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Terms in this set (126)
Vertebral segment involved
The level of SCI is identified by what?
Lowest nerve root with normal sensory and motor function
The level of injury for SCI is identified by the vertebral segment involved and is defined as what?
Normal motor function, defined by MMT, must be at least ________ in the key muscle for that nerve root as defined by ASIA.
This SCI has no motor or sensory function below the level of injury.
This SCI has sparing motor or sensory below the level of injury.
This type of SCI is always associated with an injury in the cervical region.
CVA, falls, and violence
Name the three most common causes of SCI.
These are the two most common levels that SCI occurs.
It is the most flexible part of the spine
Why are C5 and C6 the most common levels of SCI?
Reflex arcs are still intact with injuries to which nervous system?
Brain at foramen magnum
Where does the SC originate?
Where does the SC terminate?
Distal nerve roots from cauda equina
Whats in the spinal canal below level L1?
Composed of myelin and is where the nerve tracts are found.
Composed of cell bodies and synapses.
All cervical nerve roots exit above their respective vertebra except which one?
Where does C8 exit?
The lumbar nerve roots continue into what?
Key muscles for C5.
Key muscles for C6.
Key muscles for C7.
Key muscles for C8.
Key muscles for T1.
Key muscles for L2.
Key muscles for L3.
Keys muscles for L4.
Long toe extensors
Key muscles for L5.
Key muscles for S1.
Complete SCI is based on what kind of pattern?
Lateral corticospinal tract
A lesion here will cause muscle weakness or paralysis below the injury.
In medulla before it becomes the SC
Where does the lateral corticospinal tract cross over?
Lateral dorsal cord, anterior horn of gray matter
The lateral corticospinal tract descends in the ________ and synapses at each level in the cord in the ________.
Pain and temp
The lateral spinothalamic tract carries information about ________ and ________ information from peripheral receptors to the brain.
Crosses to opposite side of SC within 1-2 segments of entering cord
Where does the lateral spinothalamic tract cross?
Contralateral loss of pain and temp
Lesion of one side of the lateral spinothalamic tract causes what below the level of injury?
Proprioception and stereognosis
The dorsal column tract carries information about what two sensations?
Ascends ipsilaterally and crosses at medulla
Where does the dorsal column tract cross?
Ipsilateral loss of proprioception
Lesion of one side of the dorsal column tract will cause ________ below level of injury?
Flexion, extension, and compression
What are the three types of vertebral disruption?
Guillain barre, chronic inflammatory demyelinating polyneuropathy, west nile, post polio, syringomyelia, MS, ALS, and localized infection
List the eight disease processes that can result in SCI.
GSW, stabbing, and impalement
List three examples of penetrating injuries that can cause SCI.
Central cord syndrome
Incomplete injury caused by compression of the central portion of the spinal cord, causing more damage to the centrally located fibers.
This SCI syndrome is only seen with injuries in the cervical spine.
Central cord syndrome
This is commonly seen as a result of cervical spinal stenosis.
Greater weakness in UEs than LEs
Central cord syndrome results in what?
Brown sequard syndrome
Incomplete injury due to hemi-section of the spinal cord.
Motor function, proprioception, pain, and temp
Brown sequard syndrome causes loss of what four sensations?
Upper Motor Neuron
What type of injury is brown sequard syndrome?
Brown sequard syndrome causes loss of motor function and proprioception on the ________ side of the injury and loss of pain and temperature on the ________ side of the injury.
Cauda equina syndrome is seen in injuries below the ________ vertebra.
Peripheral sacral nerve roots
Cauda equina syndrome affects what?
Cauda equina syndrome causes what?
This consequence of SCI occurs initially.
Level and severity
Extent of weakness is determined by ________ and ________ if injury.
Paralysis, two years
Incomplete injuries will have very variable presentations of ________ and may continue to improve up to about how long post injury?
Hyperactive stretch reflex.
This only occurs in voluntary muscle.
Spasticity is increased by ________.
Can be used to assist in transfers and gait.
________ in LEs can be beneficial because it can help with standing and walking.
A period immediately after injury during which there is no reflex activity.
Up to 2 weeks
How long does spinal shock last?
It cannot be determined whether a SCI is complete or incomplete until after this stage.
No spasticity will be present during this stage.
When a SCI happens, there are initially no symptoms due to what?
Which lesions require immediate artificial ventilation?
These lesions involve the phrenic nerve which innervates the diaphragm.
Patients with lesions here may be able to wean off the ventilator.
Patients with lesions here are able to breathe on their own but will lose 60% of their lung capacity due to paralysis of accessory breathing muscles.
This is the leading cause of death in spinal injury patients.
In a ________ SCI, sensation will be lost below the level of injury in a dermatomal pattern.
Bony prominences, heels, sacrum, and ITs
Name the four areas most at risk for pressure ulcers.
Abnormal response to a noxious stimulus causing a rapid uncontrolled increase in BP.
Autonomic dysreflexia can lead to ________ or can be ________ if left untreated.
UTI, distended bladder, bowel impaction, pressure injury/irritation, and pain
List five triggers for autonomic dysreflexia.
T6 and above
Autonomic dysreflexia occurs with injuries at what level?
Increased BP, pounding headache, bradycardia, nasal congestion, chills without fever, sweating/goosebumps/flushing above level of injury
List the six symptoms of autonomic dysreflexia.
Move pt to sitting position to lower BP, notify nursing staff, and check for noxious stimulus and correct it
List the three treatments for autonomic dysreflexia.
Abnormal deposition of bone across a joint.
Swelling/redness around the joint and pain/resistance to passive movement
Name two symptoms of heterotopic ossification.
No cure is available for this and treatment options are limited because it can recur after surgical repair.
This orthosis is the most restrictive and is commonly used when a fusion is not performed.
This orthosis allows rehab to begin more quickly.
Flexion and extension
The SOMI brace prevents what two motions of the cervical spine?
Sternal occipital mandibular immobilization
What does SOMI stand for?
If a patient has this type of orthosis, treatment can't be down without it.
Strengthening, functional mobility, ROM, skin protection, gait training, and equipment/positioning
List the six physical therapy interventions for SCI.
Age, weight, strength, ROM, and other co-morbidities
Limiting factors for treatment of SCI include what five things?
Maximize strength in intact muscles and gain strength in weakened muscles
Describe strengthening for SCI.
Educate patient's about long term ________ issues.
ASIA motor index score
This may be used to document improvement or to set a goal.
Expected outcomes for injuries at this level include being dependent in all bed mobility and transfers and able to use alternate drive power chair.
Expected outcomes for injuries at this level include being able to roll and come to sit independently, transfer to level surfaces independently with sliding board, and able to propel manual WC on level surfaces. Will need power chair for full independence in community.
Expected outcomes for injuries at this level include being independent in all bed mobility and level transfers and WC propulsion.
T1 and above
Expected outcomes for injuries at this level include complete independence from WC.
Rolling, coming to sit, sitting balance, manipulation of LEs in/out of bed, transfers, WC use including curbs and stairs, and independent loading of WC into vehicle
List the seven things included in functional mobility training for SCI.
Improve ROM, educate on stretching, and maintain tightness in selected areas to promote function
List the three things included in ROM interventions.
Expected outcomes for injuries at this level include being dependent in ROM.
Expected outcomes for injuries at this level include being able to assist in self ROM.
C7 and below
Expected outcomes for injuries at this level include being independent with a self ROM program.
1 minute every 30 min to an hour
How often should pressure relief occur?
Pushup from WC, forward or side lean, and power tilt
List three methods for pressure relief.
Choice of method for pressure relief depend on what?
Expected outcomes for injuries at this level include being dependent unless using power recline or tilt.
Expected outcomes for injuries at this level include being independent in side to side pressure relief from manual WC.
C7 and below
Expected outcomes for injuries at this level include being independent in pushup type pressure relief.
Cervical and high thoracic
Injuries to these two regions of the SC will result in non-ambulatory patients.
Expected outcomes for injuries at this level include possible household ambulation with KAFOs and a walker.
Expected outcomes for injuries at this level include independence with KAFOs and forearm cx on level surfaces.
Expected outcomes for injuries at this level include independence in community with AFOs and ADs.
Donning/doffing braces and orthotics, coming to stand and sit, proper gait technique for stairs/curbs, and how to get up from a fall
Instruct your patient in what four things as part of gait training?
Hips, knees, and ankles
Full ROM is what three joints is needed for KAFOs?
Neutral ankle DF
This is needed for se of AFOs.
If quads improve in strength to at least ________ then progression to use of an AFO can be considered.
Use of an AFO should be continued for DF strength less than ________.
________ is needed for ambulation with an AD if weakness is present in the LEs.
Don't order bracing too early as a ________ patient may change rapidly and this decision is typically made on an outpatient basis.
Goals for positioning include keeping the pelvis and trunk in a ________ position as much as possible.
This may indicate inadequate seat width or contractures on one side.
This may indicate inadequate seat depth or leg rests that are too short.
Poor foot position
This may require angle adjustable footplates or heel loops added.
Lumbar support and seat belt to keep hips from sliding forwards
Patients with PPT and kyphosis may need what to adjustments?
PPT and kyphosis
These two positions may indicate that the seat depth is too long.
An obliquity is name for the ________.
Cushion buildup, low side
Use of a ________ of some type under the ________ may correct pelvic obliquity.
________ may require use of lateral supports or a more narrow seat width to allow better support on armrests.
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