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Year 2: Neuromuscular II > Test 1: SCI > Flashcards

Test 1: SCI Flashcards

1
Q

Describe DCML

A

ascending

in posterior SC

processes info about conscious proprioception, vibration, and fine touch

crosses at medulla

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2
Q

describe spinothalamic tract

A

ascending

in anterior/lateral part of SC

processes info about sharp pain, temp, crude touch

crosses at anterior commissure of SC

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3
Q

describe the corticospinal tract

A

descending

motor signals

in lateral portion of SC

crosses at medulla

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4
Q

somatotopy of the SC from medial to lateral

A

UE to LE

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5
Q

etiology/common characteristics of SCI/SCI pts

A

17000 new cases annually in US

80% males

most common between 15-29 years old or over 65

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6
Q

common mechanisms of SCI from most to least common

A

MVAs (38%)

Falls

violence

sports related (9%)

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7
Q

mechanisms that can mean a NON TRAUMATIC SCI

A

arterial venous malformation

thrombus, embolus, hemorrhage to arterial supply of SC

infection of cord (i.e. IV drugs)

tumor

MS with lesions in SC

ALS

spinal stenosis

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8
Q

what characteristics determine life expectancy in those with SCIs

A

incomplete injury = longer life expectancy than complete

paraplegia longer than tetra

lower cervical tetra longer than higher cervical (less involved levels)

mortality rate is highest in 1st year post injury

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9
Q

what is spinal shock

A

occurs immediately following SCI

~24 hr period of areflexia (no refelxes/flaccid)

reflexes gradually return over 1-3 days

can have hyperrelfexia for 1-4 weeks following return

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10
Q

when to do asia

A

after 24 hours but before 72

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11
Q

SCIs are named by what 3 characteristics

A

spinal level of injury

anatomical location of injury in cord

completeness of injury

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12
Q

What is the ASIA/ISNCSCI

A

American Spinal Cord Association (ASIA) created International Standard for Neurological Classification of SCI (ISNCSCI) to determine SCI level

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13
Q

what does ASIA look at

A

motor level of injury

sensory level of injury

neuro level of injury

complete or incomplete

zone of partial preservation

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14
Q

when naming a SCI by level of injury, what does this mean

A

names by the level of function NOT the vertebrae; nerve involvement is what determines level

i.e. can have a C8 lvl injury w/o C8 vertebrae

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15
Q

what is interesting about cauda equina with SCI

A

this is where SC transforms to spinal nerves

UMN transitions to LMN

can have both UMN and LMN symptoms

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16
Q

ASIA A

A

complete

no motor or sensory preserved in sacral segments S4-S5

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17
Q

ASIA B

A

incomplete

Sensory but not motor is preserved below neuro level and includes sacral segments s4-s5

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18
Q

ASIA C

A

incomplete

motor function is preserved below neuro level

MORE THAN HALF key muscles below neuro level have a mm grade of LESS THAN 3

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19
Q

ASIA D

A

incomplete

motor function preserved below neuro level

AT LEAST HALF of key muscles below neuro level a mm grade of 3 OR MORE

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20
Q

ASIA E

A

normal motor and sensory function

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21
Q

what is motor level of injury and how do you determine it

A

lowest myotome that has a grade of at least a 3 if the one above it is a 5

determined by testing 10 key muscles on R and L side of body

graded on scale 1-5

can differ on L and R

may differ from sensory level of injury

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22
Q

what is sensory level of injury and how do you determine it

A

most caudal level with normal light touch and pinprick sensation

determined by light and pin prick on R and L sides

3 point scale: 0 = absent, 1 = impaired, and 2 = normal

can differ L to R

can differ from motor level of injury

23
Q

what is neurologic level of injury

A

most caudal level of SC with normal motor and sensory function both R and L sides of body

24
Q

what is zone of partial preservation

A

dermatimes and myotomes caudal to the sensory or motor level that remain partially innervated

used to only apply to complete (ASIA A) injuries but now can include incomplete motor with absent voluntary anal contraction or incomplete sensory with absent deep anal pressure

25
Q

sensory incomplete complete ASIA level

A

ASIA B

sensory but not motor preserved at sacral segments

26
Q

motor incomplete ASIA levels

A

ASIA C

ASIA D

27
Q

posterior cord syndrome

A

usually due to hyperextension injury

common with falls or in MVAs w/o headrest

motor is generally intact due to location of tracts

B loss of DCML

28
Q

anterior cord syndrome

A

usually due to hyperflexion injury

may have an intact DCML still

often lose motor and pain/temp

B loss of CST and STT

29
Q

central cord syndrome

A

usually due to hyperextension injury

with people who have stenosis

more UE involved than lower (somatotopy)

tetraplegia common

carying degrees of sensory impairment

sacral sparing

30
Q

brown sequard syndrome

A

one half SC affected

DCML and corticospinal tract involvement = ipsilateral S&S

spinothalamic involvement = contralateral S&S

rare unless pt is stabbed or shot

31
Q

cauda equina S&S

A

LMN

flaccid paresis

saddle anesthesia

32
Q

below what level of injury is most likely LMN or mixed S&S

A

T12

33
Q

LMN characteristics

A

generally below T12

hyporefelxive, flaccid, decreased tone/spasticity

negative UMN signs

flaccid bowel/bladder

psychogenic responses for sexual function

34
Q

UMN characteristics

A

generally above T12

hyperreflexia, increased tone/spasticity

positive UMN signs

spastic or hyper retentive bladder and bowel

reflexogenic arcs for sexual function

35
Q

describe acute care setting, when SCI pt may be here, and general focus of PT

A

i.e. ICU/floor

1-3 weeks

getting upright tolerance and basic mobility

36
Q

describe acute rehab setting, when SCI pt may be here, and general focus of PT

A

4-12 weeks

learn ADLs, mobility, WC training, and bracing

37
Q

describe LTACH, what SCI pts go here

A

usually with pts with higher SCI or on vents

also could be after flap sx

38
Q

what is outpatient PT for with SCI pts

A

community integration

MSK injury prevention

sports

39
Q

secondary complications of SCI for the cardio/pulm system

A

pneumonia

aspiration

diaphragmatic/respiratory mm impairement

PE/DVT

BP management

40
Q

secondary complications of SCI related to ANS

A

autonomic dysreflexia - can be fatal (T6 and above)

BP management

sweating response

unopposed parasympathetic drive with injuries above T6

41
Q

S&S of autonomic dysreflexia

A

HTN
bradycardia
HA
profuse sweating
increased spasticity
vasodilation above lvl of injury (flushing)
constricted pupils
nasal congestion
pilierecition (above lvl injury)
blurred vision
dry/pale skin (vasoconstrict below lvl)

42
Q

secondary neurologic complications following SCI

A

tone/spasticity changes

neuropathic pain

sensory loss

43
Q

secondary complications following SCI involving MSK system

A

motor loss
osteoporosis
secondary overuse injury
heterotopic ossification
osteomyelitis (in setting of pressure injury)

44
Q

secondary psychological complications for SCI

A

adjustment to trauma/loss
high depression rates
high psychiatric illness dx post injury
higher health care utilization for psychiatric dx

45
Q

GI/GU secondary complications following SCI

A

UTI (leading type of infection following SCI)

reflexive bowel/bladder (UMN)

flaccid bowel/bladder (LMN)

46
Q

SCI pts have high risk of pressure injury due to

A

decreased sensation, mobility, and blood flow as well as increased potential for incontinence

47
Q

stages of a pressure injury

A

1 = intact skin but non blanchable

2 = partial thickness looks like blister/scrape

3 = full thickness, into subcutaneous fat layer

stage 4 = full thickness, involving muscle or bone

48
Q

what is a deep tissue pressure injury

A

persistent and non blanchable discoloration with dark wound bed due to prolonged pressure or shear

may evolve to stage 3 or 4 pressure injury

49
Q

PT management/focus in acute care

A

early mobility once stable

focus of exam: sensory/motor, respiratory function, skin integrity, PROM, BP fluctuation

intervention:
-PROM/prevent contracture
-BP management with position change
-Respiratory fxn
-pt edu
-upright positioning
-basic mobility

50
Q

PT management/focus in acute rehab

A

PT exam: ROM, strength, outcome measures, functional mobility levels

interventions:
-aerobic
-skin integrity/management
-ADLs/functional mobility
-pain/spasticity management
-edu
-strength
-DME, WC, bracing

51
Q

LTACH PT management/focus

A

mobility with pt as able

exam focus: sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations

interventions:
-PROM/contracture prevention
-Skin prevention or treatmetn
-BP management with positioning
-respiratory function
-edu
-upright positioning
-basic mobility

52
Q

PT management/focus for outpatient

A

exam focus: MSK/neuro/cardio pulm/skin integrity; knowledge of SCI and level of independence

PT intervention:
-community reintegration/navigation
-goal directed activities (i.e. childcare, return to work)
-prevent overuse MSK injury
-overall strengthening
-CV endurance
-pain management

53
Q

considerations for durable medical equipment with SCI pts

A

padded shower chair
custom WC
bracing
walker/mobility device
adaptive equipment
ramps
grab bars
tach supplies
O2

54
Q
A

Year 2: Neuromuscular II (18 decks)

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