Spinal Cord Injury (Mercuris) Flashcards
(114 cards)
1
Q
ASIA stands for
A
American Spinal Injury Association
2
Q
drawback of ASIA
A
only clinically essential data is considered
3
Q
ASIA is
A
an international standardization that ensures consistency in measurement technique, data and communication. ASIA should be supplemented with other assessment tools
4
Q
define neurological level (ASIA)
A
The most caudal segment with normal sensory and motor function on both sides of the body.
5
Q
define skeletal level (asia)
A
The level at which the greatest vertebral damage is found by radiographic examination.
6
Q
define motor level (asia)
A
The lowest key muscle that has grade 3 or more as muscle power and all the muscles receiving innervations from above that level are normal
7
Q
define complete injury
A
No sensory and motor function in the lowest sacral segment
8
Q
define incomplete injury
A
Partial preservation of sensory and/or motor functions below the neurological level and the sacral segment.
9
Q
what is the zone of partial preservation?
A
includes the dermatomes and myotomes that remain innervated caudal to the level of injury in complete injuries only.
10
Q
ASIA SCALE
A
LOOK AT PP SLIDE AND BE FAMILIAR WITH IT :)
11
Q
neuro complications (7)
A
decreased motor fxn, decreased sensory fxn, altered muscle tone, altered temp regulation, respiratory problems, b/b dysfxn, sexual dysfxn
12
Q
what is spinal shock
A
After injury, CNS shuts down, period of hypotonicity. After this wears off, spasticity sets in. Shock lasts anywhere from a week to 6 months.
13
Q
spasticity is most prevalent in which 2 SCI’s?
A
cervical and thoracic. 2/3rd of all SCI cases have spasticity
14
Q
SCI patients often have disabling (3) that impairs motor performance and ADL
A
pain, musculoskeletal complications and skin breakdown
15
Q
spastic hypertonia includes what 5 characteristics
A
spasticity, muscle spasm, hypertonia, increased DTRs, clonus
16
Q
management of spastic hypertonia includes
A
wt bearing, PROM, meds, Baclofen pump, botox
- start with oral meds and progress to pump if needed
17
Q
benefits of spastic hypertonia include
A
LE extensor spasticity can help with standing, prevent osteoporosis, maintain muscle bulk, calorie burning
18
Q
spastic hypertonia aka
A
UMN
19
Q
Respiratory fxn C1-C3
A
C1-C3 will be on mechanical ventilator. Unlikely to survive to hospital
20
Q
C1-C3 ventilation is limited I nwhich plane
A
limited in all planes
21
Q
weak muscles in c1-c3 for respiration?
A
pecs, SA, scalenes, trap, SCM, diaphragm
22
Q
result of decreased respiration in c1-c3?
A
significant decrease in TV and VC. 95% require mechanical vent
23
Q
respiratory fxn in C4 - vent needed?
A
may or may not need mechanical vent
24
Q
muscles involved in C4
A
scalenes, diaphragm, SA, pecs
25
planes of ventilation C4
marked decrease in anterior and lateral expansion, slight decrease in inferior and superior expansion
26
results of C4 ventilation
decreased TV
27
REspiratory fxn C5-C8 muscles
weak pecs, SA, scalenes
28
C5-C8 planes of ventilation
limited, therefore decrease in ant/lat expansion and slight decrease in posterior expansion
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results of C5-C8 respiratory fxn
decrease in VC, FEV, cough effectiveness, paradoxical breathing
30
weak muscles in T1-5 (3 muscles)
weak or absent abs, intercostals and erector spinae
31
T1-T5 limited in which planes of ventilation
anterior and lateral expansion limited
32
results of T1-T5 resp fxn
slight to moderate decrease in VC, decreased cough effectiveness, may show paradoxical breathing, issues w/ chest expansion
33
what about respiration below T5?
respiration below T5 is usually ok
34
Quad cough info
- assisted cough for weak abs
- lay pt down, hand below zyphoid and above belly button
- assist cough during expiration
- sitting or supine
35
sweating does not occur where in relation to the lesion?
no sweating below the level of the lesion
36
S/S of altered temp regulation
HA, nasal congestion, tiredness, reduced concentration
37
treatment for lack of temp regulation
water intake, sponging, patient education!!!!
38
What are the 2 levels of control of bladder dysfxn?
1) Spinal reflex center of micturition at conus medullaris (S2-S4)
2) Pontine micturition center
39
function of pontine micturition center? (bladder)
integrates the reflex, coordinates contraction of detrusor muscle and sphincter relaxation. Some voluntary control
40
Spastic bladder aka what other 2 names
hyperreflexic or UMN
41
where is the lesion for hyperreflexic bladder
lesion above the conus medullaris
42
reflex arc for spastic bladder?
reflex arc for emptying bladder is intact
43
detrusor muscle spastic bladder?
Detrusor muscle contracts reflexly in response to pressure built within the bladder – bladder may empty spontaneously
44
triggers of bladder emptying in spastic
Bladder emptying can be spontaneous, triggered by manual stimulation (tapping suprapubic region, pinching the thigh, pulling hair of thigh/lower abdomen/suprapubic region)
45
what happens if sphincter cant relax - spastic bladder
urinary retention - can cause UTI or kidney infection
46
flaccid bladder aka
areflexic or LMN
47
lesion location for flaccid bladder (2)
lesion of conus medullaris or cauda equina
48
reflex arc in flaccid bladder
reflex center absent
49
characteristics of flaccid bladder
Urinary retention
| Emptying by Valsalva maneuver/ manual compression / Clean Self Intermittent Catheterization (CSIC)
50
2 types of catheterization
1) indwelling
| 2) intermittent
51
goals of cathertization
prevent UTIs, infection, kidney stones
52
Indwelling cath info
Risk of infection
Often unsatisfactory, difficult to transfer because of bag
Other: Condom/ suprapubic catheter
Condom catheters will never stay on during transfers
Suprapubic: surgically inserted, for long-term use
53
intermittent cath info
Self catheterization
Emphasis on clean rather than sterile
Timed voiding program - autonomous bladder
Residual volume drainage – automatic bladder
May need to reschedule time seeing pt for PT based on cath schedule. May also need to limit fluids and/or tract amount they drink
54
2 types of bowel dysfxn
1) reflexic/spastic
| 2) areflexic/flaccid
55
reflexic/spastic bowel dysfxn
internal anal sphincter relaxes reflexively when rectum is distended. SCI above S2
56
areflexic/flaccid bowel
incontinence due to flaccid sphincters; feces may become impacted. SCI S2-4 or cauda equina/peripheral nerves. Ongoing release of feces.
57
management of bowel dysfxn
```
Prevent constipation and impaction
Promote regular BMS
Manual removal of stool
Digital stimulation of the rectum/sphincter
Suppository
Abdominal massage
High fiber diet – fruits and vegetables
Meds, stool softeners, laxatives
```
58
sexual fxn - impaired
impaired sensation and genital fxn. physical mvmts hard, fear of incontinence, anxiety
59
male erection
```
Psychogenic reflex (thoughts): T12 –L3 and S2-S4
Reflexogenic (genital stimulation): intact reflex arc in S2-S4
```
60
male ejaculation
Greater ability in LMN lesions (S2-4) and in incomplete injuries
Difficult in lesions above T12
61
male orgasm
Cerebral event (not physiological)
Varies with level and extent of injury
More likely with incomplete injury and those below T12
62
erectile fxn is greater in ___ and ___
UMN and incomplete
| UMN = lesion above S2-S4
63
Female UMN lesion sexual fxn
reflex arc intact so sexual arousal components (vaginal lubrication, clitoral erection) will occur. Psychogenic response is lost LMN lesion- psychogenic responses will be preserved but reflex responses lost
64
fertility - men
Decreased fertility (erectile dysfunction/ impaired ejaculation/ low sperm count/ low motility)
Retrograde ejaculation
Physical aids for erectile dysfunction
Electro-ejaculation or by penile vibration
65
fertility - women
Fertility unchanged
Menstruation stops post injury, but resumes after 6 mths- 1 yr
Can become pregnant , carry baby full term and deliver vaginally
Risks of pregnancy: Autonomic dysreflexia, DVT, can go into labor without realizing it
Additional concerns: incontinence, spasms, respiratory problems
66
osteoporosis
- most bone loss seen in 1st six months after injury
- kidney stones can be caused from calcium lost into urinary system
- imbalance of calcium deposition and reabsorption
67
heterotopic ossification s/s
swelling, warmth, decreased ROM, low grade fever
68
heterotopic ossification
associated with rauma UTI pressure sores
69
Pt considerations for heterotopic ossification
gentle ROM, avoid resistance ex, active mvmts in pain free ROM ok
70
DVT is most common when
in acute phase
71
normal BP for tetraplegia
90/60
72
normal BP for paraplegia
may be lower than that in those without SCI
73
BP due to
lack of regulation of BP by SNS
| lack of muscle contractions
74
treatment for autonomic dysreflexia
if supine, sit up. loosen tight clothing, kinked catheter most commoncause, also noxious stimulus, pressure sore, UTI, bladder distention. monitor BP
75
goal of PT
achieve max fxnl independence
76
treatment should (3 things)
promote max physiologic capacity, provide compensation for paralysis deficits, provide education
77
physiological capacity trtment includes what 4 thigns
muscle strengthening, improve respiratory capacity, endurance training, maintain ROM
78
standardized measures for acute-subacute (3-6 mo) (5 tests)
1) FIM
2) Spinal cord independence measure
3) walking index for SCI
4) sickness impact profile
5) modified ashworth
79
Spinal cord independence measure (SCIM)
Self-care, Respiration and sphincter mgt, bed mobility/transfers, mobility inside and out
80
walking index for sci 2
20 item description of ambulation
| Includes use of parallel bars, AD, orthotics, number of people assisting, all for 10 meters.
81
sickness impact profile 68
behavioral depression scale
82
standardized mearues chronic (4)
1) craig handicap assessment and reporting technique
2) sickness impact profile
3) WC skills test
4) WHO QOL BREF
83
CHART
craig handicap assessment and reporting technique
Function in physical, cognitive, mobility, occupation, social integration, and economic self-sufficiency
Excellent assessment tool
84
WC skills test
32 items of w/chair mobility in environment/obstacles
| Speed, turns, ramps, ability to maneuver in environment
85
WHO QOL BREF
26 items in domains of: physical health, psychological health, social relationships, and environment
86
CHART is valid for what populations
SCI, CVA, TBI, MS, amputee, burn
87
MMT considerations
Substitutions are done and often missed by the examiner!!
Fatigue gives the impression of less strength- do not do several repetition or exercise before MMT. Get grade correct the first time.
Check one level above and one level below the suspected level of ‘normal function’
88
common muscle substitutions: tenodesis for
finger flexors
89
common muscle substitutions: supination + gravity =
wrist extension
90
common muscle substitutions: shoulder ER + sup + gravity =
elbow extension
91
push ups in WC
Serratus anterior = used for sitting push-ups with lower trapezius (scapular protraction= functional lengthening of UE)
Deltoid takes over in the absence of serratus anterior = winging of scapula = reverse action in closed chain = lifting of the buttocks
Lower trapezius - reverse action = actively lifts lower trunk
Neck flexors take over in the absence of lower trapezius = drop the head, passive lifting of pelvis through spine and tight connective tissue
92
T/F normal ROM may not be the goal
true
93
ROM considerations - neck
don't overstretch cervical extensors. avoid flexion. forward head interferes with breathing and blaance
94
ROM trunk
don't overstretch back extensors.
95
fxn of tight lumbar fascia
provides passive trunk stability. helps with rolling and transfers
96
loose low back =
kyphotic posture. interferes with breathing and casues sacral sitting
97
ROM hamstrings - SLR of what degree needed for long sitting
110 degrees
98
ankle DF - what degree needed for amublation
0 deg
99
ROM shoulder
Stretch pectorals and encourage hyperextension (not in injuries higher than C4)
Sitting support (UE swung behind for support)
Supine on elbows- assist to sitting position
Hooking onto wheelchair handles
External rotation ROM important
100
ROM elbow
Full elbow extension (especially if weak Triceps or spastic Biceps) & forearm supination-pronation
Required for all ADL skills
101
ROM wrist
attain 90 deg extension for stability and wt bearing
102
fingers ROM
Avoid stretching finger flexors with wrist extension
Fingers should flex with wrist extension and extend with wrist flexion = mild tightness
Avoid overstretching the thumb web space
Adequate enough to allow the hook grasp
But tight enough that the thumb is pulled in opposition by tenodesis
103
info for WC prescription
```
Goals of the patient
Environment in which wheelchair used
Changing conditions- wt, recovery
Type of WC may change as pt recovers
Assistance required for transfers/propelling
Insurance
Physical characteristics of the owner
```
104
C1-C4 WC recommendation
power WC w/ mouth stick activities
105
C5 WC recommendation
electric WC w/ hand controls: manual SC w/ quad peg for short distances
106
C6 and below WC recommendation
manual WC but consider long distances - may need power chair
107
pre-gait activities
orthosis, start in parallel bars, strengthing, pelvic control, push ups for UE stregth
108
factors that influence expected functional outcome
```
Level and extent of injury
Psychological state (motivated/ anxious)
Body type (weight/ height)
Pre-existing medical conditions (DM/ HT)
Associated injuries (wounds/ fractures/ infections)
Secondary complications
Resources (support systems)
Environment
```
109
Peds - paraplegia in what age group
0-12
110
Peds - quadriplegia more common I nwhat age group
13-21
111
concerns for peds sCI
Neuromuscular scoliosis- occurs frequently. <12 y/o then 3.7 times more likely need spinal fusion
Hip subluxation-occurs in 100% of children injuried <5 y/o and 94% injuried <10 y/o.
Unable to detect autonomic dysreflexia or other symptoms (fever, change in spasticity, headache, sweating)
Decreased community participation and QOL compared to peers
Ongoing checks with growth
Education: child, caregivers, siblings, teachers
DVT are less common
Latex allergies
112
Spinal cord injury w/o radiographic abnormality (SCIWORA)
Occurs in 64% of younger children
Bony structures of spine differ from adult until 8y/o
Facet joints more horizontally oriented and vertebral bodies more anteriorly wedged>decreased stability
Ligaments and capsules more elastic
113
T/F SCI in kids can be delayed 30 min to 4 days after injury
true - occurs in 50% of kids with SCI
114
measures for kids
May use Adult Spinal Cord Independence Measure (SCIM)
Pediatric Wee-FIM
Pediatric Evaluation and Disability Inventory (PEDI)
Pediatric Powered Wheelchair Screening Test
Pediatric AOL
School Function Assessment (SFA)
