long do you immobilize for
| - Thoracolumbar Fusions
4-6 mo using a rigid body jacket (TLSO)
87
What is spinal shock?
Onset: Immediate
Duration: 1 wk - months
W/FLACCID paralysis & loss of sensation below level of lesion, absent bowel and bladder tone, and decreased BP
88
What is the zone of injury & why is it important
- 1-3 neurological levels below the neurological level of injury.
- Important because this area has the most potential for recovery
89
Define spasticity
A motor disorder characterized by a velocity dependent increase in tonic stretch reflexes with exaggerated deep tendon reflexes resulting from the hyper--excitability of the monosynaptic stretch reflex as one component of the UMN syndrome
90
Relationship b/t spasticity and function
```
Inversely proportional
(Increase spasticity = decrease function)
```
91
T or F: Spasticity is constant throughout the day
F - spasticity can change based on many factors, including t of day, position, meds, T, mood, fatigue, etc
92
Spasticity in your patient is greater than usual - what do you do?
Investigate it
- UTI?
- Noxious stimulus
- syrinx (increased swelling in tissue that is compromising the SC)
- Use baclofen as a first line agent
93
What is synrinx?
It is increased swelling in tissue that is compromising or pressing on the SC - concern if spasticity is greater than usual
94
What kind of rehab interventions would you utilize for spasticity?
- Position on a consistent basis
- Modalities
- Ther ex
- Orthotic management
95
What is a DEXA scan used for?
a) score of >= -1
b) score of -1 - -2.5
c) score < -2.5
Classification of osteoporosis/osteopenia
a) normal
b) osteopenia
c) osteoporosis
96
List some interventions for Osteoporosis
- WB in all positions
- Easyglide
- FES Cycling
- Vitamin D / CA+ supplement
- Obesity reduction
97
What is heterotopic Ossification
Ca++ Deposits in soft tissues around joints that receive stress causing a limitation of ROM
98
What is a dysrhythmia?
Abnormality in the physiological rhythm of the heart
99
What is hypertension?
Hypotension?
(Values)
> 140/90 mmHg
| < 90 mmHg systolic
100
What is orthostatic hypotension
Symptomatic or asymptomatic decrease in BP w/drop of at least 20 mmHg systolic or 10 mmHg diastolic w/in 3 minutes of moving
101
What are the symptoms of orthostatic hypotension (per ASIA)
dizziness, headache, or neck ache and fatigue
- others are lightheadedness, generalized weakness, leg buckling, nausea, blurry or "fading to black vision"
102
What causes orthostatic hypotension?
- Loss of sympathetic input below level of lesion
- Failure of body to compensate for drop in BP
- Loss of mm pumping action to return blood from LEs
103
Define autonomic dysreflexia (AD)
Massive sympathetic hyperactivity in response to noxious stimuli below the level of the SC injury in complete SCI above T6
104
What triggers AD?
- Full bladder/blocked catheter
- Tight clothing
- Prolonged pressure by object (tight shoe, ill fitting brace)
- UTI, pain, sunburn, pressure injuries, ingrown toenails
105
What are the s/s AD?
- Pounding headache (**from elevation of BP)
- Flushed face w/blotching of skin
- Goosebumps & standing hairs
- sweating above injury & vasoconstriction below injury
106
What are some complications of AD?
Seizures
CVA
Organ Failure
Death
107
Sweating - what occurs above and below the level of the lesion?
- hyperhydrosis above lesion in response to noxious or non-noxious stimuli
- hypohydrosis below in response to increased T
108
Define Temperature dysregulation
change in body (core) temperature without signs of illness or infection which may result from environmental temperature change
109
Why can a person w/SCI not regulate their temp?
Because they cannot sweat or shiver below the level of the lesion
110
T or F: Those w/SCI have a decreased risk of DVT
False - they have an increased risk
111
At C8-T12, approx what respiratory vital capacity do pts lose?
20-70% decrease in capacity
112
List the urological system complications from SCI
- UTI
- Kidney stones
- Bladder stones
113
List the gastrointestinal complications from SCI
- Loss of bowel control
- constipation or obstruction
- bowel accidents due to medications treating constipation
114
How do you manage gastrointestinal complications from SCI?
Surgically via colostomy or ileostomy
115
What is true about the reproductive system in women post SCI?
- will return to menses (50% after 6mo, 90% 1 yr)
| - can get pregnant even if can't feel below level of injury
116
What nerves control reflexogenic erections?
S2-4
117
What is neuropathic pain?
| Who experiences it?
Burning sensation below the level of lesion felt by 70-90% (MOST) SCI pts
118
How long does it take to get a pressure injury over a bony prominence?
32 mmHg in as little as 30 min
119
How much pressure can lead to necrosis in >2 hrs
70 mmHg
