1. What are the 3 rish factors for a SCI?
    • automobile accident (40%)
    • contact sports
    • diving into shallow water
  2. What are 3 MOI for non-traumatic SCI?
    • compression (tumor), hemorrhage, degenerative disease
    • disruption of blood flow
    • infection
  3. concussion
    temporary loss of function due to violent blow
  4. contusion
    spinal cord surface intact, internal damage
  5. laceration
    glia are disrupted and cord tissue is torn
  6. 7 types of secondary damage that can occur
    • ischemia: microhemorrhage in SC grey matter and edema causes release of nts and inflammatory mediators which causes vasoconstriction, necrosis and glial scarring result
    • inflammation: results in apoptosis
    • disturbances in ion/electrolyte levels: Na/K balance (inability to generate APs), influx of Ca (triggers neuron death)
    • demyelination: damage to oligodendrocytes
    • scar formation
    • dural scarring: causes adhesions of cord to dura
    • syringomyelia: can block CSF flow and cause pressure build up
  7. Methyprednisolone
    steriodal anti-inflammatory that dec secondary damage to neurological tissue, recommended within 8 hrs of injury; however may inc risk of infection, wound complications
  8. Spinal shock
    all reflexes, motor, and sensory function below level of injury absent in initial period after injury; reflexes return 1-3 days post
  9. Neurological return
    resumption of some voluntary motor and sensory function; most occurs in first year after injury
  10. Mechanisms of neurological return
    resolution of hemorrhage, re-myelination of surviving neurons, injury induced plasticity
  11. Paraplegia
    affects thoracic, lumbar, and sacral regions
  12. Tetraplegia
    affects cervical region
  13. How to determine motor level for each sd
    lowest level myotome that scores at least 3/5 when level above scores 5/5
  14. ASIA A
  15. ASIA B
    incomplete- sensory but not motor preserved below
  16. ASIA C
    incomplete- motor function preserved below level and more than 1/2 key muscles below level less than 3/5
  17. ASIA D
    incomplete- motor level preserved below and at least 1/2 key muscles below level at least 3/5
  18. ASIA E
    recover to normal
  19. zone of partial preservation
    used only with complete; lowest segment that has some sensory and/or motor function
  20. Muscle tone after SCI
    areflexic during spinal shock; spasticity after resolves; may have flaccidity where AHCs damaged or nerve root/peripheral nerve damage
  21. Heterotropic ossification
    bone formation within soft tissue (below neurological level); may be caused by microtrauma to soft tissue; swelling, pain, redness, inc temp
  22. Osteoporosis
    in extremities but not spine below level of injury; may be due to dec muscle action, dec weight bearing, changes in circulatory/ANS/endocrine functions
  23. Dec ROM
    risk of contractures due to dec movement (adaptive shortening); due to muscle imbalances, spasticity, postural effects
  24. Cardiovascular effects of SCI
    disruption of sympathetic responses in injuries above T6, reduced venous return, inc risk of DVT (**risk of pulmonary embolism- leading cause of death in 1st yr post SCI)
  25. Respiratory effects above C3
    ventilator dependent
  26. Respiratory effects at C4
    require ventilation in acute stage, but may be able to breathe independently later on; can't cough
  27. Respiratory effect C5-T12
    preserve diaphragm, lose accessory muscles (altered breathing); can't cough
  28. Other respiratory effects
    risk of aspiration, pneumonia
  29. Autonomic dysreflexia
    due to disconnect between brain and autonomic reflexes in sc; sudden inc BP, pounding headache, profuse sweating above level of lesion
  30. Management of autonomic dysreflexia
    remove noxious stimuli, place pt upright to inc postural hypotensive response **medical emergency, if this doesn't dec BP, contact physician
  31. Thermoregulation problems
    • hypothermia soon after injury (loss of vasomotor tone causes excess vasodilation and heat loss)
    • hyperthermia later on
  32. GI effects
    • stress ulcers in acute stage
    • constipation long term
  33. Bowel/bladder effects
    • micturition center S2-4
    • during spinal shock, bladder is flaccid (won't empty), need indwelling catheter
    • lesion to S2-4 causes flaccid detrusor muscle (reflex loop interrupted)
    • lesion above sacral levels- may have refexive bladder emptying
    • inc risk of UTI
  34. Psychogenic vs reflexive arousal
    • psychogenic- input from higher brain centers via T/S
    • reflexive- reflex response to sensory stimulation
  35. Males sexual effects higher lesion
    achieve reflexive erection but not ejaculation
  36. Males sexual effect lower lesion
    can ejaculate but erection more difficult
  37. Males sexual effect cauda equina lesion
    Erection and ejaculation both not possible
  38. Female sexual effects higher lesion (above T6)
    achieve reflexive arousal but not psychogenic
  39. Female sexual effects thoracolumbar region (sparing sacral)
    may have both types of arousal
  40. Female sexual effects lower lesion
    may have psychogenic but not reflexive
  41. Other female sexual effects
    menstrual cycle resumes several months after, can become pregnant although risk of autonomic dysreflexia; lesion above T10- may not notice when labor begins
  42. Better outcomes for pts with SCI when:
    younger; compression fx instead of crush fx
  43. Biggest problem in early stage:
    respiratory infection
  44. Problem in later stages:
  45. Phase 1 rehab
    acute care; may begin out of bed activity, prevent secondary complications
  46. Phase 2 rehab
    Early rehab; inc tolerance for out of bed activity
  47. Phase 3 rehab
    intensive rehab; functional skills aimed at inc independence, mobility skills, transfers, ADLs, begin community re-integration
  48. Phase 4 rehab
    pre-discharge; activities focused on transition to home
  49. Phase 5 rehab
    continue community re-integration, continue functional skills
  50. PT mgmt for SCI
    stretching and positioning, rhythmic passive movements, prolonged standing, low frequency vibration, NMES, orthoses or casting
  51. Indications for surgery
    • deteriorating neuro status
    • continuing cord compression
    • gross mal-alignment
    • fracture that won't reduce with traction
  52. What levels of damage require intermittent or indwelling catheter?
    • S2-4 yes
    • above sacral levels maybe
Card Set
clin path 2