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Neuromuscular

SCI review

QuestionAnswer
What are causes of SCI? Motor vehicle accidents 41% followed by falls and acts of violence, gun shot wounds.
Life expectancy; Mortality rates? Lower life expectancy for non SCI; mortality rates are higher in the first year
How is a patient with SCI classified according to level and extent of injury? Complete or incomplete; use the ASIA impairment scale
ASIA A Complete; No sensory or motor function is preserved in the sacral segments S4 and S5
ASIA B Incomplete; Sensory bot not motor function is preserved below the neulogical level and includes the sacral segments S4 and S5.
ASIA C Incomplete; Motor function is preserved below the neurological level, and more than half of the key muscle below the neurological level have a muscle grade of less than 3
ASIA D Incomplete; Motor function is preserved below the neurological level, and at least half of key muscle below the neurological level have a muscle grade greater than or equal to 3
ASIA E Normal; Sensory and motor function are normal
Myotome C5 Elbow flexion
C6 Wrist extensors
C7 Elbow extensors
C8 Finger flexors
T1 Finger abductors
L2 hip flexors
L3 knee extensors
L4 ankle dorsiflexors
L5 long toe extensors
S1 Ankle plantar flexors
Tetraplegia and Quadriplegia four extremities affected
Paraplegia The UE are not affected
Reflexic Injury upper neuron lesions; symptoms, spasticity, hypertonicity, and pathologic reflexes
Areflexic lower motor neuron injuries; peripheral nerves, flaccidity, atrophy, and absence of reflexes
Brown –Sequard contralateral loss of pain and temperature sensations, ipsilateral loss of proprioception, and ipsilateral spastic motor paralysis below level of injury
Central cord syndrome seen with older people with cervical spondylosis and hyperextension injuries, greater involvement of the UEs than the Les
Anterior cord syndrome anterior portion of the spinal cord more so than the posterior, proprioception is spared but motor function is affected
Cauda Equina Syndrome areflexic motor injury is seen
C3-C5 inspiration, keep the diaphragm alive
T1-T11 Inspiration – intercostal muscles
T8-T12 Abdominal muscles, forced breathing and coughing
C2-C4 neck muscles
Signs and Symptoms of Autonomic Dysreflexia Elevated systolic and diastolic BP, pounding headache, nausea, chills and goose bumps, sweating, flushing, restlessness, brady or tachycardia, blurred vision or spots, nasal congestion, minimal or no symptoms, cardiac arrhymias
Stage I Nonblanchable erythema of intact skin
Stage II Partial thickness skin loss
Stage III Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia
Stage IV Full thickness skin loss with extensive destruction, tissue necrosis, or damage to soft tissue
Non-stagable Sore is covered with eschar so that one is unable to determine the condition of the tissue below
Parameters for frequency of pressure relief for 15 seconds every 15 minutes; 30 seconds every 30 min; 1 min for ever 1hr
C1 to C3 mechanical lift; mouthstick activities; power w/c with recliner or tilt-in-space, sip and puff
C4 mechanical lift; mouthstick activities; power w/c with recliner sip and puff with head control JS
C5 Mechanical lift, assisted sliding board; self feeding, light grooming; power w/c with recliner with hand control JS
C6 Sliding board assisted or (I), possible depression; Rolling, coming to sit, dressing, drive car with assistive devices, sitting balance; power upright with hand control JS, manual w/c
C7 Depression, may require sliding board; Roll, coming to sit, dressing, sitting balance; manual w/c, power w/c
C8 Depression, independent functional activities except floor and stairs; manual w/c
T1 Depression, same as C8; manual w/c
T2 to L1 Depression;Ambulation with RGO and UE A/D for exercise only, modified independent for all functional activities except floor and stairs; manual w/c
L2 Depression; Ambulation with KAFOs or RGOs and UE assistive devices for exercise only, mod (I) for all functional activities; manual w/c
L3 Stand or squat pivot; ambulation with AFOs and UE A/D, mod (I) for all functional activities; manual w/c
L5 Stand pivot; ambulate with AFOs, may not need UE A/D, mod (I) for all functional activities; may require w/c for long distance
S1 As able-bodied; Ambulate with no orthoses or UE A/D, (I) for functional activities; may be modified for bowel and bladder care. No w/c
Created by: ckdabne