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618 Quiz 3 > SCI > Flashcards

SCI Flashcards

1
Q

SCI : Statistics

A

Prevalence in 2014: 276,000
Age in 2010 : 42 (29 in the 70’s)
80% are mail
MVA, Falls, Violence, Sports, Uncertain

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2
Q

Hospital Stay : Acute

A

14-28 days

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3
Q

Hospital Stay : Rehab

A

2-4 months

92% are d/c to non-institutional residences

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4
Q

Spinal Shock

A

Period of swelling around S.C. (spinal cord) -> affects sensory & motor in/outputs

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5
Q

American Spinal Injury Association (ASIA) : Motor Level, C5

A

Elbow flexors

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6
Q

ASIA : C6

A

Wrist extensors

Decent elbow, hand function but limited trunk control.

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7
Q

ASIA : C7

A

Elbow extensors

Can do depression transfers

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8
Q

ASIA : C8

A

Finger flexors

Results in increased function

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9
Q

ASIA : T1

A

Finger abduction

Lession is at nipple area

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10
Q

ASIA : C4

A 
Shoulder motion (i.e. shrug) 
No trunk control
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11
Q

ASIA : Sensory Level

A 
Key sensory points along dermatome 
Light touch & pink prick
0-absent 
1-impaired
2-normal
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12
Q

Sensory Testing

A

Acute: Usually tested every shift by a nurse or neurologist
Rehab: once stabilized decreased monitoring occurs

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13
Q

ASIA : T6

A

Sports chairs, low back w/c, increased trunk control

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14
Q

ASIA : L1

A

Pt. starts to walk more

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15
Q

Respiratory Impairment & SCI

A

A direct relationship exists between the level of cord injury and the degree of respiratory dysfunction
Leading cause of hospital re admissions & death

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16
Q

Respiratory : C1 or C2

A

vital capacity is only 5-10% of normal & cough is absent

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17
Q

Respiratory: C3-C6

A

vital capacity is 20% of normal, cough is weak/ineffective

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18
Q

Respiratory : T2-T4

A

vital capacity is 30-50% of normal, cough is weak

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19
Q

Respiratory : Lower level injures

A

Respiratory function improves

20
Q

Respiratory : T11

A

respiratory dysfunction is minimal; vital capacity is essentially normal & cough is strong

21
Q

Brown Sequard Syndrome

A

Damage to 1/2 cord (i.e. stab wound, incomplete injury)
Ipsilateral propioceptive & motor loss (R sided injury, No movement on R side)
Contralateral loss of pain & temp (R sided injury, no temp/pain on L)

Pt. positioning will be difficult
Increase pts visual skills & compensatory strategies

22
Q

Central Cord Syndrome

A

Incomplete Injury
Cervical region
Damage to center part of cord (most often d/t tremor)
UE weakness > LE weakness

May be walking w. crutches or walker

23
Q

Anterior Cord Syndrome

A

Variable motor & sensory loss
Intact propioception

Whiplash injuries

24
Q

Cauda Equina Syndrome

A

Bowel & bladder issues

Sacral & Lumbar nerve/roots

25
Autonomic Dysreflexia
T6 & Above Uncontrolled sympathetic activity flowing from SC below lesion level. -bladder infection, over distended bladder/rectum -sexual stim, abdominal pressure, pressure sores
26
Autonomic Dysreflexia : Sx
Severe, pounding headache Sweating above lesion level Stuffy nose, flushing, bradycardia
27
Autonomic Dysreflexia : Tx
Elevate head, eliminate offending stim Positioning to prevent pressure sores Skin checks, loosen clothing/constrictive devices Check catheter for kink, monitor BP
28
Orthostatic Hypotension : Sx
Blood pressure drops dangerously low in response to upright positioning, light headedness, pallor visual changes, T6 and above. Seen during supine->sit
29
Orthostatic HTN : Tx
Recline pt. so head is below level of heart Lift legs, tilt table, monitor Bp, call nurse & MD Put pt. to bed with LE's elevated above heart
30
Surgical stabilization : Cervical Spine
``` Philadelphia collar (23-24 hrs per day) SOMI Brace (sternal-occipital mandibular mobilizer) usually 6-8 weeks ```
31
Surgical Stabilization: Thoracolumbar Spine
Screws or rods
32
Surgical Stabilization : Transpedicular screws & Harrington Rod
May be impoloized or have limited rotation/lateral flexion
33
Nonsurgical Stabilization : Cervical Spine
HALO Traction : 4 pins inserted into skull | 6-12 weeks
34
Pressure Relief
Increase risk for skin breakdown | Constant WS pressure relief schedule
35
Bladder & Bowel : Initial TX
During spinal shock both are flaccid Prevention of bladder distention Bowel impaction Bladder & bowel reflexes return 1st marking the end of spinal shock
36
Bladder & Bowel : s/p Spinal Shock
``` UMN: Refleogenic, automatic, spastif Relex emptying of bladder/bowel Injuries above T2-L1 LMN: areflexogenic, atonic, flaccid Manual emptying of bladder/bowel Paraplegia lessions below L1 ```
37
Bowel & Bladder & OT
Pt. ed on leg spreaders & mirrors Limited hand function related to self-cathing, typically cant follow the streal techniques OT: work on positioning, adaptive techniques & fine motor skills
38
Bladder Management
Controlled by S2-5 spinal segments Complete lessions at & above S2 lose ability to void voluntarily Indwelling catheter, intermittent catheterization
39
Bowel Management
Oral/suppository meds | Digital stim
40
Bladder Management & OT
Clothing management, body positioning Set-up & cleanup of equipment Disposal of urine Cleanup or self
41
Other problems
``` Fatigue (d/t respiratory decline) - prioratize pt. routine DVT : calves & triceps Pain Heterotopic ossification Depressions ```
42
SCI General Functional Tests
``` Minnesota Upper extermity function test (UEFT) Purdue Prgboard Test Jebsen test of hand function 9 hole peg test Smith hand function eval Box & Block Test (BBT) Physical Capacities Eval of hand skills (PCE) Sollerman hand function test ```
43
Specifically designed for tetraplegic persons
``` Standardised object test (SOT) Vandenberge hand function test Grasp & Release Test (GRT) Capabilities of UE Instrument Thorson's function test ```
44
SCIM
Spinal cord independence measure | -in tetraplegic pt.'s, the FIM missed 22% of the functional changes dictated by the SCIM
45
Assessment & Tx
Occupation Hx (living Envt- accesability) BAD & IADL Trunk balance A/PROM & Muscle strength (biomechanical approach) Pain (Modalities) Endurance Make whatever muscles that can be used stronger b/c they will need to compensate for lost innervation
46
Assessment & Tx Continued
Hand function (pinch & grasp) (splinting0 Leisure Communication Bowel & Bladder Mobility Vocation, school, home & community access

618 Quiz 3 (5 decks)

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