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Neuromuscular
SCI review
| Question | Answer |
|---|---|
| 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
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