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NBCOT LAST Attempt > SCI > Flashcards

SCI Flashcards

1
Q

C1-C3 functions

A
  • need respirator/ventilator
  • limited head and neck movement
  • Able to use “sip and puff” wheelchair, eye gaze
  • Completely dependent in ADLs and transfers
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2
Q

C4 functions

A
  • full mobility of the head and neck
  • no respirator, ADL/transfer dependent
  • Possibility of autonomic dysreflexia
  • “Sip and puff” mouthstick power wheelchair required
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3
Q

C5 functions

A

ELBOW FLEXION
- Supination, no finger/wrist movement
- mobile arm support
- Electric wheelchair with hand control may be used

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4
Q

C6 functions

A

WRIST EXTENSORS
- Independent in transfers from toilet to wheelchair
- can reach forward.
- splint to promote wrist tenodesis.
- Able to do some ADLs : shaving, dressing UB
- Assistance for LB dressing & transfer from bed to wc

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5
Q

C7 functions

A

TRICEPS for elbow extension
- partial intrinsic hand muscles
- wrist flexion, finger extension (reduced grasp)
- I: self care, transfers
- Mod I: feeding, bathing, grooming, toileting
- Mod I to min: Dressing
- some assistance for bowel/bladder care
- manual wc with wc pushups for pressure relief (depression relief techniques)

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6
Q

C8-T1 functions

A
  • Full UE control, including fine coordination and
    grasp
  • I: personal care (few hours of homemaking assistance each day after d/c)
  • Mod I: ADLs, mobility and communication
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7
Q

T6 functions

A
  • Increased endurance
  • Larger respiratory reserve
  • Pectoral girdle stabilized for heavy lifting
  • ADLs Independent (No assistive devices)
  • Uses braces with great difficulty for ambulation
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8
Q

T12 functions

A
  • Improved endurance and trunk control.
  • ADLs/IADLs independent
  • long leg braces and crutches, wc for energy conservation
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9
Q

L4 functions

A
  • Independent in all activities plus ambulation
  • involuntary bowel and bladder control
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10
Q

How should sensation testing be conducted in a SCI?

A
  • Tested proximal to distal
  • Vision occluded
  • Test uninvolved side first
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11
Q

At what SCI level can a person use a universal
cuff?

A

C5

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12
Q

what stage does tenodesis occur?

A

C6

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13
Q

What is spinal shock?

A

can start 30 min after injury, lasts 4-8 weeks
- acute physiological loss or depression of spinal cord function following a spinal cord injury
- Associated loss of sensorimotor function and flaccid paralysis lasting several days
- all reflex activity gone below level of injury
- transitions to spasticity
- cannot evaluate deficit until spinal shock ends

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14
Q

ASIA E

A

NORMAL motor & sensory function

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15
Q

ASIA D

A

INCOMPLETE

50% of muscles more than grade 3
Can raise arms or legs off of bed

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16
Q

ASIA C

A

INCOMPLETE

50% of muscles less than grade 3
Can’t raise arms or legs off of bed

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17
Q

ASIA B

A

INCOMPLETE
sensory only, no motor

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18
Q

ASIA A

A

COMPLETE
no motor, no sensory, no sacral sparing

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19
Q

what is the tone of muscles after a SCI?

A

initially flaccid below level of injury then become spastic
- hyperactive sympathetic functions
- sensory loss below LOI

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20
Q

orthostatic hypotension

A

low BP while upright
- lean client back/help them lie down to return to normal
- leg wraps to prevent

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21
Q

autonomic dysreflexia

A

headache, sweating, congestion, high BP, bradycardia
- sit client UP, remove restrictive clothing
- check catheterization (bladder voiding)
- T6 and above
- causes: irritants that would normally cause pain to area below injury, bladder irritants, skin irritants, sexual activity, heterotopic ossification, skeletal fx, appendicitis
- immediately discontinue sesion to allow client to stabilize and recover

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22
Q

what are some driving adaptations for SCI?

A
  1. palmar cuff and spinner knob to steer wheel single handedly
  2. pedal extensions for acceleration/braking for limited LE reach
  3. hand controls for acceleration/braking (all levels with paraplegia)
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23
Q

AE for SCI

A

C1-C3: eye gaze, sip & puff
C4: sip & puff
C5: mobile arm support for feeding, universal cuff, wrist cock-up splint
C6: tenodesis splint, built-up handles, sliding board, transfer board for transfers
C7: hook & loop straps

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24
Q

in which SCI level are wrist extensors?

A

C6

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25
Q

in which SCI level are triceps?

A

C7

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26
Q

in which SCI level are finger flexors, extensors, intrinsics?

A

C8

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27
Q

C8 functions

A

FINGER FLEXORS, EXTENSORS, INTRINSICS
- at risk for heterotopic ossification
- independent car transfers
- same functions as C7
- independent bladder function with intermittent catheterization

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28
Q

what approach is used with SCI (acute phase)?

A

top down approach

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29
Q

how often do weight shifts occur?

A

every 30-60 min

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30
Q

stage 1 pressure ulcer

A
  • NO OPEN WOUND or tear in skin
  • red
  • NO BLANCHING
  • Warm
  • Surrounding area may feel either firmer or softer
  • May report PAIN
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31
Q

Stage 2 pressure ulcer

A
  • Partial thickness skin loss
  • Exposed dermis
  • Open wound (scrape, blister, tear)
  • pain & tenderness
  • Warm
  • Localized EDEMA
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32
Q

stage 3 pressure ulcer

A
  • Full-thickness skin loss
  • Open wound (crater)
  • Wound extends into fat layer
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33
Q

stage 4 pressure ulcer

A
  • Full-thickness tissue & skin loss
  • Open wound, visible muscle, tendon, bone
  • Tunneling or undermining present
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34
Q

unstageable pressure ulcer

A
  • Full thickness skin & tissue loss
  • Wound completely covered by eschar or slough
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35
Q

hollow back is

A

lumbar lordosis

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36
Q

round back is

A

kyphosis

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37
Q

lateral curvature of the spine is

A

scoliosis

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38
Q

sciatic pain

A

nerve trapped by herniated disc

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39
Q

compression fracture

A

vertebral osteoporosis

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40
Q

spinal stenosis

A

narrowing of intervertebral foramen (disc)

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41
Q

spondylolysis

A

Stress fracture through pars interarticularis of lumbar vertebrae

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42
Q

spondylolisthesis

A

Vertebrae slipping out of position (forward due to pars fracture instability)

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43
Q

causes of low back pain

A

Poor physical fitness, obesity, reduced muscle strength, poor endurance

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44
Q

osteopenia

A
  • REVERSIBLE weakening of bone, precursor to osteoporosis
  • Risk factors: inadequate calcium intake, estrogen deficiency, and a sedentary lifestyle
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45
Q

UMN damage

A
  • CNS
  • CVA, TBI, SCI (cortex, brain stem, corticospinal tracts, spinal cord)
  • HYPERTONIA: velocity dependent
  • flexor/extensor muscle spasms
  • NO voluntary movements: dyssynergic patterns, obligatory synergies
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46
Q

LMN damage

A
  • PNS
  • polio, Guillain-Barre, PNI, peripheral neuropathy, radiculopathy
  • SC: anterior horn cell, spinal roots, peripheral nerves,
  • CN: cranial nerves
  • LOW TONE: not velocity-dependent
  • Involuntary muscle twitching
  • Voluntary movements weak/absent if nerve interrupted
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47
Q

windswept deformity

A

Pelvis rotated laterally to one side, resulting in the spine, trunk, and thighs moving to the opposite side

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48
Q

cauda equina

A

LMN lesion
- Loss of long nerve roots at or below L1 level (lost sensation, movement)
- no spinal reflex activity, areflexic bowel/bladder, loss of sensation
- nerve regeneration: often incomplete, slows/stops within a year- may become paralyzed

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49
Q

conus medullaris/tethered SC syndrome

A
  • Injury of sacral cord & lumbar nerve roots, L2 lesions
  • LE motor & sensory loss, weakness, pain, bowel/bladder issues
  • PRESERVED: reflexes if lesion is in sacral segments
  • children: lesions, fatty tumors, hairy patches, dimples on LB
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50
Q

posterior cord syndrome

A

least frequent, injury to posterior columns
- LOST: PROP
- preserved: pain, touch, temperature, motor function to varying degrees

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51
Q

anterior cord syndrome/Beck’s Syndrome/Anterior Spinal Artery Syndrome

A

UMN lesion- FLEXION INJURIES

  • bilateral: loss of motor function, pain, pinprick, temperature
  • PRESERVED: prop, light touch
  • OH, possible bladder, bowel, sex dysf
52
Q

Brown-Sequard Syndrome

A

UMN lesion (trauma-gunshot wound, infection, inflammatory disease) in SC
- opposite side (contralateral): loss of sensation (pain & temperature) BELOW lesion
- same side (ipsilateral): weakness/paralysis (light touch, motor, tactile discrimination, pressure, vibration, prop, spastic paralysis)
- bilateral: loss of pain/temp AT LESION

53
Q

Central Cord Syndrome

A

UMN lesion- most common incomplete SCI, HYPEREXTENSION INJURIES
- MORE UE DEFICITS THAN LE
- sensory loss, FM control/paralysis in hands/arms
- mild loss of control in legs, no reflexes
- Bilateral loss of pain and temperature (sensory), motor function (UEs), bladder
- PRESERVED: prop & discriminatory sensation

54
Q

body mechanics for low back pain

A
  • straight back, min lumbar lordosis (anterior pelvis)
  • good posture
  • load close to body
  • lift with legs
  • wide BOS
  • lift in sagittal plane
  • lift slowly
  • semi squat is safest for back
55
Q

what should be done with bed mobility for low back pain?

A

log rolling

56
Q

what type of lift is used for low back pain when removing laundry?

A

golfer’s lift (lift leg opposite arm used in reach)

57
Q

anterior pelvic tilt is found in

A

lumbar lordosis

58
Q

causes of the incomplete SCIs

A
  • central cord: neck trauma, herniated disc, narrowing of spinal column due to age, HYPEREXTENSION INJURIES
  • brown-sequard: tumor, puncture wound to neck/back, tissue death due to obstructed BV, infection, inflammatory disease
  • anterior cord: atherosclerosis, aortic block, external compression from herniated disc, trauma (stab wound), FLEXION INJURIES
  • conus medullaris: scar tissue secondary to SCI, spina bifida (congenital)
  • cauda equina: secondary to ruptured disc (material from disc pushed into spinal canal, compression L & S nerves)z
59
Q

zone of partial preservation (ZPP)

A

ONLY WITH COMPLETE INJURIES (ASIA A)
- refers to partially innervated dermatomes/myotomes
- most caudal = extent of sensory or motor ZPP
- record single segments on worksheet
- only include key muscles

60
Q

if the right sensory level is C5 & some sensation extends from C6 through C8, what is recorded in the right sensory ZPP block on the worksheet?

A

C8

61
Q

does someone without a SCI receive a score on the ASIA scale?

A

no, only with a prior deficit with SC

62
Q

what is required to receive a grade of C or D on the ASIA scale?

A

must have either
- voluntary anal sphincter contraction
OR
- sacral sensory sparing at S4/5 or DAP with motor function sparing more than 3 levels below the motor level for that side of the body
- non-key muscle function more than 3 levels below the motor level can be used to determine motor incomplete status (AIS B vs C)

63
Q

incomplete injury

A

preservation of any sensory/motor function below level of injury including S4/S5

64
Q

sacral sparing

A

sensory/motor function preserved at levels S4/S5

65
Q

sensory sacral sparing

A

sensation preservation (intact or impaired) at the anal mucocutaneous junction (S4-5 dermatome) on one or both sides for light touch, pinprick, or deep anal pressure

66
Q

motor sacral sparing

A

presence of voluntary contraction of. the external anal sphincter upon digital rectal examination

67
Q

what is the ASIA impairment scale used for?

A

grading the degree of impairment

68
Q

NLI

A

neurological level of injury
- most caudal segment of the SC with normal sensory & antigravity motor function bilaterally provided there are normal sensory & motor function rostrally

69
Q

sensory level of NLI

A

most caudal, intact dermatome for both light touch & pinprick sensation

70
Q

motor level NLI

A

most caudal myotome with a key muscle function of at least grade 3

71
Q

If there is a discrepancy between the most caudal intact section between the four possible levels (R & L sensory level, R & L motor level) what happens?

A

the NLI is considered the most rostral segment of these 4 levels

72
Q

what are the 4 different segments which may be identified in determining neurological level?

A
  1. R sensory
  2. L sensory
  3. R motor
  4. L motor
    (NRI is most rostral of these levels)
73
Q

how is motor level determined?

A

examine key muscle function within each of 10 myotomes on each side of body
- lowest key muscle function with grade 3 on MMT while in supine
- may be diff for R/L

74
Q

motor scores

A

summary score of motor function
- max score of 25 for each extremity
- total = 50 for UE, 50 for LE
- reflects degree of neurological impairment with SCI

75
Q

how is sensory level determined?

A
  • examine key sensory points within each of 28 dermatomes on each side of body (R & L)
  • most caudal, normally innervated dermatome for both pinprick & light touch sensation
  • may be diff for R/L
76
Q

pinprick sensation

A

sharp vs dull discrimination

77
Q

sensory scores

A

summary score of sensory function
- total = 56 points each for light touch & pinprick
- total = 112 points on each side of body
- degree of neurological impairment due to SCI

78
Q

skeletal level

A

level by radiographic exam where greatest vertebral damage is found

79
Q

myotome

A

muscles served by spinal nerve root
- set of muscles innervated by specific single spinal nerve

80
Q

how many muscle groups represent motor innervation to cervical & lumbosacral SC?

A

10

81
Q

myotomes for C5-C8

A

C5: elbow flexion
C6: wrist extension
C7: elbow extension
C8: finger flexion

82
Q

myotomes for T1-S1

A

T1: finger abduction
L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: great toe extension
S1: ankle plantarflexion

83
Q

dermatome

A

area of skin innervated by sensory axons within each segmental nerve (root)
- important for assessing/dx SCI on ASIA scale

84
Q

how many segments are in the SC?

A

31
- each has pair (R/L) of ventral & dorsal nerve roots innervating motor & sensory function

85
Q

which SCI level does not have a dermatome

A

C1

86
Q

how many spinal nerves are there?

A

31
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

87
Q

C2-C8 dermatomes

A

C2: occipital protuberance
C3: supraclavicular fossa
C4: acromioclavicular joint
C5: lateral antecubital fossa
C6: thumb
C7: middle finger
C8: little finger

88
Q

how is the vertebral column made up?

A

7 C, 12 T, 7 L

89
Q

where is cauda equina?

A

below L2 (only spinal roots)

90
Q

atlas

A

C1

91
Q

axis

A

C2

92
Q

which SC level is the exception in regards to spinal nerves?

A

C7: set of spinal nerves extending above (at C7) & below (at C8)
- there are 8 spinal nerves, 7 spinal verebrae

93
Q

muscle innervations for C1-C8

A

C1-C3: sternocleidomastoid, cervical paraspinal, neck accessories
C4: diaphragm, upper traps, cervical paraspinal muscles
C5: biceps brachii, biceps, brachialis
C6: ECRL, ECRB
C7: triceps
C8: FDP

94
Q

muscle innervations for T1-S5

A

T1: abductor digiti minimi
T2-T6: dorsal/palmar interossei, abductor pollicis brevis, full lumbricals, erector spinae of upper back, abs
T7-T12: abs
L2: iliopsoas
L3: quadricep
L4: tibialis anterior
L5: extensor hallucis longus
S1: gastrocnemius, soleus

95
Q

muscle movements for C1-C8

A

C1-3: no motor innervations
C4: shrugs shoulders
C5: elbow flexion
C6: wrist extension
C7: elbow extension
C8: middle finger flexion

96
Q

muscle movements for T1-S5

A

T1: abduct pinky
T2-T6: finger abduction, adduction of IP, thumb abduction, MCP joint flexion with IP joint extension, thoracic spine extension
T6: ab strength
T7-T12: partial-full innervation for trunk flexion & rotation
L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: long toe extensors
S1: ankle plantarflexion

97
Q

communication abilities in SCI

A

C1-C3: sometimes difficult/impossible (mouth stick)
C4: communication devices may be needed or may be normal

98
Q

wheelchairs for SCI

A

C1-C3: power wc with tilt & recline, sip & puff (head control, mouth stick, chin control)
C4: power wc with tilt & recline
C5-C6: power wc with arm drive control for outdoors, manual wc for indoors (level and non-carpeted surfaces)
C7 & up: manual rigid or lightweight folding wc with modified rims

99
Q

when are leg braces used in SCI?

A

T7-L2 = possible
L3-L5 = able along with straight cane, may use wc for sports/long distance

100
Q

when can SCI patients walk without leg braces?

A

S1-S3 (but may be needed)

101
Q

complications of SCI

A
  • respiratory: decreased vital capacity, pneumonia
  • decubitus ulcer formation
  • orthostatic hypotension
  • DVT
  • autonomic dysreflexia
  • UTI
  • heterotopic ossification
102
Q

deep vein thrombosis

A

inflammation of a vein with formation of a thrombus
- usually in LEs
- deadly- can turn into pulmonary embolism

103
Q

how to prevent autonomic dysreflexia

A
  • teach client/caregiver pressure relief
  • compliance with intermittent catheterization
  • well- balanced diet habits
  • ensure medication compliance
  • educate client/caregivers on prevention methods, recognize signs/symptoms, initiate first aid
104
Q

heterotopic ossification

A

formation of bone in abnormal areas

105
Q

myositis ossificans

A

reaction to a bruise in a muscle that has been injured

106
Q

appendicitis

A

appendix becomes sore, swollen, and diseased

107
Q

pressure sores are also known as

A

decubitus ulcers, bed sores

108
Q

integramouse

A

joystick or set to keyboard mode – ideal for gaming, has sip & puff selection
- C1-C3 SCI

109
Q

how can a C1-C3 SCI client operate a computer?

A
  • Integramouse (sip & puff selection)
  • morse code with switch operated by tongue, eye movement or other facial muscles
  • single switch scanning
  • limited voice recognition for commands and using macros/shortcuts
  • eye gaze technology
110
Q

environmental control units

A

devices that allow people with mobility impairments to operate electronic devices, including televisions, computers, lights, appliances, and more
- C1-C3/C4

111
Q

Electric Trendelenburg Hospital Bed

A

for C1-C5

112
Q

what type of splint is worn at C5?

A

day: wrist cock up
night: intrinsic plus
- air splints for elbow extension for home exercise program for increasing shoulder/scapula strength.

113
Q

how can a C3-C4 SCI client operate a computer?

A
  • Mouthstick and holder/mini keyboard
  • trackball mounted at chin
  • onscreen keyboard
  • separate switch and interface for L/R click (operated by sip/puff, cheek, shoulder shrug
  • eye movement
  • mouse devices designed to be mounted at chin
  • mouth, “Hover” or “dwell” software for automatic selection of icons/controls
  • single or double switch scanning
  • morse code/switch activation
  • voice recognition
114
Q

how can a C5-C6 SCI client operate a computer?

A
  • typing aids ( with/ without wrist support)
  • mouthstick as back up, or if UE pain is present
  • mini-keyboard
  • laptray
  • trackball /joystick / touchpad for mouse movement
  • separate switch and interface for L/R click
  • keyboard shortcuts (Sticky Keys, Hotkeys, etc.)
  • word prediction/completion software for rate enhancement
  • voice recognition for ease and efficiency
115
Q

at what level SCI is a client independent with all self care?

A

T1

116
Q

side to side weight shifts occur at SCI level

A

C5

117
Q

forward weight shifts occur at SCI level

A

C6

118
Q

independent feeding, dressing, bathing with adaptive equipment occurs at SCI level

A

C7

119
Q

level surface transfers with assistance occur at SCI level

A

C6

120
Q

when does spinal shock end? *multiple options

A

appearance of the bulbocavernosus reflex within the first few days of injury
- recovery of deep tendon reflexes (DTRs) which may not reappear for several weeks
- return of reflexive detrusor function which can happen months following injury

121
Q

bulbocavernosus reflex

A

spinal mediated and involves S2-S4
- somatic reflex
- mediated through the pudendal nerve
- contraction of the bulbocavernosus muscle in response to squeezing the penis/tugging on the indwelling Foley catheter or clitoris
- tests the conus medullaris (distal end of the spinal cord) and the S2 to S4 pelvic nerves
- signifies the end of spinal shock, classifies SCI as complete or incomplete

122
Q

If the BR is present 48 hours following injury, it can be assumed that

A

client is out of spinal cord shock

123
Q

Bulbocavernosus Reflex absent =

A

spinal shock

124
Q

Bulbocavernosus Reflex present =

A

severed spinal cord (lesion or injury of the conus medullaris or sacral nerve roots)

125
Q

stages of spinal shock

A
  • initial hyporeflexia: 0-1 days
  • initial return of some reflexes: 1-3 days
  • Early hyperreflexia: 4 days to 4 weeks
  • Late hyperreflexia: 1 to 12 months
126
Q

what is the order of reflex return following SCI?

A
  1. polysynaptic reflexes
  2. delayed plantar reflex
  3. bulbocavernosus reflex

NBCOT LAST Attempt (50 decks)

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