SCI

Question 1

At which spinal cord levels (and below) is estim going to be ineffective?

Answer 1

L1/L2 and below

Question 2

T/F using estim for a peripheral nerve injury is an ineffective treatment.

Answer 2

True

Question 3

The spinal cord has 2 enlargements: ________ and ________.

Answer 3

Cervical and lumbosacral enlargements

Question 4

The spinal cord terminates at the _______________.

Answer 4

conus medullaris

Question 5

What does the DCML pathway mediate (3)?

Answer 5

Proprioception
Vibration
discriminative touch

Question 6

What does the spinothalamic tract mediate (3)?

Answer 6

Pain
Temperature
Non-discriminate touch

Question 7

Which gender is at a higher risk of SCI?

Answer 7

Male

Question 8

What age group is at a higher risk of SCI?

Answer 8

16-30

Question 9

What underlying bone disorders are risk factors for SCI?

Answer 9

Osteoporosis
Rheumatoid arthritis

Question 10

70% of SCI are caused by ________ and _________.

Answer 10

accidents and falls

Question 11

___% of SCI are traumatic and ___% are non-traumatic.

Answer 11

95%; 5%

Question 12

What is the most common motion that leads to an SCI?

Answer 12

Flexion

Question 13

Identify three ways to classify an SCI:

Answer 13

Level of injury
Degree of impairment (complete or incomplete)
Syndromes associated with injury

Question 14

Define paraplegic

Answer 14

Loss of lower extremities

Question 15

Define tetraplegic

Answer 15

Loss of all 4 extremities (quadriplegic)

Question 16

How is the level of the injury classified?

Answer 16

The most caudal level of the spinal cord with normal function bilaterally.

Question 17

Define a complete SCI

Answer 17

No sensory or motor function in the lowest sacral segments S4-S5.

Therefore no voluntary control over the sphincter and no anal sensation.

Question 18

Asia impairment scale: A

Answer 18

Complete. No sensory or motor function preserved in sacral segments S4-5

Question 19

Asia impairment scale: B

Answer 19

Incomplete. Sensory but not motor preserved below the neurological level and includes sacral segments S4-5.

Question 20

Asia impairment scale: C

Answer 20

Incomplete. Motor function preserved below neurological level, and more than half of key muscles below the level have a muscle grade less than 3.

Question 21

Asia impairment scale: D

Answer 21

Incomplete. Motor function is preserved below neurological level, and at least half of key muscles below level have a muscle grade greater than or equal to 3.

Question 22

Asia impairment scale: E

Answer 22

Normal. Sensory and motor function is normal

Question 23

What is the period immediately following an SCI termed?

Answer 23

Spinal shock

Question 24

During spinal shock what happens to reflex activity?

Answer 24

Absence of all reflex activity.

Question 25

What are the 3 phases of spinal shock?

Answer 25

Loss or weakening of reflexes return of some reflexes Hyperreflexia

Question 26

One of the first indicators that spinal shock is resolving is the presence of a positive ____________ reflex.

Answer 26

bulbocavernosus

Question 27

T/F tetraplegia and paraplegia can be either complete or incomplete.

Answer 27

True

Question 28

Describe the consequences of Brown-Sequard syndrome

Answer 28

Ipsilateral weakness and loss of position and vibration. Contralateral loss of pain and temperature.

Question 29

Describe the consequences of cord syndrome

Answer 29

Below injury level, motor paralysis and loss of pain and temperature sensation. Proprioception, touch, and vibratory sensation preserved.

Question 30

Describe the consequences of cord syndrome

Answer 30

Loss of proprioception, two-point discrimination, graphesthesia, stereognosis. Normal motor, pain and light touch function.

Question 31

Describe the consequences of central cord syndrome

Answer 31

Early loss of pain and temperature. Upper extremities and cervical tracts affected. Lumbar and sacral preserved.

Question 32

What is the most common cause of Brown-Sequard?

Answer 32

Penetration trauma (i.e. knife)

Question 33

Based on the following symptoms, identify the syndrome: Bowel/bladder incontinence Low back pain Radicular pain down the legs Lower extremity paralysis Diminished reflexes

Answer 33

Cauda Equina syndrome

Question 34

Autonomic dysreflexia typically occurs in lesions above ___.

Answer 34

T6

Question 35

T/F autonomic dysreflexia subsides over time.

Answer 35

True

Question 36

Identify some symptoms of autonomic dysreflexia (5):

Answer 36

HTN dizziness headache bradycardia sweating

Question 37

If you suspect a patient has autonomic dysreflexia, what's the first thing to do?

Answer 37

Put them in a seated position. DO NOT place them in supine.

Question 38

Describe the type of pain: Acute pain that subsides with healing.

Answer 38

Traumatic pain

Question 39

Describe the type of pain: Caused by damage to the nerve roots.

Answer 39

Nerve root pain

Question 40

Describe the type of pain: Phantom pains below the level of the lesion.

Answer 40

Spinal cord dysesthesia aka neuropathic pain

Question 41

Describe the type of pain: Pain above the level of the lesion.

Answer 41

Musculoskeletal pain

Question 42

List three treatment considerations for orthostatic hypotension:

Answer 42

Slow progression to vertical position Monitor vital signs Use compression stockings and abdominal binders

Question 43

It's common for SCI patients to have on-going LOW/HIGH BP levels

Answer 43

Low

Question 44

Define maceration

Answer 44

Skin that becomes wet. Impairs blood flow. i.e. band aid after shower

Question 45

There is an increased risk of _______ and death due to pressure sore infections going untreated.

Answer 45

Sepsis

Question 46

Three treatments for pressure ulcers:

Answer 46

Bed rest (stay off wound) Alternating pressure mattress Wound clinic attendance

Question 47

Weight shifting should be performed every ___ - ___ minutes in sitting for ___ minutes.

Answer 47

15-20; 1 minute

Question 48

Describe an abdominal binder and what it helps with.

Answer 48

Goes from below ribs to top of pelvis. Assists with BP Assists with inspiration

Question 49

When worried about skin integrity, what motion should be avoided?

Answer 49

Shearing. Lift over slide

Question 50

How often should patients change position in bed?

Answer 50

every 2 hours

Question 51

Why are splints used?

Answer 51

to prevent contractures

Question 52

Optimal ROM for SCI patient: Lumbar spine

Answer 52

mild extensor tightness

Question 53

Optimal ROM for SCI patient: Shoulder extension

Answer 53

Greater than normal

Question 54

Optimal ROM for SCI patient: Wrist

Answer 54

90 degrees of extension

Question 55

Optimal ROM for SCI patient: fingers

Answer 55

Mild tightness of the long finger flexors.

Question 56

Optimal ROM for SCI patient: hamstrings

Answer 56

SLR 110-120 degrees

Question 57

Optimal ROM for SCI patient: Ankle DF

Answer 57

0 degrees if non-ambulatory