Spinal Cord Injury Flashcards
(106 cards)
1
Q
What is central cord syndrome?
A
Weakness in UE > LE + sacral sparing present
2
Q
What is Brown-Sequard syndrome?
A
Motor and proprioceptive deficits are more severe IPSI and pinprick/temperature sensation more severe CL to the lesion
3
Q
What is anterior cord syndrome?
A
Proprioception is preserved; there is variable loss of motor function and sensitivity to pinprick and temperature
4
Q
What is conus medullaris syndrome?
A
Flaccid paralysis of LE and areflexive bowel/bladder. Some cases sacral reflexes are retained
(UMN and LMN)
5
Q
What is cauda equina syndrome?
A
Flaccid paralysis of the LE, areflexive bladder and bowel
(more LMN)
6
Q
List some cardiopulm impairments someone with an SCI may have
A
- OH
- AD (>T6)
- DVT
- impaired cough/breathing
7
Q
What does the cababilities of UE Instrument measure?
A
UE functional limitations in individuals with tetraplegia
8
Q
What does the Spinal Cord Independence Measure (SCIM III) Measure?
A
Impact of SCI on self-care, respiration and mobility
9
Q
What is the wheelchair skills test?
A
A comprehensive generic instrument to measure both safety and performance of an individuals WC skills
10
Q
What is the SCI Functional Ambulation Inventory?
A
A measure of functional walking ability in those able to ambulate that includes observation of 3 domains of walking function (gait parameters, AD, Temporal distance)
11
Q
What is the walking index for SCI II
A
Assess the amount of PA needed + devices required for those post SCI
12
Q
What is the Craig Hospital Inventory of Environmental Factors (CHIEF)
A
A tool that assess the degree to which elements of the physical, social, and political environments act as barriers w/the frequency and magnitude of each barrier defined
13
Q
What is the Craig Handicap Reporting and Assessment Technique (CHART)
A
Measures 6 domains of social participation in those with an SCI
14
Q
What are the movement system diagnoses of SCI?
A
- Force Production Deficit
- Fractionated Movement Deficit
15
Q
What are positive prognostic factors for SCI?
A
- spared voluntary motor function below the lesion
- Spared sensation below the lesion
- Central Cord or Brown Sequard (vs anterior cord)
- younger age at time of injury
16
Q
T or F: Incomplete Tetraplegia has better outcomes for ambulation than Incomplete Paraplegia
A
False- it is the opposite
17
Q
What are the general goals of acute care?
A
- prevention of secondary complications
- preparing patient for full rehabilitation participation
- initiate discharge planning and family training
18
Q
What are the treatment ideas for acute care?
A
Out of bed, increase tolerance to upright sitting, ROM, early strength training, skin management
19
Q
What are the treatment ideas for IPR?
A
ADLs, transfers, mobility, community outings, family training, preparing for transition back home
20
Q
What are the treatment ideas for OP?
A
Advanced transfer training, adv w/c training, locomotor training, upgraded ADL training, and upgraded HEP
21
Q
What are the general goals for IPR?
A
Maximize independence in ADLs, transfers, and mobility
Prep for DC back home
22
Q
What are the general goals for OPR?
A
Maximize independence, support community reintegration and participation in life activities
23
Q
Which comes first:
- prevention of secondary complications
- functional training
A
prevention of secondary complications
24
Q
What are the four main areas to target for SCI intervention?
A
- Pt/family education and training
- Functional and gait training
- Therapeutic Exercise
- Equipment recommendation
25
What are important education topics to teach?
- pressure relief
- bowel/bladder program
- healing time
- exercise
- S/S of AD
26
What is the WC pressure relief program?
For T1 and lower, its every 15 mins for 15 seconds, and all else is every 30 mins for 30 seconds
27
How do you instruct an anterior weight shift pressure relief?
WC locked w/castors forward
Gaurd pt in the front
pt rests elbows on thighs to relieve pressure on sacrum
Pt continues to slide down to anterior tibias
Return upright with triceps or wrist extensors and momentum
28
How do you instruct lateral weight shift pressure relief
WC locked and castors forward, patient pushes rim or chair handle for stability to lean to opp side of WC
29
How do you instruct push-up weight shift?
WC locked and casters forward
Elbow ext and shoulder depression to lift buttocks
Start w/Hips slightly anterior in WC to avoid shearing the sacrum against the back of the chair
30
How do you instruct a tilt back WS?
Its a dependent method where the WC is locked, caregiver sits in sturdy chair behind Pt, and leans patient back and then slowly returns them upright after the desired amount of time
31
Without triceps, how do you get a patient to be able to sit and maintain elbow extension?
> than normal shoulder extension, ER and full elbow extension
32
Which is essential for locking out the elbows?
a. forearm supination
b. forearm pronation
c. wrist flexion
d. wrist extension
a and d: forearm supination and wrist extension
33
When would you want a tenodesis grip?
At C7 or higher quadriplegia
34
How do you do ROM without losing a tenodesis grip?
Finger extension ROM in neutral or fully flexed wrist, full finger flexion with wrist fully extended
35
T or F: You need loose back extensors to help with transfers
False - mild tightness is required so that head and shoulder motions can be transmitted to the lower body during transfers and other functional activities
36
How much DF is needed for ambulatory patients?
Full DF
37
What is the goal of postural drainiage?
Use passive positioning to use gravity to mobilize secretions in the lungs
38
What does L side lying do for postural drainiage?
It increases perfusion on the LEFT and ventilation on the RIGHT
39
When would you use glossopharyngeal breathing?
Pts C1-3 to use accessory mm of ventilation to improve VC
40
What are the four stages of a cough?
I: Inspiration
II: Hold (for gas distribution)
III: Compression (glottis closes and increases intrathoracic pressure)
IV: Expulsion (glottis opens and pushes air out)
41
To improve breathing, you should do cervical thoracic ___ with exhalation and ___ with inhalation
flexion with exhalation and extension with inhalation
42
How do you do the Heimlich-assisted cough?
Manual contact placed over the epigastric area w/a quick in and upward force as the pt attempts to cough
43
How do you do the costophrenic assist cough?
Manual contacts on lateral aspects of lower ribs to then move down and in towards the navel
44
What is a short-sit self-assist cough?
Pt takes deep breath during extension of upper body as balance allows followed by cough w/flexion forward at the trunk with Heimlich contact on self
45
What is a long-sit self-assist cough?
Pt in long sit and takes deep breath in w/cues to extend trunk and retract scapula, on cough, pt throws trunk and arms forward to enhance forced exhalation
46
What are the 3 basic concepts of functional mobility in those w/SCI?
Muscle substitution
Head-hips relationship
angular momentum
47
What motions do you want to train with SCI?
elbow extension, shoulder flexion and horizontal adduction, scapular protraction and depression
48
What should therapists do for gait training w/SCI?
Walk at high aerobic intensities (up to 85% HR max or RPE of 17-18) and use VR
49
What may therapists do for gait training w/SCI?
Strengthening at 70% of 1RM
Circuit training, cycling at 85%, and balance w/VR
50
What should therapists not do for gait training wSCI?
Static/dynamic balance
BWSTT w/emphasis on kinematics
Robot assisted walking training
51
What is the starting level aerobic and strength activity recommendations for SCI
20 minutes 2x a week at moderate to vigorous intensity with 3 sets of 10 reps 2x a week for each major muscle group
52
What is the advanced level aerobic and strength activity recommendations for SCI
30 minutes 3x a week of mod to vigorous intensity with 3 sets of 1- reps 2x a week for each mm group
53
When does SCI treatment focus on:
a. compensation
b. recovery
a. AIS A or B
b. AIS C or D
54
What do you do if OH occurs in your patient?
move to recumbent position + elevate LE
55
When does OH commonly occur in SCI patients?
Acute recovery phase
56
How do you get your patient to tolerate upright postures if they have OH?
- gradual positioning
- abdominal binder
- thigh-high anti-embolism compression stockings
57
What is the main sign of autonomic dysreflexia?
a pounding headache
58
What should you do if Pt has AD?
Move them into upright short sitting position and assess their BP - if high, loosen restricted clothing
59
Where do you want patient hypermobility w/SCI?
Shoulder and HS
60
On the capabilites of UE instrument, do you want a higher or lower score?
Higher = greater function
Scale of 32 - 224
61
Which test rank orders the ability of a person to walk 10m after a SCI from most to least severe impairment?
The walking index for SCI II
62
On the CHART, do you want a higher or lower score?
Higher = less handicap
63
SCI Disrupts which systems?
- respiratory
- CV
- gastrointestinal (neurogenic vowel)
- genitourniary (neurogenic bladder)
- endocrine (osteoporosis)
64
What should integumentary education consist of?
- pressure relief
- avoid prolonged immobilization
- daily skin checks
- evaluate support surface
65
Ability to walk as AIS A
- usually non-functional
- potential increases as LOI is more caudal
- Below T11 greatest potential to walk
66
Ability to walk as AIS C or D
- incomplete greater than complete
- Brown-Sequard or Central Cord highest potential to return to walk
- more accurate sensation is better chance of walking
67
What are guidance/assist as need techniques for propulsion?
- stabilizing straps w/anterior forces
- slow speeds
- weight support
- hand hold
68
What are guidance/assist as need techniques for stance control?
- BW support (up to 40%) reduced as tolerated w/o knee buckling
- hand hold
69
What are guidance/assist as need techniques for limb advancement?
- manual assistance
- elastic assistance
- mechanical facilitation
70
What are guidance/assist as need techniques for stability and balance?
- anterolateral straps to minimize pelvic translation
- hand-held support
71
What are error augmentation techniques for propulsion?
- increase speed (on treadmill)
- resisted walking
- stair climbing
- uphill walking
72
What are error augmentation techniques for stance control?
- weighted vest
73
What are error augmentation techniques for limb advancement?
- leg weights
- elastic resistance
74
What are error augmentation techniques for stability and balance?
- balance beams
- uneven surfaces
- multidirectional walking
- obstacle avoidance
- stair climbing
75
What are some key things to remember about strengthening for SCI?
- UE as stabilizer w/trunk movement
- better to do multi-joint movements
- functional strengthening is important
76
What modifications can you use for a patient without triceps when completing strengthening of the UE?
- air cuffs
- shoulder ER
- machines
77
What modifications can you use for a patient without grip?
- wrist straps
- ace wraps
- gloves
78
What modifications can you use for a patient in antigravity?
-powderboard
- active assist
- skate on table
79
What % of people w/SCI have shoulder pain
30-70%
80
According to the STOMPs protocol, where should you stretch your shoulder?
- anterior shoulder joint
- posterior shoulder joint
- UT
81
What should you do for a warm-up (STOMPS Shoulder HEP)
- scaption
- ER
- scapular retraction
- shoulder adduction
82
What resistive training should you do (STOMPS HEP)
- scaption, ER, cap retraction, shoulder adduction + resistance
- hypertrophy: 8 rep max
- endurance: 15 rep max
83
What is the STOMPS movement optimization transfer and raise?
- lead w/painful side
- close surfaces, level whenever possible, use graded heights if necessary
- use a forward or side to side lean
- turn hands outward whenever possible
84
What is the STOMPS movement optimization WC Propulsion?
Use long, smooth strokes w/natural drift downward at end
push off tires
avoid steep inclinces
85
What types of exercises should those w/SCI do?
aerobic, strengthening, and flexibiility
86
What are some negative effects of spasticity?
contractures
positioning
sleep
comfort
hygiene
87
What are some positive effects of spasticity
- assist w/mobility
- preserve mm mass and contribute to circulation
- bowel and bladder function
88
What are some physical treatments of spasticity?
- muscle stretching
- serial casting
- bracing
- E-stim
89
What are some pharmacological treatments of spasiticty
- baclofen
- diazepam
- dantrium
- zanaflex
- botox
90
When does the most bone loss occur in SCI?
The first 6 months
91
When does the most bone loss occur in SCI?
The first 6 months
92
What percent of bone is lost in the first two years?
40%
93
Where do most fractures occur post-SCI?
In the distal femur and proximal tibia
94
T or F: People with paraplegia have more fractures than those with tetraplegia?
True
95
What are signs of a fx after a SCI?
- pain
- limb deformity
- swelling
- hematoma
- increased difficulty w/functional mobility
- increase in mm spasms
- AD
- sweating
96
What are non-modifiable risk factors for a fx w/SCI?
- inc. time since injury
- more complete SCI
- Female
- peds
- previous fragility fx
- paraplegia
97
What is Heterotopic Ossification?
The formation of pathological bone in muscle or soft tissue
98
When is there the highest risk of HO?
First 2 months after SCI, below the level of paralysis
99
Where is the most common location for HO?
In the hips, but could also be at elbows or knee
100
What are early signs/symptoms of HO?
swelling, joint and muscle pain, decreased ROM, erythema, and local warmth near a joint
101
When would you see a spastic/hyperreflexive bladder (UMN bladder)
- pts w/lesions above conus medullaris & sacral segments
102
When would you see a flaccid or areflexive bladder (LMN Bladder)
Conus medullaris or a lfesion of the sacral segment
103
What occurs with sexual function in males at the cauda equina/conus medullaris level of injury?
- no reflex erections
- occasional ejaculation
104
What occurs with sexual function in males at the thoracic/cervical level of injury?
- short duration reflex erections
- occasional ejaculation
105
What occurs with sexual function in females at the cauda equina/conus medullaris level of injury?
- absent vaginal secretions
- fertility still usually intact
106
What occurs with sexual function in females at the thoracic/cervical level of injury?
- vaginal secretions are present
- fertility intact
- absent sensation of labor pain
