Flashcards in Spinal Cord Injury Deck (39):
Define pediatric SCI
An acute traumatic lesion of the spinal cord and nerve roots in children from newborn through the age of 15
What are the 3 most common causes of SCI in children?
- MVA (restraints and fulcrum affect)
- birth trauma
- child abuse
What is the correct positioning of a child (10 years old) in regards to restraints?
- lap belt needs to be on lap, not only belly
- the knees are able to bend without the child having to slouch
- shoulder belt should be comfortable and come across chest, not neck
What are the 2 landmarks to aim for when adjusting car restraints in an older child?
sternum and ASIS
What is the correct positioning of a baby in regards to restraints?
the horizontal bar should be under the clavicles and across the sternum, because if placed too low it could result in a T-spine injury
What are 3 atraumatic causes of SCI in children?
What are the 2 types of myelopathies? Give a few examples of each
- Compressive: stenosis, Chiari malformation, protruding discs
- Inflammatory: acute transveres myelitis, Guillain-Barre’ Syndrome, multiple sclerosis
The average age of SCI is __ years, with 53% occurring between the ages of __ and __
Boys are ___ as likely as young girls to have a SCI
A child's spine does not fully mature until between the ages of _ and __.
Where do the majority of SCIs occur in children under the age of 10? Explain why...
The upper c-spine at the level of C3 or above
Due to ligamentous laxity, disproportionately large head size, and relative horizontal facet joints can create a fulcrum for a sagittal force and allow a large amount of translatory movement
A child 11 years or older tends to have a SCI where?
in the lower c-spine (C3 or lower)
Why are thoracolumbar injuries in young children unique in comparison to adults?
On account of anatomic differences, specifically the ring apophysis in the growing spine can slip or separate into the spinal canal from an axial traumatic force and mimic the symptoms of a herniated disc
Because the pediatric spinal column is relative lax due to ligamentous laxity what does it often allow for following a blow to the spine or head?
The vertebra to stretch and recoil, which in turn also causes the inflexible spinal cord to stretch as well causing distraction or ischemia to delicate neuropathways and cause an invisible SCI
This phenomenon is which there is a spinal cord injury with radiographic abnormality is called what?
SCIWORA is a prevalent manifestation, and has been reported in __-__% of children who experience SCI
Patients with SCI are at a risk for what type of BP disorder?
Patients with a lesion above T6 are also at risk for what?
Vigilant pressure relief and proper skin care are imperative to avoid what?
What 5 things must be assessed musculoskeltally?
Shortening of what structures may be desirable in some situations?
- long finger flexors
- low back extensors
Overlengthening of what structures may be desirable in some situations?
- shoulder IRs
True or False
Heterotopic ossification has the potential to develop in children with SCI
The standards for neurologic and functional classification of SCI were identified by who?
American Spinal Injury Association
What does the ASIA Impairment Scale do?
- Assess myotomes and dermatomes to determine a motor and sensory diagnostic level for both the left and right sides of the body
- Designates ‘complete’ or ‘incomplete’ injury
Describe the 4 levels of ASIA impairment
A) complete: no sensory or motor function is preserved in S4 or S5
B) incomplete: sensory but not motor function is preserved below the neurologic level and extends through S4 to S5
C) incomplete: motor function is preserved below the neurologic level, and the majority of key muscles below the level have a muscle grade of <3
D) incomplete: motor function is preserved below the neurologic level, and the majority of key muscles below the level have a muscle grade of 3 or greater
What are a few surgical interventions?
- muscle transfers
- tendon lengthening
- tendon transfers
Spasticity is the clinical manifestation that accompanies ____ motor neuron disease
Describe the progression of tone in SCI patients
2) spastic flexors
3) spastic extensors
How is spasticity typically treated?
with baclofen or botulinum toxin
Describe nociceptive pain
Musculoskeletal and visceral and is characterized by dull, aching, movement related pain that is eased by rest and responds to opioids
Describe neuropathic pain
Classified as above the level, at the level, or below the level of injury and is usually described as sharp, shooting, burning, and electrical with abnormal sensory responsiveness
Are reports of nociceptive or neuropathic pain greater in children with SCI?
What are 2 ways of treating pain?
- surgical procedures (cordectomy, cordotomy, and myelotomy)
- spinal cord stimulators
How do spinal cord stimulators work?
They inhibit spinal transmission of pain through electrical stimulation via the gate control theory
Special ROM attention should be given to the areas where tone is abnormal. What are these 5 places?
- heel cords
- hip adductors
- elbow flexors
- wrist flexors
Why is aerobic and endurance conditioning imperative in children with SCI?
Due to loss in respiratory function resultant of decreased posture
What are 5 growth abnormalities common in children with SCI?
- hip subluxation
- renal disease
- skin integrity
- decreased bone density (osteopenia and osteoporosis)