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Level at which the greatest vertebral damage has occured.
Skeletal level
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The most caudal segment of the spinal cord with normal sensory functions as determined by testing the 28 dermatomes on each side of the body.
Sensory level
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The most caudal segment of the spinal cord with normal motor function as determined by testing 10 myotomes on each side of the body.
Motor level
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The most caudal segment of the spinal cord with normal sensory and motor function.
Neurological level
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Prediction of self-care and ambulation is usually based on the ______ level.
Motor
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Period immediately following the injury during which there is an abscence of reflex activity, flaccidity, and loss of sensation below the level of the lesion.
Spinal shock
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Elbow flexors innervation?
C5
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Wrist extensors innervation?
C6
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Elbow extensors innervation?
C7
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Finger flexors innervation?
C8
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Little finger abductors innervation?
T1
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Trunk flexors innervation?
T6 - T12
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Hip flexors innervation?
L2
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Knee extensors innervation?
L3
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Ankle dorsiflexors innervation?
L4
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Long toe extensors innervation?
L5
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Bowel and bladder innervation?
S2, S3, S4
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All patients with tetraplegia and high-level injury in paraplegia have some degree of _______ impairment.
Respiratory
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- Gradual increase during the first 6 months, reaching a plateau about 1 year post injury.
- Influenced by many factors.
Spasticity
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The abscence of thermoregulatory responses of sweating and shivering below the level of the lesion results in what?
Impaired temperature control
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With impaired temperature control, there may be diaphoresis _____ the level to compensate.
Above
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- Typically occurs with lesions above T6, but may be seen at levels close to T6.
- Signs and symptoms: hypertension, sweating, severe headache, increased spasticity, etc...
Autonomic dysreflexia
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Decreased blood pressure with movement from horizontal to vertical caused by loss of vasoconstriction and decreased muscle tone.
Postural hypotension
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A peculiar pain below the level of the lesion.
Dysesthesias
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Pain due to improper positioning and ROM exercises as well as muscle imbalances.
Musculoskeletal pain
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The motor level is defined by the lowest key muscle that has a grade of at least 3, providing the key muscles represented by segments above that level are judged to be normal (grade 5).
ASIA definition of "normal"
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The shorter the time of spinal shock the ______ the prognosis.
Better
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- Muscles with consistency for being innervated by the segments indicated.
- Muscles that add significantly to a patient's functional capability at each successive level of lesion.
Key muscle groups
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What do you do when you suspect a patient having autonomic dysreflexia?
- - Sit them up, to decrease BP
- - Look for irritants: full catheter, tight garment
- - Check skin for pressure areas
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What to avoid when maintaining or increasing range of motion in patients with paraplegia from a SCI?
- Avoid motion of trunk and excessive motion of hips.
- Avoid SLR greater than 60 degrees.
- Avoid combined hip flexion with knee flexion greater then 90 degrees.
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Stretching some muscles less than full range and full stretching of others.
Selective stretching
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Examples of selective stretching?
- Tenodesis
- Back extensors
- Gastrocsoleus
- SLR
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With tetraplegia, what is contraindicated for scapular and shoulder muscles?
Resistance
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Upper extremities activities to decrease asymetric, rotational stress on spine must be performed ______.
Bilateraly
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What is the main thing a body jacket is preventing?
Rotation
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Used to develop the strength, ROM, endurance, coordination, and the early use of substitutions and compensations for balance and movement.
Mat program
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What can be created to maximize the effect of the force of the muscles being activated.
Leverage
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What is the Learning of Activities sequence?
- Develop stability in a position
- Develop controlled mobility
- Develop functional skill
-
What gait pattern is used by patients with no hip flexors?
Swing-to and swing through
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Hanging on the "Y" ligaments.
Para-stance
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