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MedCon Rehab II > SCI Part 1 EXAM 1 > Flashcards

SCI Part 1 EXAM 1 Flashcards

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1
Q

Divisions of the NS (2)

A
  • CNS
    • Brain
    • SC
  • PNS
    • spinal nerves
    • cranial nerves
      • Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens
        • Some Say Marry Money But My Brother Says Big Boobs Mattr More
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2
Q

CNS vs. PNS Pathology

A
  • brain
  • SC
  • P. nerves
    • sensory AND motor components
  • NMSK Junction
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3
Q

Other NS divisions?

A

UMN (originate in cortex)

LMN (2nd order neurons)

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4
Q

UMN Syndrome

What are some POSITIVE sx’s?

A
  • Hyperreflexia== overactive
    • abnormal babinski
    • clonus
  • Altered mm tone
    • hypERtonicity
      • extra response to stretch
  • Spastic paralysis
    • cannot get individual mm to work or abnormal mvmt
    • only move in a stereotypical pattern
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5
Q

UMN syndrome occurs WHERE and found in WHAT?

A
  • Found in:
    • stroke
    • SCI
    • MS
    • CVA
    • PD
  • Brain + SC == UMN syndrome
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6
Q

Babinski reflex (UMN) NORMAL in what

A

infants

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7
Q

Babinksi reflex: how to do it

A

stroke outside of sole from heel to toe w/ pointed obj

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8
Q

Babinksi Reflex

Normal Response?

A
  • Normal Response:
    • Flex and ADD. of all toes
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9
Q

Babinski reflex:

Positive Response?

A

Babinski positive response:

Great toe EXT w/ ABD of toes 2-5

*re-emerges w/ motor system damage *

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10
Q

Clonus normally checked where?

A

ankle or wrist

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11
Q

What is Clonus ?

A
  • Clonus
    • Repetitive, rhythmic contraction of mm when held in a STRETCHED state
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12
Q

Clonus is an ________ SC reflex

A

abnormal spinal cord reflex

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13
Q

Clonus

–abnormal SC lvl reflex that is a sign of?

A

Damage to nerve tracts ABOVE reflex lvl

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14
Q

Clonus and the # of beats:

A
  • Unsustained:
    • # of beats
  • Sustained
    • Stays on as long as the stretch is on
  • NOTE: Clonus is NOT myoclonus​
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15
Q

Discuss Altered Muscle Tone

A
  • Tone== mm’s resistance to passive stretch
    • mm tension @ rest basically…
    • Normal tone resists the effects of gravity in posture and mvmt, yet is LOW enough to all FREE MVMT
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16
Q

In SC or UMN damage…explain Spinal shock

A
  • MM’s initially flaccid due to loss of descending stim. from GAMMA motor neurons RIGHT AFTER THE INJURY
    • NOTE: this is what we see in LMN syndromes
  • later, GMNs become hypERexcitable resulting in INC mm tone
    • ​INC mm tone is sign of UMN syndrome ***
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17
Q

Explain HypOtonia

A

DEC resistance to passive mvmt

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18
Q

Explain HypERtonia

A
  • INC resistance to passive mvmt
    • MAY be present w/ or w/out normal control of voluntary mvmt
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19
Q

What are the 2 types of HypERtonia?

A
    1. Spasticity
    1. Rigidity
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20
Q

Explain Spasticity: type of hypERtonia

A
  • Velocity dependent INC to PROM
  • measured w/ Mod’d Ashworth Scale
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21
Q

Explain Rigidity: type of hypertonia

A
  • NON-velocity dependent INC to PROM
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22
Q

NEGATIVE signs of UMN syndrome:

(meaning there is LOWER of this or LESS than should be)

A
  • Fatigue
  • Dyscoordination
  • Impaired motor planning and control ***
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23
Q

POSITIVE signs of UMN

(more of these things)

A
  • Athetosis
    • irregular contractions
  • Dystonia
    • prolonged
    • spastic
  • Emergence of primitive reflexes
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24
Q

LMN Syndrome: where is the damage?

A

Damage b/w anterior horn and the NMSK junction

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25
3 symptoms of **LMN Syndrome + examples**
1. flaccid paralysis --\> **mm's do NOT work** 2. mm atrophy 3. hypOreflexia Examples: polio, P. nerve lesion (most common)
26
Comparing Syndromes: LMN vs. UMN
* **LMN** * weakness * atrophy * fasciculations * DEC reflexes * DEC tone * **UMN** * **​**weakness * NO atrophy * NO fasciculations * INC reflexes * INC tone
27
UMN vs LMN **Paresis or paralysis of ONE mm/myotome**
LMN
28
UMN vs LMN ## Footnote **Paresis or paralysis of ONE SIDE/AREA of _body_**
UMN
29
UMN vs LMN ## Footnote **Paralyzed MVMTS**
UMN
30
UMN vs LMN ## Footnote **Paralyzed MUSCLES**
LMN
31
SCI epidemiology
* 6% first time admissions to hospitals * ~13,000 new SCI/yr * ~300,000 prevalence * most common cause: MVA, * falls, violence, sports * violence inc'ing!!!
32
Who is MOST vulnerable for SCI?
Young adult b/w 16-30---\> **risky behavior** ## Footnote **NOTE: 4:1 ratio M:F**
33
Racial disparity SCI
Blacks, Native-Am, Alaska native
34
Most common causes of death w/ SCI:
Respiratory Sepsis PE (blood clot in body comes loose into pulm aa system)
35
Where do MOST people go after SCI?
Private residence
36
CURRENTLY, what is the avg LOS for SCI
Acute== 11 days IP Rehab== 34 days
37
SCI Costs:
* 1st year medical costs w/ tetraplegia * ~$750,000-$1M * Annual medical costs * $15,000-$30,000/yr * Lifetime costs * $500,000- more than $3mil * severity
38
Mortality rates for SCI HIGHEST when?
1st year after injury PNA, Septicemia
39
Explain an SCI: **Complete Lesion**
* Complete Lesion * NO S or M function BELOW injury lvl * Complete transection... * compression or vascular impairment of cord
40
Explain SCI: **Incomplete Lesion**
* Incomplete lesion * **Sparing** of some sensory/motor function * Contusion... * swelling in spinal canal or **partial transection of cord**
41
3 Common Incomplete SCI syndromes
1. Anterior Cord 2. Central Cord 3. Posterior Cord 4. Hemicord (aka **Brown-Sequard)** 5. Conus Medullaris Syndrome (L1/L2 term end SC) 6. Cauda Equina Syndrome (SCI, Horse's Tail)
42
**Anterior Cord Syndrome**
* **Most common incomplete syndrome\*\*\*** * **Due to:** * **​**head on collision * blow to back of head * **Common assoc'd fx:** * **​**Ant. Wedge fx * Fx of POST elements * SP, laminae, pedicles
43
What would be 3 presentations of **Anterior Cord Syndrome?**
* **​**Loss of **motor function** * **​Dmg to corticospinal** * ffLoss of **pain and temp sensation** * **Dmg to spinothalamic** * Proprio and kinesthesia **intact!** * **​DCML spared**
44
Neuro Flashback: Corticospinal Tract
See attached photo
45
Neuro Flashback: DCML
See attached photo
46
Neuro Flashback: Spinothalamic (Anterolateral) Tract
See attached photo
47
**Central Cord Syndrome** Common w/...
Cervical hyperextension
48
Central Cord Syndrome associated w/...
Narrowed vert. canal - common in OLDER adults due to **spinal stenosis**
49
Central Cord syndrome Frequently caused by......
Rear end MVA Fall in which chin strikes a stationary object
50
Central Cord syndrome results in:
Edema and/or bleeding into the **central grey matter** of the cord
51
3 Presentations of **Central Cord Syndrome:**
* injury most often in **cervical region** * Loss of UE function w/ **relative sparing of LEs** * **​pts often ambulatory** * **INC risk of falls and injury from falls 2\* to absent UE protective extension** * **diff. utilizing ADs** * **AKA "Walking Quad"**
52
Hemi-cord (Brown-Sequard) often caused by....
Penetrating wound to cord
53
Prognosis for Hemi-cord (Brown Sequard) Hemi==Half
\*generally GOOD for **regaining ambulation, hand and B&B function**
54
Presentation of Hemi-Cord Syndrome \*confusing, REMEMBER THIS!!!
* **IPSILATERAL LOSS of MOTOR function and Position sense** * **​BELOW LVL OF LESION** * **Dmg to corticospinal AND DCML** * **CONTRALATERAL LOSS of Pain/Temp** * **​begins a few lvls below lesion****​** * **Dmg to spinothalamic-** * **​**Ascends **ipsilaterally** for a few segments BEFORE crossing
55
Posterior cord syndrome is \_\_\_\_\_\_\_\_\_\_\_\_
LESS common vs others
56
Post cord syndrome USUALLY caused by\_\_\_\_\_\_\_\_\_\_\_
Compromise of **Post spinal artery** **\*****Often a long-term consequence of** Tabes Dorsalis (untreated syphillis)
57
Presentation of Posterior Cord syndrome: **dmg primarily to what?**
* Dmg primarily to **DCML** * **​**Loss of **somatosensation BELOW lvl of injury** * **​**Can't feel pos. of legs * Wide based gait * distal signs of **Ataxia** * **​Drunk Walking**
58
Explain Cauda Equina Syndrome
* **Below L1** * **NOT CNS injury** * Results in **LMN syndrome** * \*\*\*Complete lesion is RARE because of # of nerve roots and the area they encompass * **P.nerve--\> so SOME poss. for REGEN**
59
3 MOI's:
1. Compression 2. Shearing 3. Distraction
60
MOI: **Compression**
see attached photo
61
MOI: **Shearing**
see attached photo
62
MOI: **Compression** ## Footnote **\*\*\*Burst Fx\*\*\***
* diving or football tackle * **Axial blow to skull** * **Often coupled w/ FLEX INJURY** * Leads to a **Vertebral Burst Fx** * **​**Bony fragments enter cord and **rupture IV disc**
63
MOI: **Shearing**
* **Horizontal Force** applied to spine relative to an adjacent segment * **Most common in T-spine** * Results in **Vertebral Fx and ligament damage** * **​**Think about it.... * If it is most common in T-spine...T-spine is most common place for **Vertebral fx's**
64
MOI: **Distraction**
* Think **Whiplash!!!** * **LEAST common SCI** * **Longitudinal axonal shearing**
65
What is some **Acute mgmt of SCI?**
* Pharmacologic * Sx realignment and stabilization * **Prevention of 2\* complications**
66
**Primary damage in SCI**
* Trauma!!! * disrupted axons traversing injury site
67
**Secondary damage in SCI**
* inflammation * local infarction * **ischemia, hypoxia** * prevention of impulse transmission * **Hemorrhage or edema**
68
Pharamcologic Mgmt for SCI: **Methylprednisone** **\***strong anti-inflamms What do they do???
* DEC edema and compress ischemia * INC blood flow in the injured cord * **prevents progressive post-traumatic ischemia** * HIGH DOSES * \*\*\***MUST BE GIVEN W/IN 8 HRS OF ONSET OF INJURY!!!**
69
Surgical Mgmt SCI: what are 2 methods?
* **Surgical stabilization** * **​**stabilize spine * **Sx decompression** * **​**recovery is INVERSELY RELATED to intensity and duration of compressive forces * ex. LOTS of compressive or high intensity compressive forces===SLOWER RECOVERY
70
SX MGMT: SCI ## Footnote **Gardner-Wells Tongs** **How are they used and where???**
* **Used ACUTELY to provide TRACTION** * **​**DEC dislocation and maintain alignment * Inserted into SKULL w/ wts to provde traction
71
Sx Mgmt: SCI ## Footnote **Internal Fixation** **\*Hardware** **what is this and where is the STRONGEST site for it?**
* Fusion of unstable jts * **Pedicle** is the strongest site **posteriorly for fixation**
72
NON-Sx Mgmt SCI \***Halo Traction** **\*exactly what it sounds like** **Advantages?**
* Advantages Halo Traction * **Early mobility** * **avoid/delay sx**
73
NON-SX mgmt SCI \***Orthoses** **Explain...**
May be used **in lieu of sx, OR post-op** to protect fusion site **by limiting spinal mvmt**
74
Classification of SCI 3 Tools
* American Spinal Injury Association Standardized * **ASIA scale** * **​MOST USED SCALE FOR SCI** * S and M lvls tested bilaterally * **Lvl of injury is represented by the MOST CAUDAL lvl w/ intact S and M function**
75
How is the Lvl of injury represented with an SCI?
Lvl of injury represented by **most caudal (lowest) lvl w/ intact S and M function**
76
ASIA Scale Sensory testing based on....... and Grading???
* Sensory testing based on 28 dermatomes * **Light touch AND sharp/dull discrim** * Grading: * 2= intact * 1= impaired * 0= absent
77
ASIA Scale: ## Footnote **Motor Testing**
* Confounded by **mult lvl innervation of mm's** * **​Mm tests may reflect function of 2 OR MORE cord segments\*\*\*\*\*\*** * MM tests are NOT the standard MMTs we reg. perform * **To determine lvl of innervation....** * **​tester looks for strength of 3/5 in one muscle, and AT LEAST 4/5 in the next ROSTRAL (superior) muscle**
78
ASIA Scale Motor Testing **Determining lvl of innervation?**
**To determine lvl of innervation....** ​tester looks for strength of 3/5 in one muscle, and AT LEAST 4/5 in the next ROSTRAL (superior) muscle
79
ASIA Scale: **Key Muscles** ## Footnote **ID following:** **C5-T1** **L2-S1**
C5: elbow flexion C6: wrist extension C7: elbow extension C8: DIP flex of middle digit T1: 5th digit ABD L2: hip flexion L3: Knee EXT L4: ankle DF L5: long toe EXT S1: Ankle PF
80
Explain **Spinal Shock** ## Footnote **3 common components:**
* Flaccid paralysis * Arreflexia * Sensory loss **below lvl of lesion** * Hrs to weeks, typ resolves w/in 24 hrs * early resolution==good * **sepsis/malnutrition prolongs spinal shock**
81
Resolution of **spinal shock** indicated by what?
**Return of bulbocavernosus reflex**
82
What is the Bulbocavernosus reflex?
Reflex contraction of anal sphincter in resp to pressure on glans penis or glans clitoris
83
Although return of Bulbocavernosus reflex indicates end of **spinal shock,** what may it precede???
presence of DTRs or spasticity
84
**(+) reflex W/OUT later sensory or motor return====\>**
lesion is COMPLETE
85
Severity of Injury class. SCI
Graded A thru E
86
Severity of injury class. ## Footnote **Grade A ==**
* COMPLETE * NO MOTOR function is preserved in the **sacral segments S4-S5**
87
Severity of Injury Class. ## Footnote **Grade B==**
* INCOMPLETE * SENSORY but NOT MOTOR function preserved **below neurological lvl and includes sacral segments S4-S5**
88
Severity of Injury Class. ## Footnote **Grade C==**
* INCOMPLETE * MOTOR function preserved **below neurological lvl, AND more than HALF of key mm's below neuro lvl have a muscle grade LESS THAN 3**
89
Severity of Injury Class. ## Footnote **Grade D==**
* INCOMPLETE * MOTOR function is preserved **below neuro lvl, AND at least HALF of key muscles below neuro lvl have a muscle grade of 3 OR MORE**
90
Severity of injury class. ## Footnote **Grade E==**
* NORMAL * Motor and Sensory function are **normal**
91
ASIA Scale Score guides, but does NOT dictate PT tx Absence of fully functioning spinal lvl does not prevent attempt to strenghthen mm's innvervated by that lvl How do we still get improvements in strength?
* Nerve Regen * Hypertrophy of **remaining motor units** * Improved **motor control/learning**
92
Considering primary impairments w/ an SCI Motor and Sensory lvls w/ resulting impairments and abilities **Based on EXPECTED lvl of function w/ ASIA A or B**
NO MOTOR
93
Considering primary impairments w/ an SCI Motor and Sensory lvls w/ resulting impairments and abilities **Minimum expected lvl of function w/ ASIA C thru E**
SOME Motor
94
C1-C4 SCI
* Active MM's * Neck + Facial * Diaphragm to C4 * Functional outcomes * Pt totally dependent, except power WC propulsion and pressure relief * No walking
95
C5 SCI
* Expected MM's * C1-C4 * biceps, brachialis, brachioradialis * deltoid * infrasp, subscap * Functional outcomes: * Min-assist w/ some ADLs, dependent bathing, standing dressing * No walking
96
C6 SCI
* Expected mm's * C1-C5 * ECR * Serratus Ant * Functional Outcomes * More independent w/ UE, min-Mod LE, independent grooming and eating * no walking
97
C7-C8 SCI
* Expected MM's * C1-C6 * triceps, FCU, finger extensors * finger flexors thru C8 * Functional outcomes: * independent most ADLs, some min assist LE * no walking
98
T1-T9 SCI
* Expected MM's * C1 to lvl of injury * Intrinsics hand * intercostals\*\*\* --- breathing!!! * erector spinae\*\*\*--- posture!!! * abdominals to T6 * Functional Outcomes * Independent all ADLs * walking not functional
99
T10-L1 SCI
* Expected MM's * C1 to lvl of injury * intercostals, ext/int obliques * rectus abdominis * L1 **partial hip flexor** * Functional outcomes: * Independent all ADLs * walking functional; independent to min-assist
100
L2-S5 SCI
* Expected mm's * C1-lvl of injury * Iliopsoas, QL, piriformis, obturators * Functional Outcomes * Independent all ADLs * Walking functional; independent to min-assist
101

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