Spinal Cord Injury Flashcards
1
Q
Describe an upper motor neuron injury
A
- UMN (Suprasegmental Control): Motor neuron that carries motor information from motor cortex or subcortical region to cranial nerve nuclei
- Interneurons that synapse with motor cell bodies in the ventral horn (LMNs)
- Intact reflex loop (sensory nerve -> spinal motor neuron -> motor nerve -> muscle activation)
- Flaccidity at the level of injury
- Hyperreflexia below level of injury
- SCIs above T12/L1
2
Q
Describe a lower motor neuron injury
A
- LMN (Segmental Control): Motor neuron that carries information from motor neuron cell bodies in anterior horn to skeletal muscles
- Includes cranial nerves and cauda equina
- Flaccid paralysis
- Hyporeflexia
- SCI’s at and below T12/L1
3
Q
Many individuals with SCIs have signs associated with both UMN and LMN pathology (True/False)
A
- True
4
Q
Spinal precautions for SCI
A
- In cases of confirmed spinal or spinal cord injury, maintain spine immobilization until definitive treatment
- Logroll the patient with a potentially unstable spine as a unit when repositioning, turning, or preparing for transfers
5
Q
Describe neurogenic shock
A
- May occur after a cervical or high thoracic (T1-T5) injury that interrupts thoracic sympathetic outflow
- Causes hypotension and bradycardia
- May not be possible to restore a pt’s BP by fluid infusion resuscitation may generate pulmonary edema
- BP can instead be restored by supplementing moderate volume replacement w/judicious use of inotropes (pressors)
- Muscarinic antagonists, such asatropine, can be used to treat hemodynamically significant bradycardia
- MAP >85 mmHg for 1st wk post-injury
6
Q
Describe spinal shock
A
- Refers to the muscle flaccidity and loss of reflexes seen after SCI.
- The “shock” to the injured cord may make it initially appear completely functionless.
- However, because the cord is usually not completely destroyed in SCI, the duration of this state is variable; recovery usually occurs
7
Q
Vital sign recommendations for SCI
A
- BP: collaborate with medical team to address hypotension (SBP <90 mmHg) prior to PT sessions; MAP goal of 85-90 mmHg for at least 1st wk following injury for adequate spinal cord perfusion
- O2 Sat: SCI pt’s typically present with impaired pulmonary function secondary to a restrictive dysfunction depending on type & level of injury; monitor SpO2 especially in individuals with ineffective cough or excessive mucus retention
8
Q
Describe treatment and effects of hypotension on SCI
A
- Hypotension may exacerbate CNNS injury
- Avoiding hypotension is paramount in early treatment to prevent secondary neuronal injury from lack of perfusion
- 1st treatment priority for hypotension is fluid resuscitation
- Goal is to maintain optimal tissue perfusion & to resolve shock
- Uncontrolled studies that used fluids and vasopressors to achieve a mean arterial pressure (MAP) of 85 mmHg for a minimum of 7 days in patients with acute SCI have reported favorable outcomes
9
Q
How can you provide meticulous skin care for SCI patients
A
- Reposition to provide pressure relief or turn at least every 2 hours while maintaining spinal precautions.
- Keep the area under the patient clean and dry and avoid temperature elevation.
- Assess nutritional status on admission and regularly thereafter.
- Inspect the skin under pressure garments and splints
10
Q
Describe importance of patient handling
A
- Place the patient on a pressure-reduction mattress or a mattress overlay, depending on the patient’s condition.
- Use a pressure-reducing cushion when the patient is mobilized out of bed to a sitting position
- Some degree of pressure ulcer formation occurs in 30%–50% of patients with new SCI during the first month post-injury, and the sacrum is the most common location for these ulcers
- Educate the patient and family on the importance of vigilance and early intervention in maintaining skin integrity.
11
Q
Describe the rehab management for SCI
A
- PTs should be involved during the acute hospitalization phase
- Consider directing SCI pts expeditiously to a specialized spinal cord injury center that is equipped to provide comprehensive, state of the art care
- Educate patients and families about the rehabilitation process and encourage their participation in discharge planning discussions
12
Q
Describe how to manage OH in SCI patients
A
- Use nonpharmacologic and pharmacologic interventions for orthostatic hypotension as needed.
- Provide non pharmacological interventions:
- Mobilize the patient out of bed to a seated position once there is medical and spinal stability.
- Develop an appropriate program for out-of-bed sitting.
- Limit in-bed and out-of bed semireclined sitting, as it often produces excessive skin shear and predisposes to pressure ulcer formation.
13
Q
Describe the Costophrenic assist technique for manually assisted coughing
A
- Can be performed in any position (supine, sidelying, and sitting most common)
- Therapist places their hands on the Costophrenic angles of the rib cage
- At the end of the patients exhalation, the therapist provides a quick manual stretch down and in toward the patients navel to facilitate a stronger diaphragmatic and intercostal muscle contraction during the succeeding inhalation
- You then have the patient hold it and just a moment before asking the patient to actively cough, the therapist applies a strong pressure again
- Most commonly used for patients with weak or paralyzed intercostal or abdominal muscles
14
Q
Describe an abdominal thrust (Heimlich type) technique for manually assisted coughing
A
- Therapist places heel of hand at the patients navel
- Patient takes in a deep breath and holds it
- As the patient is instructed to cough, the therapist quickly pushes up and in under the diaphragm
- Can be uncomfortable because: Abrupt nature, Concentrated area of contact & Force may cause GER
- Should only be used when the patient does not respond to other techniques
- Can emphasize one side for someone with unilateral or thorax disease, hemiplegic, or s/p trauma
15
Q
Describe the anterior chest compression assisted cough technique
A
- Therapist puts one arm across the pectoralis region to compress the upper chest
- Other arm placed parallel on the lower chest or abdomen
- Inspiration is facilitated first
- Followed by a hold
- Force is applied: Down and back on the upper chest & Up and back on the lower chest
- Effective for patients with very weak chest wall muscles
