SCI: Body Structure/Function Impairments (Pulmonary Impairments)

Question 1

What is Spinal Shock?

Answer 1

Immediately following SCI.

Period of areflexia that is part of spinal shock. The initial absence of all reflex activity and impairment of autonomic regulation.

Total flaccid paralysis present

Question 2

What is Autonomic Dysreflexia? What spinal level does this commonly occur at?

Answer 2

Occurs in lesions T6 and Above.

• Acute onset of autonomic activity from noxious stimuli below the level of the lesion.

[This is LIFE THREATENING]

Question 3

Autonomic Dysreflexia: Irritating Stimuli

Answer 3

• Bladder and bowel distension/irritation.
• Blocked/kinked catheter, UTI
• Tight Clothing/Straps
• Pressure injures/sores

Question 4

Autonomic Dysreflexia: Symptoms

Answer 4

• Hypertension
• Bradycardia
• Headache (Severe and Pounding)
• Profuse Sweating;Diaphoresis
• Vasoconstriction below level of lesion, vasodilation above level of lesion (flushing)

Question 5

A rise in SBP of what degree is diagnostic of an episode of Autonomic Dysreflexia?

Answer 5

Rise in SBP 20 - 30 mmHg.

Question 6

Autonomic Dysreflexia: Intervention, if patient is lying flat what should be done?

Answer 6

Bring patient to upright position;sit up, lowers blood pressure, and loosens clothing.

Question 7

Autonomic Dysreflexia: Intervention

Answer 7

• Check catheter, to make sure it is not blocked
• Check for tight clothing/straps,
• Ask when last bowel/bladder movement occured, check for impaction/bladder distension
• Have bladder drained if not already catheterized

Question 8

What is Spastic Hypertonia? Symptoms?

Answer 8

Part of UMN syndrome:
- Spasticity
- Muscle spasms
- High muscle tone
- Hyperactive DTR
- Clonus

Question 9

With high spinal cord injuries C1 and C2, what is lost/preserved in terms of pulmonary function. What interventions are necessary?

Answer 9

Phrenic nerve innervation is lost (C3, C4, C5)

SCM and Upper traps are the only muscles that are intact.

Artificial ventilator or phrenic nerve stimulator are required to sustain life.

(Will need assistance with airway clearance)

Question 10

Pulmonary Impairment: C3-C4

Answer 10

Partial diaphragm innervation (C3, C4, C5)

Scalenes + Levator Scapulae Function

(Will need assistance with airway clearance)

Question 11

Pulmonary Impairment: C5 - C8

Answer 11

Fully innervated diaphragm + many accessory muscles.

Forced expiration is severely impaired, some cough ability preserved but generally weak.