Spinal cord injury Flashcards

Question

Alterations in Spinal Reflexes

Answer 1

UMN (upper motor neurons) Lesions: -Affected by any injury at the T12 level or above -Results in spastic paralysis of affected skeletal muscle groups, and muscles that control bowel, bladder, and sexual function LMN (lower motor neurons) Lesions: -Occur with injuries below T12 -Result from damage to the peripheral nerves that exit each segment of the spinal cord -Causes flaccid paralysis of involved skeletal muscle groups and muscles that control bowel, bladder, and sexual function

Answer 2

Temporary self limiting: falcid paralysis is not an indicator of lifelong paralysis State of areflexia that occurs after spinal injury Involves loss of all or most of the spinal reflexes below the level of the injury Also involves the motor pathways MANIFESTATIONS: flaccid paralysis, lack of tendon reflexes and autonomic function May last minutes, hours, days, weeks Usually self-limiting

Answer 3

Diaphragm innervated by C3 to C5 via phrenic nerves Intercostals innervated by T1 to T7 Major muscles of expiration innervated by T6 to T12 C1 to C3 Injury -Lack of respiratory effort -Requires assisted ventilation C3 to C5 Injury -Allows partial or full diaphragmatic function but ventilation diminished Below C5 -Ability to take a deep breath and cough less impaired

Answer 4

Verbal: -Fenestrated tracheostomy tubes Provide airflow for vibration of the vocal cords -Talking tracheostomy tubes -Diaphragmatic pacing -Electrolarynx-type devices -Mechanical ventilation with an air leak Non-verbal: -Communication boards or cards -Computerized scanning programs -Mouth-stick control devices

Answer 5

-Afferent & efferent flow above the level of injury is unaffected 🡪 normal function -Ascending & descending transmission below injury is blocked 🡪 uncontrolled spinal and autonomic reflexes -Autonomic regulation of circulatory function & thermoregulation are most severe problems -The higher the level the injury, the more profound the effect esp. above T6

Answer 6

-Vagus nerve – continuous inhibitory effect on HR -Vagal stimulation 🡪 Vasovagal response 🡪 bradycardia or asystole -Deep tracheal suctioning hyperoxygenate -Rapid position change Avoid rapid position changes have anticholinergic drugs immediately available

Answer 7

Acute episode of exaggerated sympathetic reflex responses Caused by visceral stimuli that normally cause pain or discomfort in the abdominopelvic region Does not occur until spinal shock has resolved and autonomic reflexes return (within 6 months of injury) Unpredictable in first year; can occur throughout lifetime T6 and above injuries Characterized by: Hypertension Bradycardia Headache Unregulated SNS activity leads to vasospasm, hypertension, skin pallor, piloerection, and baro-reflex mediated vagal bradycardia, but vasodilation, flushed skin, profuse sweating above the level of the injury, nasal congestion

Answer 8

CAUSES: -Visceral distension – full bladder or rectum -Pain – pressure ulcers, ingrown toenails, dressing changes, diagnostic or operative procedures -Visceral contractions – ejaculation, bladder spasms, uterine contractions INTERVENTION: -Monitor BP Q5’ -Remove/correct cause/stimulus -Position upright -Remove AE hose (allow venous pooling to ↓ BP) -IV peripheral vasodilators Hydralazine (Apresoline) Diazoxide (Hyperstat)

Answer 9

-Occurs in persons with injuries at T4 to T6 and above -Related to interruption of descending control of sympathetic outflow to blood vessels in the extremities & abdomen -Results in pooling of blood leads to decreased CO SIGNS: -Dizziness, pallor, excessive sweating above level of lesion, blurred vision, fainting PREVENTION: -Slow changes in position -Measures to promote venous return

Answer 10

SNS functions in regulation of body temp Central mechanisms for temperature regulation located in the hypothalamus Cold --> vasoconstriction + shiver--> conservation & production of heat Heat --> vasodilation + sweating --> dissipative & evaporative heat loss Sympathetic effector responses below the level of injury are disrupted : -Lack of ability to conserve/dissipate heat + sweat -Higher levels of injury (on the spine) produce greater disturbances -Poikilothermy – patients assume external temperature because of impaired temp regulation -EDUCATION: clothing & awareness of environment

Answer 11

Edema & DVT common problems ↓ PVR , areflexia or hypotonia, immobility --> ↑ venous pressure & pooling of blood in abdomen, lower limbs, and upper extremities Orthostatic or dependent edema --> elevation & compression (AE hose) DVT --> low dose heparin, ROM, compression devices, assessment

Answer 12

After spinal shock, isolated reflex activity + muscle tone not under control of higher centers returns Results in hypertonia or involuntary spasticity of skeletal muscles below the level of injury May be tonic (sustained tone) or clonic (intermittent) Occurs in injuries above T12; below T12 reflex response damaged at the cord or spinal nerve level Spasticity has some benefits but also places individual at risk for injury STIMULI: muscle stretching, bladder infection, bowel distension or impaction, pressure areas, infections INTERVENTION: PROM, avoid stimuli, antispasmodics

Answer 13

Innervation by cranial & spinal nerves in dermatomes Afferent/sensory information 🡪 Brain🡪 Efferent/motor control & reflex activity at each dermatome SNS: control of vasomotor and sweat glands provides adequate circulation, excretion of body fluids, & temperature regulation Spinal cord injury 🡪 major risk for altered skin integrity FACTORS: pressure, shearing forces, trauma & irritation INTERVENTION: relieve pressure, encourage circulation, inspect for breakdown MOST PREVENTABLE COMPLICATION !!!

Answer 14

Diverse & unpredictable pain syndromes Mechanical or fracture pain -Dull, aching pain that occurs at level of injury from soft tissue damage Radicular or spinal nerve root pain -Aching or shooting pain that radiates along distribution Visceral -Poorly localized, burning abdominal/pelvic discomfort r/t bladder distension or UTI Central -Diffuse burning sensation below level of injury -Aggravated by touch, movement, & visceral distension INTERVENTION: TENS, TCAs, Anticonvulsants, NSAIDs, PT

Answer 15

Sensory signals from bladder stretch receptors (S2 to S4) 🡪 Reflex voiding center 🡪 Motor neurons (S2 to S4) SNS: detrusor relaxation (bladder filling) PNS: detrusor contraction (voiding) UMN Injury – spastic bladder dysfunction -Lack awareness of bladder filling and voluntary control of voiding 🡪 incontinence LMN Injury – flaccid bladder dysfunction -Lack awareness of bladder filling and lack of bladder tone 🡪 unable to void 🡪 retention & overflow INTERVENTION: continuous or intermittent drainage, external collection, manual techniques

Answer 16

SNS: T6 to L3 --> decreased intestinal motility + increased internal sphincter tone PNS: S2 to S4 --> increased intestinal motility + decreased internal sphincter tone Spinal cord injuries at S2 to S4 --> flaccid functioning of the defecation reflex + loss of voluntary control of external anal sphincter Spinal cord injuries above S2 to S4 --> spastic functioning of the defecation reflex + loss of anal sphincter tone --> intrinsic contractile responses intact but no defecation reflex INTERVENTION: high-fluids, high-fiber diet, mobility, consistent pattern, privacy, positioning, laxatives, digital stimulation (questionable)

Answer 17

Physical act of sex vs. sexual/caring relationship T11 to L2 -->mental stimuli or psychogenic sexual response S2 to S4 --> sexual touch or reflexogenic sexual response Spinal cord injury at any level 🡪 disrupts neural pathways (S2 to S4) between genital and higher centers -UMN Lesion (T10 or higher): reflex sexual response to touch but not to mental stimuli (spinal lesion is blocking pathway) -LMN Lesion (T12 or below): sexual reflex center may be damaged 🡪 no response to touch; below T12 sexual arousal by mental stimuli; L2 to L1 may have sexual response to mental or touch stimuli INTERVENTION: erectile aids, lubricants, Fertility may not be lost ! Pregnancy, labor & birth control requires caution

Spinal cord injury Flashcards

(42 cards)