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sci and tbi Flashcards

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1
Q

what level does the spinal cord end?

A

T12-L1 but everyone is different

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2
Q

will a pt with a lesion to conus medullaris have an UMN or LMN presentation?

A

both

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3
Q

will a pt with a lesion to the cauda equina have a LMN or UMN presentation?

A

LMN

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4
Q

choose correct responses: the corticospinal tract is (ascending/descending) and (sensory/motor).

A

descending, motor

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5
Q

choose correct responses: the spinothalamic tract is (ascending/descending) and (sensory/motor).

A

ascending, sensory

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6
Q

the anterior STT is responsible for what?

A

crude touch

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7
Q

the lateral STT is responsible for what?

A

pain and temp

pneumonic: LPT (licensed PT)

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8
Q

choose correct responses: the DCML tract is (ascending/descending) and (sensory/motor).

A

ascending, sensory

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9
Q

the DCML is responsible for what sensations?

A

Poor Val got GBS twice

proprioception
vibration
graphesthesia
stereognosis (object identifying bu touch)
barognosis (feel weight/pressure)
two point discrimination

fine touch, precise location

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10
Q

what tract is affected in posterior cord syndrome? what is the cause usually?

A

DCML, medical error/iatrogenic

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11
Q

what tracts are affected in anterior cord syndrome?

A

lat STT, ant STT, CST

sx almost always B/L

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12
Q

what causes anterior cord syndrome?

A

hyperflexion injury

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13
Q

brown sequad is also known as

A

hemi cord syndrome

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14
Q

if i had hemi cord syndrome on the L, all symptoms will be on the L except

A

pain and temp on the R will be impaired

Brown POT (pain and temp opposite side)

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15
Q

how can a central cord injury happen?

A

hyperextension

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16
Q

what will be affected if I have central cord syndrome with a small lesion?

A

pain and temp (lat STT crosses through lesion)

sx will be bilateral

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17
Q

what will be affected if I have central cord syndrome with a large lesion?

A

all tracks will be a little affected bilaterally

MUD-E

motor
UE
distal
extension injury

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18
Q

what is usually the MOI for brown-sequad?

A

GSW or stab

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19
Q

if you suspect conus medullaris or cauda equina syndrome, what should you do?

A

emergency! call 911 or refer immediately to go right to dr

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20
Q

cauda equina has a (unilateral/bilateral), (asymmetric/symmetric) motor and sensory presentation.

A

unilateral, asymmetric

cauda equina ends with an A, for Asymmetric

conus medullaris has bilateral and symmetric presentation

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21
Q

what is better? complete or incomplete SCI

A

incomplete

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22
Q

what does a complete SCI mean?

A

no sensory or motor function in the lowest sacral segments (S4 and S5)

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23
Q

are anterior, posterior, central cord syndromes and brown sequard incomplete or complete?

A

incomplete?

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24
Q

what is an incomplete SCI?

A

you have motor and sensory function below the neurological level including sensory and/or motor function at S4 and S5

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25
C5 muscle group
elbow flexors
26
C6 muscle group
wrist extensors
27
C7 muscle group
triceps/elbow extensors
28
C8 muscle group
finger flexors
29
S1 muscle group
plantarflexors
30
L2 muscle group
hip flexors
31
L4 muscle group
dorsiflexors
32
L3 muscle group
knee extensors
33
what are the two steps to determine motor level of an SCI?
1. lowest level at which strength is at least 3/5 2. all levels above being 5/5
34
what are the two steps to determine sensory level of SCI?
1. lowest level where you have 2's 2. all above levels being 2's
35
what are the two steps to determine neurological level of SCI?
1. find motor and sensory level 2. pick the higher one (one on top)
36
what ASIA level is a complete SCI with no motor or sensory function at S4-S5?
ASIA-A
37
what ASIA level in an incomplete SCI and has sensory but no motor function below NLI and S4-S5?
ASIA-B (sensory incomplete)
38
when less than half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___
C
39
when at least half the key muscle functions below the single NLI have a muscle grade > or equal to 3, this is ASIA ___
D
40
ASIA B, C, and D are all (incomplete/complete)
incomplete, ASIA A is complete and ASIA E is normal
41
define ASIA E
motor and sensory function is normal E is ME
42
autonomic dysreflexia happens at or above what spinal level?
T6
43
what causes AD?
noxious stimuli below the level of lesion
44
what happens to HR and BP with AD?
HR decreases, BP increases (20-30mmHg)
45
AD is more common with complete SCI. (T/F)
T
46
what to do if a pt has AD?
sit them up remove painful stim loosen tight clothing and abdominal binder check bladder distention, unclamp cath and drain it monitor vitals throughout (if no change, call nursing/medial assistance)
47
what tract is intact with anterior cord syndrome?
DCML
48
what type of SCI has the best prognosis for walking?
central cord (walking SCI)
49
what are the functions of the lateral spinothalamic tract?
pain and temp sensation (LPT!)
50
list the ranges for the Glascow Coma Scale
3-8 severe 9-12 moderate 13-15 mild
51
L1 vertebral level corresponds to which spinal level
conus medullaris/cauda equina
52
innervation of the diaphragm?
phrenic nerve (C3, C4, C5 keep the diaphragm alive)
53
if a pt has a injury at C1-C2, what muscles are innervated and what will they need to breathe?
SCM, upper traps (accessory nerve, not spinal cord) pt will need a phrenic stimulator and ventilator
54
If a pt has an injury at C3-C4, what will they use to breath?
diaphragm is partially intact so these patients still need a mechanical ventilator if they want to temporarily breathe without the ventilator, they use glossopharyngeal breathing (swallowing/gulping the air)
55
at C5-C8, how is the diaphragm working/how is the pt breathing?
diaphragm is working a lot better so they wont need a mechanical ventilator but they will have a weak cough need abs to cough which get innervated at thoracic level
56
what spinal level injury will pt have near normal level of respiratory function?
T11
57
if you have a lesion above S2 spinal level (T12-L1 vertebral level), what bladder issue will you have?
UMN/spastic/reflexive bladder
58
if you have a lesion below S2 spinal level, what bladder issue will you have?
LMN/areflexic/flaccid bladder
59
for a reflexive bladder, what is the appropriate treatment?
intermittent catheterization every 3-6 hours and suprapubic tapping
60
if a pt has a LMN/areflexic bladder, what is the appropriate treatment?
intermittent catheterization every 3-6 hours, valsalva or Crede's maneuver (pressure on abdomen)
61
C1, C2, C3, and C4 are (independent/dependent) with ADLs and transfers
dependent
62
can someone with a C7 central cord syndrome walk?
yes
63
can someone with a C7 complete SCI walk?
no
64
are C7 SCIs able to use WC on even and uneven surfaces?
just even surfaces; C8 can use WC on both even and uneven surfaces
65
when doing a WC<>bed transfer, the WC should be angled ___-___ degrees from the bed/met edge
20-45
66
list the ranchos los amigos levels
remember RLA looks like R(response) C(confused) A (appropriate) 1. no response 2. generalized response 3. localized response 4. confused and agitated 5. confused and inappropriate 6. confused and appropriate 7. automatic appropriate 8. purposeful appropriate
67
is group therapy good for someone with RLA level IV?
no
68
should you cancel and agitated pt with a TBI?
no, that will reinforce behavior instead distract them and give them options to give control
69
what RLA describes responding consistently to simple commands, able to socialize for a short period?
V 5 looks like S for simple and socialize

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