Christina - Beast Mode!!! > Neuro: L.1 - SCI > Flashcards

Neuro: L.1 - SCI Flashcards

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1
Q

traumatic SCI accounts for _____% of SCI’s, with _______ being the most common cause

A

84%

MVA, then falls

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2
Q

PTs - what do you consider when moving assessing/evaluating a SCI patient? whats the big question

A

typically PTs are the fitst to mobilize the patient so ask

is the spine safe to mobilize? are their vitals stable enough?

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3
Q

what is the most common location of SCI

A

cervical (50%)

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4
Q

what is the most common type of SCI

A

incomplete tetraplegia

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5
Q

tetraplegia vs paraplegia

A

tetraplegia: involvement in all 4 extremities

paraplegia: involvement in LE (“pair”)

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6
Q

review ASIA scores

A
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7
Q

most common cause of cause of SCI in cervical spine vs thoracic spine

A

cervical: hyperextension

thoracic: flexion rotation

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8
Q

what are nontraumatic causes of a SCI

A

tumor, arthritis/degenerative changes, congenital malformation
infection
inflammation

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9
Q

primary injury of SCI

A

the sudden, traumatic impact on the spine that fractures or dislocated the vertebrae - most injuries do NOT completely sever the SC

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10
Q

types of primary injury

A

impact plus persistent compression (most common)

impact alone w/ transient compression

distraction

laceration/transection,

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11
Q

primary injury: impact plus persistent compression

A

bone fragment or fracture fragment compression on SC - need surgery

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12
Q

primary injury: distraction

A

causes stretch or tearing of neural tissue in the axial plane

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13
Q

primary injury: laceration/transection

A

severe dislocation (facet joints), penetration

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14
Q

early surgical decompression (< __ hours post injury) is most effect to limit tissue damage following primary injury

A

24

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15
Q

Secondary injury

A

a series of cellular, molecular, and biomechanics phenomena that continue to self-destruct SC tissue and impeded neurological recovery following SCI

begins within minutes of primary injury and can continue for weeks to months

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16
Q

examples of secondary injuries

A

ischemic changes
inflammation
metabolic changes
edema of the cord/surrounding tissues

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17
Q

goals of spinal fracture immediate management

A

minimize neurologic damage to vertebral injury, avoid moving spine

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18
Q

surgical management for stabilizing spine

A

surgical spinal stabilization
decompression, internal fixation with rods/screws
posterior spinal fusion vs anterior spinal fusion

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19
Q

non-surgical management for stabilization of spine

A

traction/mobilization
Gardner-well tongs
halo vest
orthoses

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20
Q

if your pt is wearing a gardner-well tongs with traction, what does this mean to you as the PT?

A

you are probably not mobilizing this pt, their spine is not stable and they may or may not be awaiting surgery while in this device

bed bound, aligns spine but does not fully immobilize, tractions for alignment

fixed into skull, invasive

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21
Q

halo vest

A

immobilizes spine, pt can walk in them

invasive, into skull

provides tractions and eliminates movement of the cervical spine

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22
Q

what is the goal of spinal orthoses? how long are pts typically in them?

A

restricting excessive bending and twisting

stabilize and restrict movement while healing occurs

6-12, 8-12 weeks

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23
Q
A

Minerva Brace - stabilizes thoracic and cervical spine

stabilize thoracic and cervical spine
Head support, chest/back shell

Limits flexion, extension, rotation, lateral flexion

More rigid than collars but less restrictive than halos

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24
Q
A

Aspen Collar

Cervical spine
Rigid two piece collar

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25
Maimi J Cervical spine Rigid two piece collar
26
Philadephia collar - typically used for bathing (temporary) Cervical spine Rigid foam collar Has trach opening
27
prefabricated TLSO Thoracolumboscaral orthosis Off the shelf brace Plastic shell
28
Jewett brace Thoracolumbar junction Three point pressure system Limits flexion Allows extension Use with anterior VB compression fxs
29
custom TLSO Thoracic and lumbar spine Custom molded for patients More rigid and precise fit
30
primary effects of SCI: spinal shock
transient flaccidity period (can last up to weeks) where spinal reflexes and voluntary motor and sensory functions are absent motor/sensory function present at end of spinal shock important prognostic indicator
31
other SCI primary effects:
sensory loss muscle tone (reflexes, spasticity) pain and dysesthesias (nerve root injuries)
32
SCI primary effects: motor
UMN LMN (cuada equina) nerve root it may be a mix! exL damage in thoracic SC and also peripheral nerves in that area damaged
33
SCI primary effects: thermoregulation
inability to cool or warm self below level of complete injury inability to accurately feel environmental temp below level of injury
34
SCI primary effects: UMN neurogenic (reflexive) bowel
intact reflex center -> tight anal sphincter/high tone -> constipation, impaction, eventual diarrhea bowel schedule is important! may have to use suppository and digital stim to relax sphincter and allow emptying
35
SCI primary effects: LMN flaccid (areflexive) bowel
non-intact reflex center --> relaxed anal sphincter --> accidents don't have abs to push it out --> need manual evacuation
36
UMN neurogenic (reflexive) bladder
unable to empty need bladder program: intermittent catheterization (fluids monitored, empties every 4-6 hours), Foley catheter (always attached), suprapubic cath
37
LMN flaccid (reflexive) bladder
bladder empties as it fills bladder program: timed voids (fluids monitored) also on a cath or foley
38
list secondary complications of SCI
PI MSK issues orthostatic hypotension autonomic dysreflexia respiratory issues DVT/PE GI/GU issues pain
39
why are SCI pts at higher risk for PI and where are they most likely to occur?
loss of motor fxn and sensation, circulation and skin changes make skin more vulnerable sacrum ishium trochanter heels
40
Pressure Injury Management
turn every 2 hours in bed, weight shifts every 30 minutes for 2 minutes in WC
41
MSK complications from SCI
contractures HO (hips, knees, elbows) decreased bone mineral density abnormal postural curves from sitting positions overuse injuries! imagine using your arms for everythinggg
42
autonomic dysreflexia
noxious stimulus **below** level of injury --> exaggerated sympathetic response due to lack of compensatory descending parasympathetic stimulation --> vasoconstriction to lower 2/3 of body --> increased BP life threatening and a medical emergency!
43
autonomic dysreflexia signs/symptoms
affects people with an injury at **T6** or above -**increased BP (>20 mmHg), decreased HR** -severe HA -flushing ABOVE lesion -sweating/piloerection ABOVE lesion -anxiety -paresthesias in head, neck, upper chest -visual changes -nasal congestion need to know your pts baseline/normal BP to be able to recognize!
44
common causes of autonomic dysreflexia
bladder distention - most common cause constipation/impaction skin issues (PI, ingrown toenails, constrictive clothing) they cant feel it but their body senses it
45
PT management of AD
**sit patient upright, lower legs, or raise head to 90 if in bed** - lowers BP remove compression garments check foley for kinks, make sure its draining ask how long since intermittent catheterization, bowel program loosen tight clothing consider skin issues assess BP frequently to see if anything is helping if unable to determine cause - 911, may need nitro paste/pharm intervention
46
what to do if pt has orthostatic hypotension
recline patient elevate legs
47
most common cause of death following SCI
respiratory complications (pneumonia)
48
what position is easier for people to breath in if they have loss of abdominal musculature function?
SUPINE diaphragm not going against gravity
49
signs of PE
chest pain, SOB, tachycardia, sweating, **apprehension**, fever, cough
50
C1-C2 injury
**Functionally relevant muscles**: SCM, cervical paraspinals, neck accessory muscles **movement possible**: neck flexion, extension, rotation **patterns of weakness**: total paralysis of trunk, UE, LE, **ventilator dependent**
51
C3-4 Injury
**Functionally relevant muscles**: upper traps, diaphragm, cervical paraspinals **movement possible**: neck flexion, extension, rotation, scapular elevation, inspiration **patterns of weakness**: paralysis of trunk, UE, LE, inability to cough, endurance and respiratory low secondary yo paralysis of intercostals
52
Expected functional outcomes C1-C4
- total assist for everything - may be independent with power WC - independent with instruction of all aspects of care -**Ventilator dependent**: C3-4 MAY be able to wean - 24 hr caregiver assist
53
need a vital capacity of > _______ to be able to wean off ventilator
1000
54
C1-4 Expected equipment needs
-ventilator - fully electric hospital bed - power WC - tilt-in-space WC - pressure reliving cushion - mechanical ligt - sliding board - voice controlled equipment
55
C5 injury
**Functionally relevant muscles**: elbow flexors!, shoulder flexors, diaphragm **movement possible**: - shoulder flexion, abduction, extension - elbow flexion, supination - scapular adduction/abduction **patterns of weakness**: - no elbow extension, pronation, all wrist/hand mvmt - total paralysis of trunk/LE - paralysis of intercostals --> low endurance/vital capacity
56
C5 Expected functional outcomes
- Total A for bed to WC transfers, LE dressing, B/B management, bathing, set up of adaptive equipment - some assist for bed mobility - independent with POWER WC - need power assist wheels for WC
57
C5 Expected equipment needs
**wrist support with U-cuff attachment** pretty much same as C4 except no ventilator
58
C6 injury
**Functionally relevant muscles**: wrist extensors!, NO finger flexors or triceps **movement possible**: -scapular protraction, some HADD, supination, wrist extension **patterns of weakness**: - NO wrist flexion, elbow extension, hand mvmt - total paralysis of trunk/LE
59
C6 Expected functional outcomes
Independent (can be) to total A: bed mobility, level surface transfers, LE dressing independent (for sure): power WC mobility, ultralight manual WC, **B/B management**, grooming/feeding/UE dressing equipment caregiver asssit 6-24 hrs
60
C6 Expected equipment needs
**sliding board**
61
C7-8 injury
**Functionally relevant muscles**: triceps!, wrist flexors, C8 = finger flexors **movement possible**: elbow extension, wrist extension/flexion, finger flexion/extension, thumb mvmts **patterns of weakness**: paralysis of trunk/LE --> no trunk control, limited grasp d/t partial innervation
62
C7-8 Expected functional outcomes
independent (can be): bed mobility, transfers on uneven surges, B/B management independent (for sure): transferring between even surfaces, **manual WC propulsion**, feeding/dressing/grooming, etc. equipment use
63
C7-8 Expected equipment needs
same
64
T1-T9 injury
**Functionally relevant muscles**: UE FULLY INTACT, upper 1/2 of intercostals, abdominals (Partially - emerge at T7) **movement possible**: limited upper trunk stability, increased endurance d/t intercostal inn **patterns of weakness**: paralysis of lower trunk and LE
65
T1-T9 Expected functional outcomes
independent: bed mobility, transfers, WC mobility, pressure relief feeding/grooming/hygiene/UE/LE dressing/bathing, B/B management, driving with hand controls
66
T1-T9 Expected equipment needs
may need sliding board at beginning
67
T10-L1 injury
**Functionally relevant muscles**: fully innervated intercostals, EO, RA **movement possible**: good trunk stability - doesn't need to rely on tripod **patterns of weakness**: paralysis of LE
68
T10-L1 Expected functional outcomes
independent with STS w/ bracing can be independent in ambulation using KAFOs/AD
69
T10-L1 Expected equipment needs
KFAOs/AD for ambulation
70
L2-S5 Injury
**Functionally relevant muscles**: fully intact abdominals/trunk, some degree of LE muscles **movement possible**: good trunk stability, partial to full control of LE **patterns of weakness**: partial paralysis of LE
71
L2-S3 Expected functional outcomes
independent with walking using KAFOs may require/prefer WC for community mobility may have volitional B/B/sexual function
72
L2-S3 Expected equipment needs
grab bars in bathroom orthotic devices AD
73
what to avoid with someone with cervical precautions
no cervical flexion, extension, rotation excessive shoulder flexion and abduction with c/o neck pain avoid prone lying
74
what to avoid with someone with spinal precautions
no BLTs SLR past 45 degrees w/ c/o back pain no hip flexion past 90 degrees
75
optimal position for patient in bed
1/4 turn
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