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SCI Flashcards

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0
Q

What’s quadriplegia? What level of spinal cord injury?

A

Any degree of paralysis of four limbs and trunk musculature
SCI C1-C7
(Injury of spinal nerves C1-C8)

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1
Q

Psychosocial issues of SCI (9)

A 
Depression
Anxiety
Vulnerability
Body image
Relationship trouble
Identity crisis
Stigma
Sense if self worth
Loneliness
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2
Q

What’s paraplegia? What SCI level?

A

Impairment in motor or sensory function of the lower extremities
T1 and below

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3
Q

What SCI level still has good use of hands but poor trunk control?

A

T1-T8

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4
Q

What’s the most common SCI?

A

Between C5-C6 vertebrae (aka C6 SCI)

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5
Q

Precautions with SCI

A 
Autonomic dysreflexia
Pressure sores
Orthostatic hypotension
Decreased vital capacity
Heterotrophic ossification
Temp regulation
Neck stability
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6
Q

What does the level of SCI designate?

A

The level of SCI designates the last fully functioning neurologic segment of the cord.

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7
Q

What’s ASIA?

A

American spinal injury association

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8
Q

What’s the ASIA impairment scale? Name the levels.

A

Classifies injury type.
Type A: complete lesion (no motor or sensory)
Type B: incomplete lesion, no motor function but sensory is intact
Type C: incomplete lesion, major motor functions intact but at level 3 (fair) or below
Type D: incomplete lesion, major motor functions intact at level 3 (fair) or above
Type E: no impairment

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9
Q

Prognosis for recovery: initial factors for complete SCI

A

If there is no sensation or return of motor function below level of lesion within 24-48hrs post injury, motor function is less likely to occur

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10
Q

Prognosis for recovery: incomplete lesions?

A

Progressive return is more likely but unpredictable

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11
Q

Prognosis for recovery: 5 general guidelines

A
  1. Depends on severity of injury
  2. Incomplete more likely to recover than complete
  3. Most recovery occurs within 1st few weeks
  4. Recovery not dependent on hard work
  5. Rehab does not affect degree of recovery. Instead, rehab is to prevent further medical complications and improve strength and skill, optimize life possibilities.
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12
Q

Simplified trick for remembering SCI C4-C8

A 
C4 - shrug (should elevation/traps)
C5 - hug (shoulder flex/deltoid, biceps)
C6 - waitress (wrist ext)
C7 - sneaky tips (triceps, wrist flex)
C8 - muscle man (fingers & wrist flex)
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13
Q

Signs of skin breakdown (3)

A
  1. Reddening skin, then blanches when pressed
  2. The reddened area does not blanch
  3. Blister/ulceration
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14
Q

OT evaluation of SCI (8)

A
  1. Review medical precautions
  2. PROM - prior to MMT & to assess for contractures/need for splints
  3. MMT
  4. Sensation (light touch, superficial pain, kinesthesia)
  5. Spasticity - enhance or interfere with function?
  6. Hand function - needed equipment
  7. Clinical observation - endurance, oral motor control, head & trunk control, total body function
  8. Cognitive/perceptual eval
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15
Q

OT intervention objectives (11)

A
  1. Collaborative
  2. Individualization
    * both lead to increased participation
  3. Maintain/increase ROM - A/PROM, splint, position, educate
  4. Increase strength of innervated muscles
  5. Increase endurance
  6. Maximize independence in all areas of occupation
  7. Aid psychosocial adjustment
  8. DME
  9. Home eval/modification
  10. Develop communication skills to direct caregiving
  11. Educate ct & family regarding benefits/consequences of lifestyle choices, habits, etc.
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16
Q

OT intervention approaches: 1st phase (5)

A
  1. Immobilization phase
    a) precautions - no flex/ext/rot spine/neck
    b) eval body positioning & hand splinting (maintain functional position, dorsal to preserve sensation)
    c) active & active assist ROM within strength, ability, & tolerance levels
    d) encourage/support participation in ADLs etc with AD
    e) initiate discussion of anticipated DME, home mods, caregiver training
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17
Q

OT intervention approaches: 2nd phase (7)

A
  1. Active Phase (mobilization)
    a) develop w/c & upright tolerance
    b) determine method for relieving sitting pressure
    c) A/PROM to prevent contractures, splint as needed, develop tenodesis grip as indicated
    d) progressive resistive exercises & resistive activities - focus on shoulder musculature *needed for transfers & weight shifts
    e) prescribe AD/DME, however always attempt to have ct perform activity without first
    f) increased participated in ADLs
    g) continued psychosocial support - encourage expression
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18
Q

Methods for relieving sitting pressure (3) & how often?

A
  1. F+ strength in shoulders & elbows - lean forward over feet using cotton loops over forearms for support
  2. C7 w/ F+ in triceps - full depression lift off arms of w/c *
  3. some ct’s w/ C6 can do the above by locking elbows while ext. rot. shoulders
    * weight shifts should be done every 30-60min
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19
Q

OT intervention approaches: post d/c

A
  1. Adaptive driving
  2. Home mgmt
  3. Leisure activities
  4. Work skill assessment
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20
Q

Level C1-C3: intact muscles, mvmt possible, & pattern of weakness

Study These Flashcards
A
  1. Sternocleidomastoid, cervical paraspinal, & neck accessories
  2. Neck flexion, ext., rot.
  3. Total paralysis of trunk, UE; D on ventilator
21
Q

Level C4: intact muscles, mvmt possible, & pattern of weakness

Study These Flashcards
A
  1. Upper traps, diaphragm
  2. Neck mvmt, scapular elevation, inspiration
  3. Paralysis of trunk, UE, LE, respiratory weak
22
Q

Level C5: intact muscles, mvmt possible, & pattern of weakness

Study These Flashcards
A
  1. Deltoid, biceps, brachialis, rhomboids, serratus anterior (partial)
  2. Shoulder flex, abduct, ext.; elbow flex., sup.; scapular add., abduct
  3. No elbow ext., wrist/hand mvmt, total paralysis of trunk/LE
23
Q

Level C6: intact muscles, mvmt possible, & pattern of weakness

Study These Flashcards
A
  1. Some pect, supinator, extensor carpi radialis longus & brevis, serratus anterior, lats
  2. Scap protraction, some horizontal add., forearm sup., radial wrist ext.
  3. No wrist flexion, elbow ext., hand mvmt, lower paralysis
24
Level C7-C8 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Lat dorsi, pects, triceps, pronator, ext. carpi ulnaris, flexor carpi radialis, flexor digitorum profundus & superficialis, extensor communis, pronator/flexor/extensor/abductor pollicis 2. Elbow ext., wrist ext., finger flex./ext., thumb flex/ext/abd 3. Limited grasp, paralysis of trunk & LE
25
Level T1-T9 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Intrinsics of hand, intercostals, rest of thumb 2. UE intact, limited trunk stability, endurance increased 3. Lower trunk & LE paralysis
26
Level T10-L1 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. External obliques, rectus abdominis 2. Good trunk stability 3. Paralysis LE
27
Level S2-S5 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Intact trunk, some upper LE 2. Partial to full control of LE 3. Partial paralysis of LE
28
Common AD/DME for SCI
U-cuff Wrist cock-up splint Eating: Plate guard, cup holder, long straw, no skid mat Bathing: wash mit, soap holder, soap on a rope, padded commode/shower chair, padded tub bench Toileting: elevated padded seat Sleep: hospital bed, side rails, specialty mattress (pressure sores) Transfers: mechanical lift, sliding board Transporation: electrical or manual w/c; tilt chair; breath control; postural supports
29
At what SCI level can someone use a manual wc?
C5 | *lightweight rigid or folding frame with hand rim modifications
30
Simplified trick for remembering SCI C4-C8
``` C4 - shrug (should elevation/traps) C5 - hug (shoulder flex/deltoid, biceps) C6 - waitress (wrist ext) C7 - sneaky tips (triceps, wrist flex) C8 - muscle man (fingers & wrist flex) ```
31
Signs of skin breakdown (3)
1. Reddening skin, then blanches when pressed 2. The reddened area does not blanch 3. Blister/ulceration
32
OT evaluation of SCI (8)
1. Review medical precautions 2. PROM - prior to MMT & to assess for contractures/need for splints 3. MMT 4. Sensation (light touch, superficial pain, kinesthesia) 5. Spasticity - enhance or interfere with function? 6. Hand function - needed equipment 7. Clinical observation - endurance, oral motor control, head & trunk control, total body function 8. Cognitive/perceptual eval
33
OT intervention objectives (11)
1. Collaborative 2. Individualization * both lead to increased participation 3. Maintain/increase ROM - A/PROM, splint, position, educate 4. Increase strength of innervated muscles 5. Increase endurance 6. Maximize independence in all areas of occupation 7. Aid psychosocial adjustment 8. DME 9. Home eval/modification 10. Develop communication skills to direct caregiving 11. Educate ct & family regarding benefits/consequences of lifestyle choices, habits, etc.
34
OT intervention approaches: 1st phase (5)
1. Immobilization phase a) precautions - no flex/ext/rot spine/neck b) eval body positioning & hand splinting (maintain functional position, dorsal to preserve sensation) c) active & active assist ROM within strength, ability, & tolerance levels d) encourage/support participation in ADLs etc with AD e) initiate discussion of anticipated DME, home mods, caregiver training
35
OT intervention approaches: 2nd phase (7)
2. Active Phase (mobilization) a) develop w/c & upright tolerance b) determine method for relieving sitting pressure c) A/PROM to prevent contractures, splint as needed, develop tenodesis grip as indicated d) progressive resistive exercises & resistive activities - focus on shoulder musculature *needed for transfers & weight shifts e) prescribe AD/DME, however always attempt to have ct perform activity without first f) increased participated in ADLs g) continued psychosocial support - encourage expression
36
Methods for relieving sitting pressure (3) & how often?
1. F+ strength in shoulders & elbows - lean forward over feet using cotton loops over forearms for support 2. C7 w/ F+ in triceps - full depression lift off arms of w/c * 3. some ct's w/ C6 can do the above by locking elbows while ext. rot. shoulders * weight shifts should be done every 30-60min
37
OT intervention approaches: post d/c
1. Adaptive driving 2. Home mgmt 3. Leisure activities 4. Work skill assessment
38
Level C1-C3: intact muscles, mvmt possible, & pattern of weakness
1. Sternocleidomastoid, cervical paraspinal, & neck accessories 2. Neck flexion, ext., rot. 3. Total paralysis of trunk, UE; D on ventilator
39
Level C4: intact muscles, mvmt possible, & pattern of weakness
1. Upper traps, diaphragm 2. Neck mvmt, scapular elevation, inspiration 3. Paralysis of trunk, UE, LE, respiratory weak
40
Level C5: intact muscles, mvmt possible, & pattern of weakness
1. Deltoid, biceps, brachialis, rhomboids, serratus anterior (partial) 2. Shoulder flex, abduct, ext.; elbow flex., sup.; scapular add., abduct 3. No elbow ext., wrist/hand mvmt, total paralysis of trunk/LE
41
Level C6: intact muscles, mvmt possible, & pattern of weakness
1. Some pect, supinator, extensor carpi radialis longus & brevis, serratus anterior, lats 2. Scap protraction, some horizontal add., forearm sup., radial wrist ext. 3. No wrist flexion, elbow ext., hand mvmt, lower paralysis
42
Level C7-C8 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Lat dorsi, pects, triceps, pronator, ext. carpi ulnaris, flexor carpi radialis, flexor digitorum profundus & superficialis, extensor communis, pronator/flexor/extensor/abductor pollicis 2. Elbow ext., wrist ext., finger flex./ext., thumb flex/ext/abd 3. Limited grasp, paralysis of trunk & LE
43
Level T1-T9 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Intrinsics of hand, intercostals, rest of thumb 2. UE intact, limited trunk stability, endurance increased 3. Lower trunk & LE paralysis
44
Level T10-L1 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. External obliques, rectus abdominis 2. Good trunk stability 3. Paralysis LE
45
Level S2-S5 1. intact muscles, 2. mvmt possible, & 3. pattern of weakness
1. Intact trunk, some upper LE 2. Partial to full control of LE 3. Partial paralysis of LE
46
Common AD/DME for SCI
U-cuff Wrist cock-up splint Eating: Plate guard, cup holder, long straw, no skid mat Bathing: wash mit, soap holder, soap on a rope, padded commode/shower chair, padded tub bench Toileting: elevated padded seat Sleep: hospital bed, side rails, specialty mattress (pressure sores) Transfers: mechanical lift, sliding board Transporation: electrical or manual w/c; tilt chair; breath control; postural supports
47
At what SCI level can someone use a manual wc?
C5 | *lightweight rigid or folding frame with hand rim modifications
48
Functional outcome of: C4 (3)
1. Mouth stick 2. Self inspect skin & weight shift through technology 3. Instruct personal care assistants
49
Functional outcome of: C5 (7)
1. Self-inspect skin & weight shift through technology 2. Instruct personal care assistants 3. Enviro set-up for independence 4. U-cuff allows writing or typing 5. Potential to operate ceiling lift 6. Potential to drive 7. Potential to bath w/ assistance/set-up
50
Functional outcome of: C6 (14)
1. Tenodesis 2. U-cuff 3. Write 4. Groom & dress 5. Self-catheterization 6. Work on trunk stability & bed mobility 7. Education/use of AE 8. Tool use via tenodesis 9. Self-inspect skin & weight shifts 10. Instruct personal care assistance 11. Bathe independently 12. Ind. slide board transfer 13. Driving 14. Public transit
51
Functional outcome of: C7 (6)
1. Grooming 2. UE & LE dressing 3. Bed mobility 4. Ind. slide board transfer 5. Ind. BM mgmt - eg digital stimulator 6. Driving

Phys Dys (6 decks)

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