Spinal Cord Injury Flashcards
(313 cards)
1
Q
Conduit for crucial information from the brain to most of the body
A
Spinal Cord`
2
Q
Length of SC
A
42-45cm long
3
Q
Width of SC
A
10-15mm
4
Q
Width of Spinal Canal
A
17mm
5
Q
Where the SC ends in children
A
L3
6
Q
Where the SC ends in adult
A
L2
7
Q
How many segments SC has?
A
31 segments
8
Q
“Horse’s Tail”
A
Cauda Equina
9
Q
Prolongation of pia mater
A
Filum Terminale
10
Q
Center for micturation
A
Conus Medullaris
11
Q
Bundle of nerve roots after the inferior of SC
A
Cauda Equina
12
Q
Connects the distal tip of SC to the distal dural sac to coccyx
A
Filum Terminale
13
Q
Distal tip of the SC
A
Conus Medullaris
14
Q
Three blood supply of spinal canal
A
Anterior Spinal Artery, Posterior Spinal Artery, Radicular artery of Adamkiewicz
15
Q
What area does ASA supplies in the SC?
A
Anterior upper 2/3
16
Q
What area does PSA supplies in the SC?
A
Posterior upper 1/3
17
Q
What area does Adamkiewicz supplies in the SC?
A
Lower 2/3
18
Q
Area in the SC with the least blood supply
A
Watershed areas
19
Q
Level of watershed area in the SC
A
T4-T6
20
Q
Drainage of SC
A
Internal vertebral venous plexus
21
Q
Sensory Neurons
A
1ON, 2ON, 3ON
22
Q
Motor Neurons
A
UMN and LMN
23
Q
Axons for ascending tracts
A
2ON
24
Q
Axons for descending tracts
A
UMN
25
Neuron for pain modulation and reflexes
Interneuron
26
Inhibitory interneuron that controls message that presynaptic neuron will relay
Pre-synaptic interneuron
27
Interneuron that inhibits gamma motor activity
Renshaw cell
28
Inhibitory and excitatory internueron
Post-synaptic interneuron
29
True or False: Is the autonomic neurons afferent?
False, efferent
30
Four target organs signaled by post-ganglionic neurons
Cardiac Muscle, Adipose Tissue, Smooth Tissue, Glands
31
Part of SC that composed of cell bodies of neurons and Rexed lamina
Gray Mater
32
Part of SC that is composed of axons and tracts
White Mater
33
Rexed Lamina: For Pain
RL I and II
34
Rexed Lamina for Sensory
RL I - VII
35
Rexed Lamina for Motor
RL VIII - X
36
Rexed Lamina: For posture and balance
RL VII
37
Rexed Lamina: For touch and pressure
RL III - IV
38
Rexed Lamina: For joint activity
RL VI
39
Rexed Lamina: Connects R and L sides
RL X
40
Rexed Lamina: For visceral sensation and pain
RL V
41
Rexed Lamina: Motor function
RL VIII and IX
42
Rexed Lamina I
Lissauer's tract
43
Rexed Lamina II
Substantia Gelatinosa
44
Rexed Lamina III and IV
Nucleus Proprious
45
Rexed Lamina V
Visceral Nucleus
46
Rexed Lamina VI
Deep Nucleus
47
Rexed Lamina VII
Clarke's Column
48
Rexed Lamina VIII and IX
Motor Pools
49
Rexed Lamina X
Central Gray Commissure
50
Three Ascending tracts
Dorsal Column, Spinothalamic, Spinocerebellar
51
Five Descending tracts
Corticospinal, Rubrospinal, Vestibulospinal, Reticulospinal, Tectospinal
52
Transmits discriminative touch, proprioception, 2-point discrimination, epicritic sensation
Dorsal Column
53
Transmit crude touch, pain, and temperature
Spinothalamic tract
54
Transmit information about posture, coordination, balance
Spinocerebellar
55
3 epicritic sensations
Barognosis, Sterognosis, Graphesthesia
56
Rexed lamina of DCML
3&4: Nucleus Proprious
57
Decussation of DCML
Lower dorsal MO
58
Funiculus for LE
Gracilis (Below T6)
59
Funiculus of UE
Cuneatus (Above T6)
60
STT for crude touch
Anterior STT
61
STT for pain and temperature
Lateral STT
62
Rexed lamina of Lateral STT
I, II, and V: Lissaeur's, Susbtantia Gelatinosa, Visceral Nucleus
63
Rexed lamina for Anterior STT
3&4: Nucleus Proprious
64
Decussation of STT
2 segments above
65
Spinocerebellar that decussates
Ventral SCT
66
Spinocerebellar that not decussates
Dorsal SCT
67
Rexed lamina of Spinocerebellar Tract
7: Clarke's column
68
2 Decussation of SCT
At level of SC and Before cerebellum
69
CST that decussates
Lateral CST; 90%
70
CTS that does not decussates
Anterior CST: 10%
71
Controls tone of flexor muscles
Rubrospinal Tract
72
Controls postural muscle
Reticulospinal Tract
73
Controls posture and coordination
Vestibulospinal tract
74
Controls bright and sudden movements
Tectospinal
75
Area of the brain that is for processing of visual information
Tectum of Midbrain
76
Facilitatory tract for Flexion
CST and Rubrospinal
77
Facilitatory tract for Extension
Vestibulospinal and Reticulospinal
78
Inhibitory tract for Flexion
Vestibulospinal and Reticulospinal
79
Inhibitory tract for Extension
CST and Rubrospinal
80
True or False: Posture is more maintained by extensors to fight against gravity
True
81
Injury above the midbrain will result into?
Decorticate
82
Injury below the midbrain will result into?
Decerebrate
83
Flexor predominate extremities
Decorticate
84
Extensor predominate extremities
Decerebrate
85
Facilitate or inhibit movement or reflexes
Reticulospinal
86
Reflex postural movements in response to visual stimulus
Tectospinal
87
Ascending tract for pain and arousal
Spinoreticular
88
Ascending tract for cutaneous sensation
Spino-olivary
89
Ascending tract for spinovisual reflex
Spinotectal
90
Three sensory fiber type for proprioceptive touch
A-alpha, A-beta, A-delta
91
Two sensory fiber type for crude touch and pain
A-delta and C
92
The function of Merkel's disc
Light touch information
93
The 2 functions of Meissner's Corpuscle
Discriminative touch and texture
94
The 3 functions of Ruffini's ending
Heat, joint activity, skin stretch
95
The 3 functions of Krause end bulb
Cold, touch, pressure
96
The 2 functions of Pacinian Corpuscle
Pressure and Vibration
97
The 3 functions of Free Nerve Endings
Tickle, Itch, Pain
98
Two motor fiber type
A-alpha and A-gamma
99
Motor fiber type for voluntary action
A-alpha
100
Motor fiber that facilitates contraction of muscle due to activation of muscle spindle
A-gamma
101
Sensory organ for reflex
GTO
102
Sensory organ for stretch stimulus
Muscle spindle
103
Pre-ganglionic autonomic neuron
B fibers
104
Post-ganglionic autonomic neuron
C fibers
105
4 target organs of Autonomic neuron
Cardiac muscle, smooth muscle, adipose tissue, glands
106
What kind of outflow does the sympathetic and parasympathetic nervous system have?
Efferent system
107
Level of PSNS
Craniosacral
108
Level of SNS
Thoracolumbar
109
Cranial level of PSNS
Brainstem
110
Thoracolumbar of SNS
T1-L2
111
Sacral level of PSNS
S2-4
112
PSNS proportion
1 pre-ganglionic: 4 post-ganglionic
113
SNS proportion
1 pre-ganglionic: 20 post-ganglionic
114
Superficial Reflex: Upper Abdominal
T7-T9 or T10
115
Superficial Reflex: Lower Abdominal
T10 or T11-T12
116
Superficial Reflex: Cremasteric
T12-L1
117
Superficial Reflex: Plantar
S1-S2
118
Superficial Reflex: Gluteal
L4-L5 or S1-S3
119
Superficial Reflex: Anal
S2-S4 or S4-S5
120
Three visceral reflexes
Bulbocavernosus, rectal, micturation
121
Reflex level of visceral reflexes
S2-S4
122
Babinski Reflex
L3-L5, S1
123
DTR Grading: Absent
0
124
DTR Grading: Hyperreflexive
3
125
DTR Grading: Normal
2
126
DTR Grading: Hyporeflexive
1
127
DTR Grading: Clonus
4
128
Law that states: "once the agonist is stimulated, the antagonist relaxes"
Sherrington's Law of Reciprocal Innervation
129
Monosynaptic reflex flow
Afferent neuron to efferent neuron
130
Polysynaptic reflex flow
Afferent neuron to interneuron to efferent neuron
131
Insult to the spinal cord that may result in alterations in the sensory, motor, and/or autonomic function below the level of the lesion
Spinal Cord Injury
132
What gender is more affected by SCI?
Males
133
What age range is predisposed to SCI?
16-30 years old (26 y.o)
134
Most common MOI of SCI
MVA
135
The most common injury that results from SCI
Hyperextension injuries
136
The most common MOI of SCI in older adults
Falls
137
Two etiology of SCI
Traumatic and Non-traumatic
138
4 causes of traumatic SCI
MVA, Falls, Violence, Sports
139
The most common sport that results from SCI
Diving
140
6 causes of non-traumatic SCI
Tumors/neoplasm, infections, toxins, degenerative processes, congenital malformation, vascular disorder
141
The common type of SCI among infants or children
SCIWORA (SCI without radiographic abnormality)
142
MOI of SCIWORA in infants
Mishandling or improper handling of infants
143
MOI of SCIWORA in a teenager
Motor Accidents
144
Incontinence seen in UMNL
Urge
145
Erection seen in LMNL
Psychogenic (Sympathetic)
146
Ejaculation seen in UMNL
Present but may need stimulation
147
Incontinence seen in LMNL
Urinary Retention
148
Paralysis and bladder seen in UMNL
Spastic
149
Ejaculation seen in LMNL
Present without stimualtion
150
Erection seen in UMNL
Reflexogenic (Parasympathetic)
151
Is UMNL/LMNL complete or incomplete SCI?
Incomplete
152
3 stimulatory techniques to improve Urge Incontinence
Suprapubic tapping, Lower abdominal stroking, Hair pulling
153
2 stimulatory techniques to improve Urinary Retention
Crede Maneuver, Valsalva Maneuver
154
(+) Reflexogenic Erection indicates what?
(+) Sacral Paring
155
What type of SCI usually has Psychogenic Erection?
Cauda Equina Syndrome
156
Painful erection
Priapism
157
Vaginal Spasm
Vaginismus
158
Painful intercourse for female
Dyspareunia
159
Female oral sex
Cunnilingus
160
Male oral sex
Fellatio
161
Cross-section injury with the worst prognosis
Anterior Cord Syndrome
162
Cross-section injury with the best prognosis
Central Cord Syndrome
163
MOI of Anterior Cord Syndrome
Hyperflexion or Flexion
164
S/sx of ACS
Bilateral motor, pain and temperature loss; Spared DCML
165
MOI of Posterior Cord Syndrome
Hyperextension or extension injury
166
S/sx of PCS
Bilateral proprioception and vibratory loss; Spared CST and LSTT
167
Two non-traumatic causes of PCS
Syphilis and Vitamin B12 Deficiency
168
What specific cause of PCS in syphilis?
(+) Tabes dorsalis: problem in dorsal SC
169
What stage of syphilis does PCS come out?
Tertiary stage
170
What DCML s/sx seen in syphilis?
(+) Sensory ataxia
171
Sensory ataxia
No relay of somatosensation as input for balance
172
Vitamin B12 deficiency causes what condition can lead to PCS?
(+) Posterolateral sclerosis problem with DCML
173
What DCML s/sx seen in Vitamin B12 deficiency?
Sensory Ataxia
174
MOI of central cord syndrome
Hyperextention
175
MOI of central cord syndrome in older adults
Cervical Osteophytes
176
Location of UE in the SC
Near in the center
177
Another name of Central Cord Syndrome
Walking SCI
178
MOI of Brown-Sequard Syndrome
Gunshot, Stab wounds
179
S/sx of Brown-Sequard Syndrome
Ipsilateral: motor, proprioception, vibratory loss; Contralateral: pain and temperature loss
180
What level does the C/L pain and temp loss manifest?
2 segment below the level of the lesion
181
The spinal level that causes quadriplegia
Cervical
182
The spinal level that causes paraplegia
Thoracolumbar
183
The spinal level that causes tetraplegia
Cervical
184
Most common spinal level affected in paraplegia
T12-L1
185
Most common spinal level affected in SCI
C5 incomplete paraplegia
186
A brief period of areflexia that occurs from 24 hours to 3 days
Spinal Shock
187
How to test for Spinal Shock?
Bulbocavernosus reflex
188
Bulbocavernosus reflex procedure
Pinch the glans penis/clitoris or pull the indwelling foley catheter
189
(+) Bulbocavernosus reflex
Anal sphincter contraction
190
Pharmacological management for spasticity
Baclofen intake
191
4 PT management for spasticity
Slow Icing, NMES, Daily Stretching program, slow PROMS
192
What is autogenic inhibition?
You will fatigue the muscle to induce relaxation
193
What is reciprocal inhibition?
You will activate the antagonists and relax the agonist
194
Surgical management for muscle
Myotomy
195
Surgical management for spinal cord
Myelotonomy
196
Surgical management for spinal nerve
Neuroctomy
197
Surgical management for tendon
Tenotomy
198
Surgical management for ventral root
Rhizotomy
199
Surgical management for dorsal root intractable pain
Dorsal Rhizotomy
200
Surgical management for scissoring gait
Myotomy of adductor longus
201
Surgical management for crutch gait
Myotomy of hamstrings
202
Hypersensitivity to external stimuli that were commonly seen in injuries above T6
Autonomic Dysreflexia or Hyperreflexia
203
Five causes of autonomic dysreflexia
BILPA: Bladder distention, Ingrown toenail, Labor pain, Pressure sores, Aggressive stretching
204
Cause of OH
Immediate Transition from STS
205
AD or OH: Tachycardia
Orthostatic Hypotension
206
AD or OH: Pounding headache
Autonomic Dysreflexia
207
AD or OH: Fainting
Orthostatic Hypotension
208
AD or OH: Piloerection
Autonomic Dysreflexia
209
AD or OH: Bradycardia
Autonomic Dysreflexia
210
AD or OH: Dizziness
Orthostatic Hypotension
211
AD or OH: Facial Flushing
Autonomic Dysreflexia
212
AD or OH: Lightheadedness
Orthostatic Hypotension
213
AD or OH: Decrease BP
Orthostatic Hypotension
214
AD or OH: Increase BP
Autonomic Dysreflexia
215
AD or OH: Diaphoresis
Autonomic Dysreflexia
216
Diaphoresis
Excessive sweating
217
Management for Orthostatic Hypotension
Elevate the legs and give ankle pumps
218
Management for Autonomic Dysreflexia
Sit the patient up and give sublingual calcibloc
219
Process of bone growth at an abnormal site
Heterotrophic ossification
220
Diagnosis where there is HO on the muscle
Myositis Ossification
221
4 common sites of HO
Hips, Knees, Shoulder, Elbow
222
What causes the presence of neurogenic HO?
Traumatic SCI
223
Site of HO in TBI and CVA
Shoulder
224
Site of HO in Burns
Posterior elbow
225
Site of HO in UE
Brachialis
226
Site of HO in LE
Quadriceps
227
Pharmacological management for HO/MO
Etidronate Disodium (didronel)
228
Laboratory hallmark seen in (+) HO or MO
Increase alkaline phosphatase
229
Slowing down of blood flow
Virchow's triad
230
Virchow's triad
Hypercoagulability, Intimal wall damage, Venous stasis
231
Preventive PT management for DVT
AROMS and Ankle Pumps
232
Pharmacological management for DVT
Blood thinners
233
3 blood thinners used for DVT
Heparin, Coumadin, Warfarin
234
Immobilization causes ____?
Decrease bone desposition
235
What law states that increase pressure = increase bone deposition?
Wolff's law
236
PT management for osteoporosis
WB and muscle contraction
237
Two commons sites of fracture in SCI patients
The distal femur and proximal tibia
238
PT management for fractures
WB activity on tilt table
239
Most common site of pressure sores in supine
Sacrum
240
Most common site of pressure sores in infants
Occiput
241
Most common site of pressure sores in sitting
Ischial tuberosity
242
Bed positioning to prevent pressure sore
Turning every 2 hours
243
Wheelchair positioning to prevent pressure sore
Chair pushups or WB relief activities every 15-20 mins
244
Common cardiac problem in SCI
Arythmia
245
The most common cause of death in SCI
Pneumonia
246
The second common cause of death in SCI
Atelectasis
247
"ASIA" scale
American Spinal Injury Association
248
Sensory scoring of ASIA
O= absent, 1 = impaired, 2 = normal, NT = not testable
249
Two sensations tested in ASIA
Light touch and Pinprick
250
Patient's position in assessing ASIA scale
Frog-legged position
251
What is the grade if the patient cannot identify the stimulus as a pinprick or light touch?
Grade 0
252
Motor scoring: 5
Normal full active ROM against gravity with full resistance
253
Motor scoring: 1
Palpable contraction
254
Motor scoring: 3
Full active ROM against gravity
255
Motor scoring: 2
Full AROM, gravity eliminated
256
Motor scoring: 4
Full AROM against gravity with moderate resistance
257
What is the sensory level?
Most caudal segment with intact sensation (2/2 score) both pinprick and light touch
258
What is the motor level?
Most caudal segment with at least 3/5 and the segment immediately above should be 5/5
259
What is the neurological level of injury (NLI)
Caudal part where motor and sensory level coincide
260
What is a complete injury?
There is no sacral sparing
261
What is an incomplete injury?
There is sacral sparing
262
Motor criteria for sacral sparing
Voluntary anal contraction (VAC)
263
Procedure for VAC
Contraction of anal sphincter upon command
264
Sensory criteria for sacral sparing
Deep anal pressure, light touch sensation, and pinprick sensation at S4-5
265
Procedure of DAP
Patient can feel the pressure put by the PT at the internal anal wall
266
Location of touch sensation and pinprick
S4-5
267
(+) Sensory sacral sparing
1/3 criteria
268
ASIA classification A prognosis
Worst
269
ASIA classification E prognosis
Best
270
ASIA classification A name
Complete
271
ASIA classification B name
Sensory Incomplete
272
ASIA classification C name
Motor Incomplete
273
ASIA classification D name
Motor Incomplete
274
ASIA classification E name
Normal
275
ASIA classification A sacral sparing
(-) sensory or motor sacral sparing
276
ASIA classification B sacral sparing
(+) sensory; (-) Motor
277
ASIA classification C sacral sparing
(+) sensory; (+) Motor = >50 muscles below NLI is 0-2/5
278
ASIA classification D sacral sparing
(+) sensory; (+) Motor = >50 muscles below NLI is 3-5/5
279
ASIA classification E sacral sparing
Normal
280
Total number of dermatomes assessed in ASIA scale
28 dermatomes
281
Total points in sensory assessment in ASIA scale
112 points LT/PP
282
Total number of myotomes assessed in ASIA scale
10; 5 = UE + 5 = LE
283
Total points in motor assessment in ASIA scale
100; 50 = UE + 50 = LE
284
C1-C3 respiratory outcomes
Glossopharyngeal breathing
285
C5 respiratory outcome
Manually assisted coughing and quad coughing
286
C6 respiratory outcome
Self-assisted coughing
287
C4 wheelchair
Power wheelchair
288
4 controls of power wheelchair
Tongue control, Chin control, Voice control, Sip & Puff
289
C5 wheelchair
Joystick
290
C5 wheelchair projections
Oblique handrim projections
291
C5 orthosis
Balanced forearm orthosis
292
C6 wheelchair projections
Vertical handrim projections
293
C6 orthosis
Tenodesis splint and wrist driven flexor hinge orthosis
294
C7 wheelchair handrims
Friction handrims
295
C8 wheelchair handrims
Standard Handrims
296
What wheelchair activity can C8 patient can do?
Wheelie
297
T1-T8 foot orthosis
KAFO
298
L4-L5 Assistive device
Loftstrand
299
T9-T12 gait pattern
Swing to
300
L1-L3 foot orthosis
KAFO
301
T1-T8 Assistive device
Walker
302
L4-L5 gait pattern
2 point
303
T9-T12 foot orthosis
KAFO
304
T1-T8 Gait Pattern
Swing to
305
L1-L3 Gait pattern
4 point
306
T9-T12 Assistive device
Walker
307
L4-L5 foot orthosis
AFO
308
L1-L3 Assistive device
Loftstrand
309
C6 2 ADL
Indep bed mobility with equipment and indep sliding board transfers
310
C7 3 basic ADL
Prop up (elbow extension), LE ROM, Dress upper and lower garments
311
C7 4 independent ADLS
Indep driving, bed mobility, transfers in all surface, toileting
312
T1 ADL
Wheelchair to floor transfers
313
T4 ADL
Squat-pivot transfers
