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NMIII SCI Exam
Terms in this set (93)
Most caudal level of the spinal cord with normal motor and sensory function on both the left and right side of the body
Neurologic Level of Injury
Most caudal segment with normal motor function bilaterally
Ipsilateral loss of proprioception, vibration, and motor function at and below level of lesion. Contralateral loss of pain and temperature
Brown Sequard Syndrome (hemisection injury)
Bilateral loss of motor function, pain, and temperature sensitivity at and below injury level. Intact light touch and proprioception
Anterior Cord Syndrome (Flexion injury of C-Spine)
Paralysis and sensory loss in UE's. Varying involvement in trunk and LE's
Central Cord Syndrome: Most common due to hyperextension injury; Central Cord Syndrome (Most commonly hyperextension injury)
Injury to the lumbosacral nerve roots. LMN signs. Flaccid paralysis of LE's. Areflexic bowel and bladder
An immediate period of areflexia post spinal cord trauma. Initial timeframe: 24 hours. Resolution: 1-3 days. Loss/dysfunction of motor, sensory, and autonomic systems
Life threatening dysfunction of autonomic nervous system. Observed in injuries above T6, most common with complete injury. Clinical Syndrome triggered by noxious stimuli below the level of the lesion
Autonomic Dysreflexia symptoms (11)
4. Profuse sweating
5. Increased spasticity/hypertonia
6. Vasoconstriction below lesion level
7. Vasodilation above lesion level(flushing)
8. Constricted pupils
9. Nasal Congestion
10. Piloerection(goose bumps)
11. Blurred vision
What do you do in response to Autonomic Dysreflexia?
1. Find and remove noxious stimuli
2. Sit Up
3. Education on triggers and how to resolve
PT Examination considerations in Acute phase with SCI pt (4)
1. Medical Stability
2. Interdisciplinary needs/referrals
3. Locomotor vs w/c propulsion
4. W/C RX
PT Examination considerations in chronic phase with SCI pt (4)
1. Prior PT experience
2. Current priority and expectation of rehab
3. W/C management
4. Community resources/referrals
This term describes impairment or loss of motor and/or sensory function in the cervical segments due to damage of neural elements within the spinal cords.
This term describes impairment or loss of motor and/or sensory function in the thoracic, lumbar or sacral neurological segments due to damage or the neural elements within the spinal canal
This term is used when there is an absence fo sensory and motor function in the lowest sacral segment. (no anal wink)
If partial preservation of sensory and/or motor function is found below the neurological level and includes the lowest sacral segment
Sacral sensation includes sensation at
1. Anal musculocutaneous junction
2. Deep anal sensation
This term, used only with complete injuries, describes those dermatomes and myotomes caudal to the neurological level that remain partially innervated.
Zone of Partial Preservation (ZPP)
Refers to the level where the most vertebral damage is found
Refers to the most caudal segment of the spinal cord with normal sensory and motor functions on both sides of the body
Four different segments that may be identified when determining neurological level
1. R Sensory
2. R Motor
3. L Sensory
4. L Motor
Precautions with Cervical collar and Halos (2)
1. No prone positioning unless permission from MD
2. No living >5lbs unilaterally
Precautions with TLSO (T10 and below) (2)
1. No hip flexion past 90
2. Log rolling
Precautions with LSO (Lumbar fractures) (1)
No hip flexion pas 90 or SLR past 60
Scapular precautions (tetraplegia or high paraplegia with surgical incision through trapezius musculature) (6)
1. No pulling arms to roll
2. No excessive shoulder protraction/retraction
3. No independent transfer
4. No resistive scapular exercises
5. No high level W/C skills
6. No long push strokes in W/C
How often should you roll a spinal cord injury patient?
Every 2 hours
How often should pressure relief be conducted in wheelchair?
Every 10-15 minutes
Occurs when a noxious stimulus below the level of lesion triggers an excessive sympathetic response
Common causes of Autonomic Dysreflexia (5)
1. Irritation of the bladder
2. Kinked catheter
3. Distension of the bowel
4. Contraction of spasm of the uterus
5. Pressure sores
What should you do with Autonomic Dysreflexia? (2)
Sit the patient up 2. Search for the source of the irritation
Spasticity treatment (5)
3. Adaptive Seating
4. Inhibitive Casting
5. Standing program
INSCI Sensory Neurological Assessment determines
Most caudal normally innervated dermatome
Sharp/dull and pain/temp evaluates what tract
Light touch, light pressure evaluates what tract
What do you use as a reference point for normal with ASIA assessment for sensory?
How many out of 10 is documented as intact?
What ASIA Impairment scale? No sensory or motor function is preserved in the sacral segments S4-5
ASIA A: Complete
What ASIA Impairment scale? Sensory but not motor function is preserved below neurological level and includes the sacral segments S4-S5 (light touch, pin prick at S4-5 or deep anal pressure), And no motor function is preserved more than three levels below the motor level on either side of the body.
ASIA B - Sensory Incomplete
What ASIA Impairment scale? Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
ASIA C - Incomplete
What ASIA Impairment scale? Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more
ASIA D - Incomplete
What ASIA Impairment scale? Motor and sensory function are normal
Why are we worried about the ability to cough? (3)
1. Atelectasis - Collapsed lung
Strengthening breathing by using (3)
1. Diaphragmatic breathing
2. Pursed lip breathing
Seat width for wheelchair is measured from
Greater tubercles or widest portion of thighs
Problems that arise with a wheelchair seat that is too wide (3)
1. Difficulty with propulsion
2. Risk for scoliosis
3. Difficulty fitting through doorways
Problems that arise with a wheelchair seat that is too narrow
Risk for pressure ulcers a greater tubercles
Seat depth is measured from
Popliteal fossa to posterior aspect of buttocks then subtract 2"
Problems that arise with a wheelchair seat that is too long
Pressure ulcers on sacrum or popliteal fossa
Problems that arise with a wheelchair seat that is too short
Pressure ulcers on posterior aspects of thighs
How many inches should be between the footplates and the floor?
Problems that arise with a wheelchair seat that is too low (2)
1. Improper LE positioning
2. Inadequate clearance between footplates and floor
Problems that arise with a wheelchair seat that is too high (2)
1. Decreased stability of chair
2. Difficulty fitting under tables
Measurement for back height is determined by
level of function and need for trunk stability
What areas of the nervous system are involved in reflexogenic erection?
Parasympathetic efferents from S2 to S4
What areas of the nervous system are involved in psychogenic erection?
Sympathetic efferents from T11 through L2
Process of innervation for seminal emission? (4)
1. Afferents from the genitals enter S2-S4
2. Ascend to brain
3. Efferents travel from brain via anterolateral column
4. Sympathetic efferents from the thoracolumbar cord innervate vas deferens, seminal vesicles, prostate, and base of bladder.
What areas of the nervous system stimulate seminal emission?
T10 - L2 sympathetic outflow
What reflex is involved in propulsatile ejaculation?
Somatic sacral reflex
What sections of the spinal cord are involved in reflexive lubrication and vasocongestion?
What sections of the spinal cord are involved in psychogenic lubrication?
Both thoracolumbar and sacral cord are thought to be involved
What sections of the spinal cord are involved in psychogenic vasocongestion?
Sympathetic outflow from thoracolumbar
What sections of the spinal cord are involved in smooth muscle contractions in the fallopian tubes, uterus, and skene glands?
Female equivalent of seminal emission. Caused by sympathetic outflow from thoracolumbar cord.
What are some interventions for erectile dysfunction? (5)
1. Firm casing that is worn over the penis
2. Artificial penis
3. Constricting band to trap blood at the base of the penis
4. Vacuum pump to attain an erection
5. Pharmaceuticals (sildenafil, injecting vasoactive drugs)
What techniques might a male try to father children?(3)
3. Surgical removal of sperm
How do you answer a females and males in regards to achieving orgasm after SCI?
Most like S2-S5 cord segments remain function. Some men and women with complete SCI still experience orgasms.
What risks are associated with pregnancy with SCI patients? (8)
1. Autonomic dysreflexia during labor contractions 2. No sensation of labor pains
5. Pressure ulcers
7. Respiratory compromise
How can you educate about sexuality after SCI?
Sexual education should begin early. Provide information appropriate for individual's gender, age, physical functioning, sexual orientation, psychosocial status, and state of readiness.
What does PLISSIT stand for?
Permission, Limited Information, Specific Suggestions, Intensive Therapy
What is PLISSIT model used for?
Provides a therapeutic approach to educate patients on sexuality and sexual function
What factors contribute to increased risk for UTI's?
1. High intravesical pressures
2. Large volumes of urine left in bladder after emptying
4. Prolonged time intervals between emptying
5. Contamination from catheters
What three areas of the nervous system are involved in normal bladder control? (3)
1. Sacral spinal cord
2. The pons
3. Several extrapontine regions of the brain
At what levels do parasympathetic control arise?
Sacral cord segments 2-4
At what levels does sympathetic control arise?
11th thoracic through the 2nd lumbar segments
During spinal shock, is the bladder flaccid or spastic?
Does the response from spinal shock result in retention or excessive emptying?
The functional sphinter at the bladder's outlet remains closed causing urinary retention
What is a areflexive bladder?
Sacral reflex arc disruptive. The absence of sacral voiding reflex results in urinary retention
What is a reflexive bladder
S2-S4 reflex arc remains but the descending input from these segments has been disruptive. As a result, the bladder empties reflexively once filling causes sufficient stretch of its wall.
What is detrusor-sphincter dyssynergia?
Involuntary external sphincter contraction occurs concurrently with detrusor contraction. High intravesical pressures and high postvoid residuals result
How is the bladder typically managed in the acute phase of injury? (3)
1. Complete/near complete emptying of bladder
2. Low-pressure voiding and storage of urine
3. Prevention of urinary incontinence between planned voidings
What is intermittent catheterization?
Involves inserting a catheter into the bladder to empty it and then removing the catheter. Repeated ever 4-6 hours
When is someone appropriate for intermittent catheterization?
Most commonly used for long-term bladder management
What is indwelling catheterization?
Involves inserting a catheter into the bladder and leaving it in place for an extended period of time (up to 30 days)
When is someone appropriate for indwelling catheterization?
Used by many individuals who are unable to manage their bladders satisfactorily by other methods
What is reflex voiding?
1. Urination stimulated by tapping their lower abdomen or Valsalva
2. Rubbing inner thigh
3. Pulling their pubics hair
Whom is most appropriate for reflex voiding?
Most appropriate for males with reflexively functioning bladders that empty effectively without high intravesical pressure during voiding
What are some complications related to bowel dysfunction in someone with an SCI?
What reflexes are involved in defecation? (2)
Intrinsic defecation reflex 2. Parasympatheitc defecation reflex
What happens to bowel function during spinal shock?
Peristalsis may be reduced and defecation reflexes may be diminished or absent
What is the areflexive bowel?
Sacral reflex interrupted. Internal sphincter remains active. External sphincter and pelvic floor remain flaccid. Feces can become impacted.
What is the reflexive bowel?
Bowel functions reflexively. Internal sphincter maintains resting tone and relaxes reflexively when the rectum is distended.
What does early management of the bowel entail?
Manual evacuation. Monitor patient for paralytic ileus.
What is bowel training for a reflexive bowel like?
Bowel movement elicited by stimulation of reflexive defecation. Before stimulation, hard stool may need to be removed
What is bowel training for areflexive bowel like?
Stool is manually removed from the rectum
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