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SCI Rehab Test 1 Flashcards

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1
Q

zone of partial preservation

A

exists with complete injuries. Does not include S4 and S5 segments. The most caudal segment with some motor and or sensory function defines the end of the zone.

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2
Q

Complete injury

A

no motor or sensory function preserved in sacral segments S4-S5

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3
Q

Incomplete injury

A

retaining fxn in the lowest sacral level of the spinal cord, S4-S

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4
Q

Neurological level of injury

A

most caudal level w/ both normal sensory and motor fxn on both sides of the body

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5
Q

Vertebral level/skeletal level of injury

A

level of greatest vertebral damage on radiograph

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6
Q

Motor level of injury

A

most caudal segment w/ normal motor on both sides. Lowest key muscle that has a grade of at least 3 as long as key muscle above it is graded at a 5.

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7
Q

Sensory level of injury

A

most caudal level of spinal cord w/ normal sensory fxn

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8
Q

autonomic hyper-reflexia

A

usually seen in T6 injuries. Usually caused by a noxious stimuli, often a kink in a catheter line with a full bladder. Causes an uncompensated autonomic overflow: severe HT, tachycardia, sweating, flushing, HA, piloerection, shivering. Can lead to a hemorrhagic CVA.

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9
Q

poikilothermia

A

inability to thermoregulate via sweating or shivering below the level of injury due to the loss of connection btwn the hypothalamus and spinal cord.

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10
Q

syringomelia

A

associated w/ spinal tumors, congential abnormalities of the foramen magnum or base of the skull, spinal tumors and arachnoiditis. associated w/ late deterioration post SCI by 2 months to 20 year. treated w/ laminectomy and drainage of cyst or surgical shunting of the cyst.

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11
Q

Percent of SCI from MVA

A

44.5%

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12
Q

Brown sequard syndrome

A

ipsilateral proprioception, vibration, and tactile sensation, and motor loss. contralateral loss of sensitivity to pain and temp below the level of the lesion b/c crossed spinothalamic tract crosses after exiting the cord.

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13
Q

Anterior cord syndrome

A

variable loss of motor function (corticospinal tract), and pain, and temp (anterior spinothalamic tracts), while preserving proprioception, light touch and deep pressure

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14
Q

Central cord syndrome

A

“grey matter injury”. “walking quad”. most common of the incomplete syndromes. greater weakness in the upper limbs than the lower limbs AND sacral sparing. occurs almost exclusively in the cervical region. frequently seen in older adults and those with cervical stensosis. hyperextension may cause the ligamentum flavum to protrude into the central cord.

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15
Q

spinal shock

A

period of flaccid paralysis characterized by complete paralysis, arreflexia and sensory loss below the level of the lesion. return of Babinski, clonus and bulbospongiosus reflex responses mark the resolution of spinal shock.

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16
Q

neurogenic shock

A

.

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17
Q

CN VIII (8)

A

Digestion, motor and sensory. Provides motor parasympathetic fibers to all organs except the adrenal glands from the neck to second segment of transverse colon

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18
Q

injury lower than L2

A

Lower motor neuron injury not SCI

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19
Q

SCI pt’s primary goal and prioritized goals

A

to gain the most independence possible before discharge from rehab. to perform tasks like rolling and sitting optimally and then learn to don/doff UE/LE splints, perform ADL’s

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20
Q

prime movers associated with C5-6 independence

A

deltoid and biceps. pt can be I after set up and transfer with AD

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21
Q

prime movers associated with C6 independence

A

wrist extensors. can potentially be independent using tenodesis for grasp but probably still couldn’t use long handled brush for bathing

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22
Q

prime movers that come in if C7 SCI

A

triceps

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23
Q

prime movers that come in if C8 SCI

A

hand instrinsics

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24
Q

primary purpose of an AD (assistive device)

A

take up slack for loss of fxn or strength

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25
prime movers that come in if T1 SCI
full hand
26
effect of vital capacity and ability to dress independently
if VC<50% will not be Ind in dressing
27
degree of hip flexion required for LE dressing
110 degrees
28
UE dressing requires
good muscle strength in UE
29
7 types of acquired spinal paralysis
infective, degenerative, neoplastic, vascular, idiopathic, iatrogenic, psychogical
30
non-traumatic spinal paralysis
developmental, structural deformities, congenital malformation, familial paralysis
31
examples of developmental spinal paralysis
incomplete closure of the spinal canal, structural deformities and familial paralysis;spina bifida w/ meningocele or meningomyocele
32
examples of structural deformity spinal paralysis
scoliosis, kyphosis, spondylolisthesis, ankylosing spondylitis (bamboo spine)
33
examples of congenital malformation spinal paralysis
Klippel-feil syndrome: hemivertebrae and fusion w/ adjacent vertebra. compression and increase SCI risk; sacralization of 5th lumbar vertebra
34
examples of familial spinal paralysis
frederick's Ataxia, SC agenesis
35
types indirect forces in traumatic spinal paralysis
retrohyperflexion-hyperextension, ventro-hyperflexion, flexion w/ rotation, vertical stress, lateral flexion, direct injury (something contacting the spinal column)
36
retrohyperflexion-hyperextension
like whiplash. acceleration injury. biggest force on posterior aspect of vertebrae. SP's pushed closer together and may fx. most common at C4-C6. highly unstable w/ loss of boney, ligamentous and capsular integrity.
37
ventro-hyperflexion
anterior flexion injury/deceleration injury-->anterior compression and fxs. PLL, supra and infrraspinous ligaments tear. fx dislocation instability. broken bones can enter spinal canal.
38
cauda equnia
nerve roots exiting at L1-2. junction of CNS and PNS. caudal equina is part of PNS.
39
conus medullaris
injury of the sacral cord and lumbar nerve roots. sacral segments may show preserved reflexes (e.g., bulbocavernosus with high conus lesions). results in areflexic bladder, bowel and lower limbs with a low lesion.
40
incomplete clinical syndromes
central cord, Brown-Sequard, Anterior cord, caudal equina, conus medullaris
41
flexion w/ rotation injury
predominant anterior bone disruption. failure of facet joint capsule-->lateral translation at facet joint. disruption of anterior and post. columns. highly unstable
42
vertical stress injury
diving or jumping. "burst"/compression fx. cone fragments and disk matter sent in all direction including into the spinal canal. tear and compress the spinal cord.
43
lateral and rotational stress
like a boxer getting hit in the head or in a MVA, there is lateral flexion of cervical spin and axial rotation. may stretch and rupture posterior lig., dislocate the facets and cause comp. fx of the bones.
44
compression fx Type I
tear drop chip ruptures superior cortical plate and breaks chip off anterior ligament. if neck flexed at impact, anterosuperior half of body is crushed with triangular wedging.
45
compression fx Type II
entire upper 1/2 of vertebral body crushed. with flexion, larger segment may be broken.
46
types of direct injury to SC
blow, GSW, blast injury, stab wounds, violent muscle contraction causing avulsion, pathological fx, disc lesions,compression of spinal cord...can lead to compression or vascularization loss
47
GSW
can penetrate completely, get lodged in intramedullary space in the cord, lodged extramedulalarly but intramurally, extraduarally, ricochet, or cause indirect cord damage
48
missile penetration of cord
sever cord or root damage resulting in total or partial paralysis from vascular and boney damage with injury to adjacent organs
49
intramedullary lodging of missile
usually left in the cord. probably a complete lesion.
50
extra medullary but intradurally lodged bullet
between the dura and the cord. most likely in the arachnoid. cord compression. removal may improve function due to pressure relief
51
extramurally lodged bullet
btwn bone and cord, easier to remove. vascular damage may have occurred which can affect cord and cause neurological damage
52
richochet injury
projectile hits the vertebral body, producing fx and injury to the cord indirectly via avulsed spinal nerve, tear in the dura or traction lesion
53
blast injury
explosives, grenades, land mines. hemorrhage of brain and cord. inflammation of meninges and surgical repair required.
54
stab wounds
associated with the uncommon Brown-Sequard syndrom.
55
pathological fxs
due to osteoporosis, tumors, and metastases
56
rapid onset compression of SC
disc, hemorrhage, vascular occlusion, pyogenic abcess
57
slow onset compression of SC
tumor, TB abcess, osteophyte
58
pathophys post injury
1. ISCHEMIA rapidly affects gray matter (in minutes) then affects white matter after 2-3 hrs. 2. INFLAMMATORY cells expand the area of tissue damage for 24-48 hours after the initial trauma. 3. ION DERANGEMENT: abnormal concentration of K and Na result in shift of Ca. concentration of Ca in neurons contributes to tissue destruction.-->breakdown of protein and phospholipids resulting in demyelination. 4. APOPTOSIS: cell death as pathological process 4-6 hours after trauma/CNS damage continues up to 24 hours. occurs in oligodendrocytes associated with production of myelin of degenerating ascending white tracts rostral to site and descending tracts cuadal to the site.
59
classification of spinal fxs and dislocations
radiaological-dislocation, position, dynamics and classification. Graded 1-4. divide AP diameter of lower vertebra into 4 equal parts. based on how much farther the superior veteran has moved anteriorly over the inferior vertebral body.
60
most common cervical injuries
75% flexion injuries in lower cervical. 50% C5/6. 12% C6/7. 10% C4/5. upper cervical spine has a bigger canal for the cord which protects it
61
jefferson fx
C1-often w/o neurological signs. just pain and restricted movement
62
odontoid fx
C2
63
extension fx w/ C2/3 pedicle
?
64
subluxation/cervical sprain C3-C7
partial or temporary disruption of normal contact between articular surface as sprain. produced pain, temporary stiffness but no damage to the SC
65
distinguishing feature between subluxation and dislocation
articular processes have not actually overridden in subluxation as they do in dislocation
66
compression fx type 3
fx of both superior and inferior places w/ fx lines throughout the body. fragmentation of the anterior segment may occur. posterior cortex of vertebral body intact
67
compression fx type 4
most severe explosive type of burst fx. crushes and destroys the entire vertebral body. Fragments of the crushed body can migrate into the spinal cord.
68
lumbar injuries
usually incomplete. intermediate stability
69
thoracic injuries
usually complete b/c the force has to be so great to cause injury at all. most common at thoracic-lumbar junction. thorax more protected by the ribcage higher up.
70
tract involved with superficial pain
lateral spinothalamic tract
71
tract invovled with deep pain
dorsal column
72
tract involved with proprioception
dorsal column
73
breathing muscles and their spinal cord level innervation
diaphragm: C4, intercostals: T1-T12, abdominals: T6-T12, accessory muscles: SCM (C2,3), Trapezius: C2-C4 and spinal accessory nerve, scaleni: C2-C8
74
centrifugal system
arises from the anterior spinal artery. supplies the central region of the cord-especially gray matter and also 1/2 the inner posterior, lateral and anterior white matter.
75
centripetal system
arises from anterior and posterior spinal arteries and supplies peripheral region of the cord (white matter)
76
C1-3 SCI
ventilator dependent but may be trained to use accessory breathing muscles to be off the ventilator temporarily. 100% dependent in ADLs. Requires tracheostomy and secretion mgmt and respiratory PT. voice limited by poor breath support. facial mm. and some shoulder mm intact. able to use sip/puff W/C.
77
C4
not ventilator dependent but at risk for respiratory compromise. scap mm. available: supraspinatus, infraspinatus, trees major, rhomboids. deltoids, partial biceps, partial elevator. 100% dependence in all ADL's and transfers. at risk for overuse syndromes esp. if PCWF
78
PCWF
posterior cervical wiring and fusion
79
C5
biceps, brachialis, brachioradialis, full deltoids, pec major. able to use shoulder girdle for balance and mobility tasks. improves for dependent to max assist. can mobilize WC short distances at high energy cost. limited ability for feeding and hygiene.
80
C6
functional toneless. full scap. mm. sternal pecs, lats. ext. carpi radialis. FIRST level at which independent transfers are possible
81
C7
triceps, finger extensors and wrist flexors. could live independently but at risk w/ respiration and impaired cough. could maybe hip hike w/ strong lats attached to iliac crest.
82
C8-T1
full hand intrinsics. amb. w/ KAFO
83
T1-T8
abs, intercostals, erector spinae. improving respiration, trunk control. Head/hip moving strategies come into play here.
84
T9-T12
full intercostals and abdominals. can use abs as hip flexors with high energy cost.
85
L1
partial innervation of hip flexors (iliopsoas)
86
L2, L3
adductors (gracilis), rec fem, QL present and decrease he energy cost of walking but KAFO and walker or loft strands still required. L3 has FULL innervation of these whereas L2 has partial.
87
L4
ABD weak, hamstrings, peroneals, hip ER, Tib.ant. possible amb w/ AFO's only
88
L5
gastroc, soleus
89
S1, S2
foot intrinsics
90
S3-S5
Bowel bladder sx, LMN signs
91
posterior cord syndrome
loss of position sense, tactile discrimination, vibration. volitional motion, pain and temp sense intact. mobility difficult unless pt trains in visual compensation.
92
cauda equina syndrome
tumors, trauma, spinal stenosis, inflammation, hemorrhage. presents gradually. absent LE reflexes. severe radicular pain but minimal LBP. asymmetric saddle anesthesia with possible loss of other specific sensory dermatomes. Asymmetric flaccid paralysis (LMN). infrequent ED, and urinary retention as a late sign.
93
conus medularis lesion
sudden bilat. presentation. preserved knee jerk. increased LBP, diminished radicular pain. symmetrical penal numbness. distal LE flaccid paralysis. frequent impotence. early overflow incontinence due to loss of bowel control retention and...
94
ASIA B
sensory but not motor function is preserved below the neurological level and extends thru sacral segments S4-S5.
95
ASIA C
incomplete: motor function is preserved below the neurological level and the majority of key muscles below the neurological level have a muscle grade less than 3.
96
ASIA D
motor function is preserved below the neurological level and the majority of key muscles below the neurological level have a muscle grade greater than or equal to 3.
97
ASIA E
normal. motor and sensory function is normal. 100% recovery. may come to this over time.

Neuro (6 decks)

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