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Spinal shock - 2
- Resolves in 24 hours
- Return of anal & bulbocavernous reflexes
-
Key mms @ C8
Finger flexors
-
Key mms @ L4
Ankle DF - tabialis anterior
-
Key mms @ S1
Ankle PF - Gastroc/soleus
-
Key sensory pt @ S3
Ischial tuberosity
-
Key sensory pt @ S2
Popliteal fossa
-
Key sensory pt @ S1
Lateral side of heel
-
Key sensory pt @ L5
Dorsum of foot @ 3rd MTP
-
Key sensory pt @ L4
Medial malleolus
-
Key sensory pt @ L3
Medial femoral condyle proximal to knee
-
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
-
SC & nn exit - cervical & thoracic
- Cervical - Above vertebrae - C3 nn exits between C2-C3
- Thoracic - Underneath vertebrae (T2 - nn exits bet T2-T3)
-
Signs of spinal shock - 4
- Motor + cardio
- Hypotension
- Bradycardia
- Paralytic vasodilation
-
Hypovolemic shock - 5
- Neurogenic shock leads to it
- Rapid, thready pulse
- Nausea
- INC than DEC BP
- Tx - Intubation + Ventilation
-
Voluntary control of urination/defecation is lost after an injury to what cord?
Sacral cord (S2, S3, S4)
-
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
-
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
-
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
-
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
-
SCI - Fertility - injury to what region? Women affected how? men affected how?
- Thoracolumbar & sacral regions
- Women - fertility unchanged
- Men - likely to become infertile
-
Ejaculation & erection - 3
- Possible @ S2-S4
- Not possible above TL junction
- No volitional component for erection - Cauda equina
-
Tetraplegia - aka; involves what? occurs bet what levels?
- Also known as quadriplegia
- Involves all 4 extremities
- Occurs bet C1-C8
-
Paraplegia - involves what? occurs bet what levels?
- Only LE involved
- Occurs bet T1-L1
-
Anatomical level of injury is acquired how?
- C2-T10 - (+) 2 levels
- T10-L1 - (+) 3 levels
-
SCI B - motor & sensory
- Sensory - intact
- Motor - gone
-
SCI C - motor & sensory
- Sensory - intact
- Motor - key mms grade <3
-
SCI D - motor & sensory
- Sensory - intact
- Motor - key mms grade 3 or more
-
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
-
Subluxation - 4
- 1st deg - 1/4 way out
- 2nd deg - 1/2 way out
- 3rd deg - 3/4 way out
- 4th deg - Fully out
-
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
-
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
-
Ventro-hyperfelxion - how; result
- Deceleration - head on collision
- Bursed or compressed d/t compression on anterior part of vertebrae
-
Jefferson fx - level; happens how
- C1
- Compression, landing on head, something falling on head
-
Odontoid fx - 2 types
- Very unstable
- Displaced - migrates cranially —> death
- Non-displaced - immobilize neck
-
-
SCI - P relief - how often?
-
SCI - thermoregulation - 2
- Above lesion - Diaphoresis
- Below lesion - no sweating
-
SCI - DVTs - when? contraindications? Tx?
- Whiting first 3 months
- What should pt do?
- AROM & PROM
- Bed rest & meds
-
Orthostatic hypotension - 2
- S/S - DEC in BP >20 mmHg, syncope, bradycardia
- Tx - abdominal binder
-
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
-
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
-
SCI - Noriceptive stimuli that may trigger INC tone - 6
- Blocked catheter
- Tight clothing or straps
- Body position
- Environmental T
- Infection
- Decubitus ulcers
-
Level of innervation for accessory respiratory mms - 4
- SCM - C1-C3
- Trapezius - C1-C4
- Levator scapulae - C3-C5
- Scalene - C3-C5
-
SCI - Respiratory insufficiency/failure occurs in lesions where?
Above C4 (phrenic nerve, C3-5 innervates diaphragm)
-
SCI - Pulmonary - DEC/INC
- DEC in tidal V, vital capacity, forced expiration (d/t inability to cough affectively)
- INC use of accessory mms
-
Inadequate inhalation/exhalation reduces ventilation of lungs, leading to what? - 3
- Atelectasis
- Pneumonia
- Respiratory insufficiency
-
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
-
SCI - Cardio - problems above what level
Problems w/lesions above T6 - Often resolve within a few weeks of injury
-
SCI - Cough - level for non-functional, functional & weak cough
- Non-functional cough - C1-T3
- Weak cough - T4-T8
- Functional cough - T10
-
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
-
Anterior cord damage - 2
- Forced flexion, compression - diving or car accident
- B/L Loss - motor, T, pain
-
Posterior cord damage - 3
- Motor OK, Sensory impaired
- B/L Loss - proprioception, vibration, 2pt discrimination
- Gait - ataxic w/wide BOS
-
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
-
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
-
Cauda Equina - 4
- Injury below L1
- Sensory loss
- Paralysis
- LMN lesion w/non-reflex bladder
-
-
Precautions for cardiovascular endurance in SCI
Pts w/tetraplegia & high-lesion paraplegia experience blunted tachycardia, lack of pressor response & very low V02 peak
-
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
-
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
-
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
-
MMs important for active expiration - 4
- Resctus abdominus
- Transversus abdominis
- External & internal obliques
-
Spinal cord compression - S/S (3); do what?
- (+) Romberg
- Sudden falls w/loss of consciousness
- Hyperreflexia
- Tx - IMMEDIATE STABILIZATION
-
For transfers & dressing what deg for hip & knee?
- What mm is most important?
- Hip 90 deg
- Knee at least 110 deg
- Sufficient HS length
-
What deg of hip extension do you need for ambulation?
@ least 10 deg
-
What deg of hip flexion do you need for sitting?
90 deg
-
What mm actions do you need to WB in long sitting - 5
- Shoulder Extension/ER
- Scapula ADD
- Elbow extension
- Forearm supination
- Wrist extension
-
Atlanto-axial subluxation w/SC impingement - S/S - 2
-
Atlanto-axial subluxation w/lemniscal impingement - S/S - 1
Sensory changes
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