SCI Flashcards
1
Q
What are the three most important concerns as a SCI pt?
A
- Sexual function
- Walk
- Bowel and bladder
2
Q
SCI is a ___ incidence and ____ cost event.
A
low; high
3
Q
SCI rarely occur in isolation, ___% have another major injury, 15% being a head injury.
A
75
4
Q
SCI = males __% of the time, mean age being early ____.
A
80; 30
5
Q
Are non-traumatic or traumatic more common?
A
non-traumatic
6
Q
Is tetraplegia or paraplegia more common?
A
tetraplegia
7
Q
________ = impairment in motor and/or sensory function of the LE’s.
A
paraplegia
8
Q
________ = impairment in motor and/or sensory function that results in the parietal or total loss of use of the limbs and torso.
A
quadriplegia
9
Q
After age 45 most common cause of SCI is ______.
A
falls
10
Q
What are the 3 ways that the SCI can be damaged?
A
- Concussion
- Contusion
- Laceration
11
Q
Excessive _______ causes 50% of SCI in younger adults.
A
flexion
12
Q
Excessive _________ more common mechanism of injury in older individuals.
A
extension
13
Q
With violent movement, SC vertebrae can _____, scatters bony fragments.
A
burst
14
Q
First ____ hours = necrotic death of axons that were damaged.
A
18
15
Q
Lesion then progressives both up and down the cord, as far as ___ segments.
A
4
16
Q
Immune response in SCI pathology trigger _______.
A
apoptosis
17
Q
________ injury = structural damage occurring instantly after the event.
A
primary
18
Q
_______ injury = more extensive injury can occur if the spine is not immediately immobilized.
A
secondary
19
Q
Often a small rim of spared _____ and ____ remains, preserving this is key for recovery of function.
A
tissue; axons
20
Q
Secondary injury = ________cascade that happens after injury.
A
pathophysiologic
21
Q
In secondary injury, what 3 things occur?
A
- Ischemia
- Hypoxemia
- Edema
22
Q
In secondary injury, necrosis can be triggered by excitotoxic changes (________ toxicity) and can continue for weeks.
A
glutamate
23
Q
Less than ___% of cord supports locomotion so sparing even a very small portion is key.
A
10
24
Q
Prevention of _______ appears to have large beneficial clinical consequences.
A
edema
25
___________ = reduces firing rate as a result of trauma to oligodendroglial cells
demyelination
26
Demyelinations triggers degeneration about the lesion and along the __________ tract.
corticospinal
27
Scar tissue formation can impede _______ regeneration.
axonal
28
Grey matter losses are confined to ___ to ___ spinal segments about the lesion.
1-1.5
29
________ scaring can permanently connect the cord to the overlying dura and tether it.
dural
30
Neural function below the lesion are subject to accelerated _______ and loss of _______.
aging; function
31
Areas of the brain under go atrophic changes from loss of signals, = ________.
diaschesis
32
Acutely after an injury the pt will go into ______ ______.
spinal shock
33
______ ___ of spinal shock = complete loss of all reflexes below the injury. This phase lasts for a day. Neurons have lost input, become hyperpolarized and less responsive to stimuli.
phase 1
34
______ _____ of spinal shock = return of some, but not all, reflexes below the SCI.
phase 2
35
______ ____ = mononsynaptic reflexes such as the deep tendon reflexes are restored.
phase 3
36
The first synapses to form in phase 3 of spinal shock are form ________ axons, usually from _______.
shorter; interneurons
37
_______ ___ = hyperreflexia occurs. Interneurons and lower motor neurons below the SCI begin sprouting, attempting to re-establish synapses.
phase 4
38
Clinical manifestations: C5?
elbow flexors
39
Clinical manifestations: C6?
wrist extensors
40
Clinical manifestations: C7?
elbow extensors
41
Clinical manifestations: C8?
finger flexors
42
Clinical manifestations: T1?
finger abductors
43
Clinical manifestations: L2?
hip flexors
44
Clinical manifestations: L3?
knee extensors
45
Clinical manifestations: L4?
ankle dorsiflexors
46
Clinical manifestations: L5?
long toe extensors
47
Clinical manifestations: S1?
ankle plantar flexors
48
What are the two scores taken in the sensory test of clinical manifestations of SCI?
1. Pin prick score
| 2. Light touch score
49
What is ASIA scale A?
Complete: No motor or sensory function is preserved in the sacral segment S4-S5
50
What is ASIA scale B?
Incomplete: Sensory but nor motor function is preserved below the neurological level and includes the sacral segments S4-S5
51
What is ASIA scale C?
Incomplete: Motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade less than 3
52
What is ASIA scale D?
Incomplete: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more
53
What is ASIA scale E?
Normal: Motor and sensory function are normal
54
________ injury = absence fo sensory and motor function in segments below the injury
complete
55
__________ injury = partial preservation of sensory and/or motor functions below the neurological level
incomplete
56
______ ________ = voluntary anal sphincter contraction or sensory function (light touch, pinprick at the S4-S5 dermatome, or anal sensation on rectal examination)
sacral sparing
57
Preservation of the _______ of the SC is key
periphery
58
Incomplete injury = indicates incomplete injury and the possibility of some recovery including ______ and ______ function.
bowel; bladder
59
Sacral sparing in incomplete SCI is important because it represents at least partial structural continuity of the _______ _______ long tracts.
white matter
60
In the _____, axonal regeneration is slow.
CNS
61
In the CNS, myelin sheaths are produced by ________. In the PNS, myelin sheaths are produced by ______ _____.
oligodendrocytes; schwann cells
62
Myelin debris is more slowly removed in the CNS, taking ___-__ weeks post injury for the macrophages to remove debris.
2-4
63
CNS myelin debris contains _______ factors which slow the regeneration process.
inhibitory
64
CNS ________ proliferate into the transected area and form _______ scars which block the pathways for axonal growth,
astrocytes; astrocytic
65
Oligodendrocytes are limited in their ability to regenerate themselves (T/F).
TRUE
66
How long can the period of cortical remodelling post SCI take?
6-12 months
67
Brown-Sequard syndrome = ______-_____ of the cord.
hemi-section
68
Hemi-section SC; ________ side = muscle weakness, abnormal reflexes, clonus/spasticity from corticospinal and reticulospinal tract damage.
ipsilesional
69
Hemi-section of the SC; _______ side = proprioception, kinesthesia and vibratory sense lost from dorsal column tract damage
ipsilesional
70
Hemi-section SC; __________ side = pain and temp loss starting a few levels below the lesion (lateral spinothalamic tact ascends for a few segments before crossing)
contralateral
71
_________ ______ _____ lesion = loss of pain, temp, and light touch below a specific dermatome level; sacral sensation may be spared
contralateral spinothalamic tract
72
______ _______ syndrome = loss of all modalities at one of several dermatome levels, loss of pain and temp below a specific dermatome love, loss of proprioception and discriminatory touch up to similar level and limb weakness.
brown sequard
73
_______ ______ lesion = bilateral loss of all modalities, bilateral leg weakness.
complete cord
74
________ ______ lesion = bilateral loss of pain and temp, preservation of proprioception and discriminatory sensation
central cord
75
central cord lesion = ______ ______ loss
suspended sensory
76
__________ = cysts in cord
syringomyelia
77
Syringomyelia can be __________ or can develop after an ________.
spontaneous; injury
78
Syringomyelia account for ___% of SCI
2
79
Cysts do not occupy the entire spinal cord area (T/F).
FALSE (they can)
80
As the cysts develops it causes what 6 things?
1. Significant pain
2. Spasms
3. Phantom sensations
4. Reflex changes
5. Autonomic changes
6. Blocks CSF flow
81
What is the most common site for cervical spine injury?
C5-C6
82
Autonomic Dysreflexia = lesions above T__.
5
83
________ _______ = irritating stimulus is introduced blow the level of SCI, and stimulus is blocked by the lesion at the level of injury.
Autonomic dysreflexia
84
In autonomic dysreflexia, the reflex is activated that increases activity of the ______ portion of the ANS
sympathetic
85
Autonomic dysreflexia results in _______, which causes a sharp rise in blood pressure.,
vasospasms
86
One of the skeletal changes associated with SCI = ______ _______.
heterotopic ossification
87
Respiratory complications of SCI will occur above a C___ paralysis.
4
88
In regards to a DVT, if the clot breaks free, what 3 areas can it go and what could it cause at these locations?
1) Go to brain and cause stroke
2) Go to heart and cause heart attack
3) Go to lung and cause pulmonary embolus
89
Muscle and nervous causes of spaspticity = increases sensory ________ and ________ .
responsiveness; relfexia
90
In regards to spasticity, where is the increased sensory responsiveness and reflexia coming from?
1. distended bladder
2. constipation
3. infection
4. fracture
5. smoking
6. pressure sores
7. physical and emotional stressors
91
What are 3 treatment for spasticity?
1. medication
2. positioning
3. stretching
92
Thermal regulation is effected in SCI due to the loss of tract from _______.
hypothalamus
93
Higher the lesion = worse thermoregulation (T/F).
TRUE
94
______ ______ = unable to get proper venous return to heart and is a rate limiter for exercise.
orthostatic hypotension
95
Heterotrophic ossification is an issue in ______ joints.
large
96
What is the most common cause of death in SCI?
pneumonia
97
What are areas of concern for skin ulcers before getting out of bed?
1. Heel
2. Sacrum
3. Scapula
98
What are areas of concern for skin ulcers once in a chair?
1. Trochanter
| 2. Ischium
99
Bowel and bladder are controlled by what sacral segments?
S2,S3, S4
100
A lesion at conus medullaris = _____ bladder.
flaccid
101
A lesion above S2 = ______ bladder (after spinal shock)
reflex
102
UTI's are almost constant due to catheterization (T/F).
TRUE
