Neuro_SCI_Everything Else

  1. Spinal shock - 2
    • Resolves in 24 hours
    • Return of anal & bulbocavernous reflexes
  2. Key mms @ C8
    Finger flexors
  3. Key mms @ L4
    Ankle DF - tabialis anterior
  4. Key mms @ S1
    Ankle PF - Gastroc/soleus
  5. Key sensory pt @ S3
    Ischial tuberosity
  6. Key sensory pt @ S2
    Popliteal fossa
  7. Key sensory pt @ S1
    Lateral side of heel
  8. Key sensory pt @ L5
    Dorsum of foot @ 3rd MTP
  9. Key sensory pt @ L4
    Medial malleolus
  10. Key sensory pt @ L3
    Medial femoral condyle proximal to knee
  11. Key sensory point @T6-10, T12
    • T6 - xiphoid
    • T10 - umbilicus
    • T7 - 1/4 way bet
    • T8 - 1/2 way bet
    • T9 - 3/4 way bet
    • T12 - inguinal ligament
  12. SC & nn exit - cervical & thoracic
    • Cervical - Above vertebrae - C3 nn exits between C2-C3
    • Thoracic - Underneath vertebrae (T2 - nn exits bet T2-T3)
  13. Signs of spinal shock - 4
    • Motor + cardio
    • Hypotension
    • Bradycardia
    • Paralytic vasodilation
  14. Hypovolemic shock - 5
    • Neurogenic shock leads to it
    • Rapid, thready pulse
    • Nausea
    • INC than DEC BP
    • Tx - Intubation + Ventilation
  15. Voluntary control of urination/defecation is lost after an injury to what cord?
    Sacral cord (S2, S3, S4)
  16. Neurogenic bladder
    Also called what?
    Lesions @ what level?
    Bladder does what?
    Can pt void & how?
    Catheterization how?
    • Spastic or Reflex (UMNL) & Automatic
    • UMNL - Seen w/lesions ABOVE T12
    • Contracts & reflexively empties in response to filling P
    • Pt can void but can't control when to void
    • Intermittent catheterization
  17. Neurogenic (Spastic) bladder - Tx - empty how? - 3
    • Manual stimulation - stroking, kneeding or tapping suprapubic area
    • Pt can void but can't control when to void
  18. Non-Reflexive blader
    Also called what?
    Lesions @ what level?
    Bladder does what?
    Can pt void & how?
    Catheterization how?
    • Flaccid & autonomic
    • LMNL - Seen w/lesions BELOW T12
    • Bladder has no reflex action = No voiding
    • Regular catheterization
  19. Non-Reflexive (Flaccid) bladder - Tx - empty how? - 3
    • Crede maneuver (manually compress lower abdomen)
    • Valsalva (INC intra-abdominal P)
    • Timed voiding program
    • Bladder has no reflex action = No voiding
  20. SCI - Fertility - injury to what region? Women affected how? men affected how?
    • Thoracolumbar & sacral regions
    • Women - fertility unchanged
    • Men - likely to become infertile
  21. Ejaculation & erection - 3
    • Possible @ S2-S4
    • Not possible above TL junction
    • No volitional component for erection - Cauda equina
  22. Tetraplegia - aka; involves what? occurs bet what levels?
    • Also known as quadriplegia
    • Involves all 4 extremities
    • Occurs bet C1-C8
  23. Paraplegia - involves what? occurs bet what levels?
    • Only LE involved
    • Occurs bet T1-L1
  24. Anatomical level of injury is acquired how?
    • C2-T10 - (+) 2 levels
    • T10-L1 - (+) 3 levels
  25. SCI B - motor & sensory
    • Sensory - intact
    • Motor - gone
  26. SCI C - motor & sensory
    • Sensory - intact
    • Motor - key mms grade <3
  27. SCI D - motor & sensory
    • Sensory - intact
    • Motor - key mms grade 3 or more
  28. Compression fractures - 4
    • I -
    • II - Fx lines on TOP of vertebrae
    • III - Fx lines on TOP & BOTTOM of vertebrae - posterior part intact
    • IV - Complete burst fx
  29. Subluxation - 4
    • 1st deg - 1/4 way out
    • 2nd deg - 1/2 way out
    • 3rd deg - 3/4 way out
    • 4th deg - Fully out
  30. Most common levels for SCI - cervical, thoracic, lumbar & how
    • Cervical - C5, C7 -
    • Thoracic - T12-L1 - Flexion or vertical compression —> wedge compression/burst fx
    • Lumbar - L1, L2 - d/t flexion
  31. Retro-hyperflexion - aka; how; fx of what?; Tx
    • Hyperextension
    • Acceleration - force from behind
    • Fx of SPs, anterior body d/t anterior longitudinal ligament tear
    • Tx - Keep neck in slight flexion
  32. Ventro-hyperfelxion - how; result
    • Deceleration - head on collision
    • Bursed or compressed d/t compression on anterior part of vertebrae
  33. Jefferson fx - level; happens how
    • C1
    • Compression, landing on head, something falling on head
  34. Odontoid fx - 2 types
    • Very unstable
    • Displaced - migrates cranially —> death
    • Non-displaced - immobilize neck
  35. Hangman’s fx - level
    C2
  36. SCI - P relief - how often?
    • 3-4x/hr
    • Every 15-20 min
  37. SCI - thermoregulation - 2
    • Above lesion - Diaphoresis
    • Below lesion - no sweating
  38. SCI - DVTs - when? contraindications? Tx?
    • Whiting first 3 months
    • What should pt do?
    • AROM & PROM
    • Bed rest & meds
  39. Orthostatic hypotension - 2
    • S/S - DEC in BP >20 mmHg, syncope, bradycardia
    • Tx - abdominal binder
  40. Autonomic dysreflexia - 4
    • Lesions above T6
    • D/t Bladder distension/infection, P sores, urinary stones, Noxious cutaneous stimuli,
    • Kidney malfunction
    • S/S - INC BP, paroxysmal HTN, Diaphoresis above T6, Bradycardia
    • MEDICAL EMERGENCY - Elevate head to lower BP; check/empty catheter
  41. Heterotropic ossification - early sign, Tx for early & late stages
    • Formation of abnormal bone within mms below lesion - appears 1-4 months after injury
    • INC alkaline phosphate
    • Tx for early stages - Aggressive PROM
    • Tx for late stages - PROM CONTRAINDICATED d/t fx risk
  42. SCI - Noriceptive stimuli that may trigger INC tone - 6
    • Blocked catheter
    • Tight clothing or straps
    • Body position
    • Environmental T
    • Infection
    • Decubitus ulcers
  43. Level of innervation for accessory respiratory mms - 4
    • SCM - C1-C3
    • Trapezius - C1-C4
    • Levator scapulae - C3-C5
    • Scalene - C3-C5
  44. SCI - Respiratory insufficiency/failure occurs in lesions where?
    Above C4 (phrenic nerve, C3-5 inner­vates diaphragm)
  45. SCI - Pulmonary - DEC/INC
    • DEC in tidal V, vital capacity, forced expiration (d/t inability to cough affectively)
    • INC use of accessory mms
  46. Inadequate inhalation/exhalation reduces ventilation of lungs, leading to what? - 3
    • Atelectasis
    • Pneumonia
    • Respiratory insufficiency
  47. SCI - pulmonary - obstructive or restrictive? what finding for C5 SCI
    • Restrictive - inability to generate (-) P
    • NOT OBSTRUCTIVE - air trapping
    • C5 - rising of abdomen d/t no abdominal mm tone on abdominal viscera
  48. SCI - Cardio - problems above what level
    Problems w/lesions above T6 - Often resolve within a few weeks of injury
  49. SCI - Cough - level for non-functional, functional & weak cough
    • Non-functional cough - C1-T3
    • Weak cough - T4-T8
    • Functional cough - T10
  50. SCI - Vital capacity - 6
    • C1-C3 - <15%
    • C3-C4 - 15%
    • Below C4 - 58% of normal
    • C6-C8 - 30% & can increase to 50%-70% at discharge
    • High thoracic - 73% of normal
    • T10-T12 - Less than normal & can increase to 100% at discharge
  51. Anterior cord damage - 2
    • Forced flexion, compression - diving or car accident
    • B/L Loss - motor, T, pain
  52. Posterior cord damage - 3
    • Motor OK, Sensory impaired
    • B/L Loss - proprioception, vibration, 2pt discrimination
    • Gait - ataxic w/wide BOS
  53. Central cord damage - 5
    • Older pts w/spondylosis in hyperextension injury
    • UE involved more than LE
    • Distal more involved than proximal
    • Loss - motor, pain, T (in UE)
    • Preservation - proprioception, vibration, 2pt discrimination
  54. Brown-Sequard syndrome - 5
    • Hemisection of spinal cord - stab or gunshot
    • Asymmetrical U/L involvement
    • IPSI loss - motor, proprioception, vibration, 2pt discrimination
    • CONTRA loss - light touch, pain, T
  55. Cauda Equina - 4
    • Injury below L1
    • Sensory loss
    • Paralysis
    • LMN lesion w/non-reflex bladder
  56. Grab bars in tub
    18"
  57. Precautions for cardiovascular endurance in SCI
    Pts w/tetraplegia & high-lesion paraplegia experience blunted tachycardia, lack of pressor response & very low V02 peak
  58. Methods to improve cardiovascular endurance in SCI - 4
    • Arm crank ergometry
    • FES leg cycle ergometry
    • Hybrid: arm crank ergometry & FES leg cycle ergometry
    • WC propulsion
  59. SCI - Absolute contraindications to exercise - 7
    • Autonomic dysreflexia
    • Severe or infected skin on WB surfaces
    • Symptomatic hypotension
    • Urinary tract infection
    • Unstable fracture
    • Uncontrolled hot and humid environments
    • Insufficient ROM to perform exercise task
  60. Phrenic nn 
    • Innervates what? Level of innervation
    • If cut what mm should PT strengthen to substitute function
    • C3-C5
    • Diaphragm - responsible for quite breathing (inspiration & expiration)
    • Accessory mms must be strengthened - SCM & scalenes
  61. MMs important for active expiration - 4
    • Resctus abdominus
    • Transversus abdominis
    • External & internal obliques
  62. Spinal cord compression - S/S (3); do what?
    • (+) Romberg
    • Sudden falls w/loss of consciousness
    • Hyperreflexia
    • Tx - IMMEDIATE STABILIZATION
  63. For transfers & dressing what deg for hip & knee?
    • What mm is most important?
    • Hip 90 deg
    • Knee at least 110 deg
    • Sufficient HS length
  64. What deg of hip extension do you need for ambulation?
    @ least 10 deg
  65. What deg of hip flexion do you need for sitting?
    90 deg
  66. What mm actions do you need to WB in long sitting - 5
    • Shoulder Extension/ER
    • Scapula ADD
    • Elbow extension
    • Forearm supination
    • Wrist extension
  67. Atlanto-axial subluxation w/SC impingement - S/S - 2
    • DEC mm strength
    • INC DTRs
  68. Atlanto-axial subluxation w/lemniscal impingement - S/S - 1
    Sensory changes
Author
Tanuisha
ID
325966
Card Set
Neuro_SCI_Everything Else
Description
Neuro_SCI_Everything Else
Updated