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spinal cord injury

scorebuilders ch 2

TermDefinition
complete lesion A lesion to the spinal cord where there is no preserved motor or sensory function below the level of lesion
Incomplete lesion A lesion to the spinal cord with incomplete damage to the cord. THere may be scattered motor function, sensory function or both below the level of lesion
Anterior Cord Syndrome An incomplete lesion that results from compression and damage to the anterior part of the spinal cord or anterior spinal artery. The mechanism of injury is usually cervical flexion. There is loss of motor function and pain and temperature sense below the lesion due to the damage of the corticospinal and spinothalamic tracts.
Brown-Sequard's Syndrome An incomplete lesion usually caused by a stab wound, which produces hemisection of the spinal cord. There is paralysis and loss of vibratory sense on the same side as the lesion due to the damage to the corticospinal tract and dorsal columns. There is a loss of pain and temperature sense on the opposite side of the lesion from damage to the lateralspinothalamic tract. Pure Brown Sequard's syndrome is rare since most spinal cord lesions are atypical
Cauda Equina Injuries An injury that occurs below the L1 spinal level where the long nerve roots transcend. Cauda Equina Injuries can be complete, however, they are frequently incomplete due to the large number of nerve roots in the area. A cauda Equina Injury is considered a peripheral nerve injury. Characteristics include flaccidity, areflexia, and impairmant of bowel and bladder function. Full rcovery is not typical due to the distance needed for axonal regeneration.
Central Cord Syndrome An incomplete lesion that results from compression and damage to the central portion of the spinal cord. The machanism of injury id +usually cerviacal hyperextension that damages the spinothalamic tract, corticospinal tract, and dorsal columns. The upper extremities present with greater involvement than the lower extremities and greater motor deficits exist as compared to sensory deficits.
Posterior Cord Syndrome A relatively rare syndrome that is caused by compression of the posterioor spinal artery and is characterized by loss of pain, perception, two-point discrimination, and sterognosis. Motor function is preserved.
Autonomic Dysreflexia AD is perhaps the most dangerous complication of spinal cord injury and can occur in patients with lesions above T6. A noxious stimulus below the level of lesion triggers the autonomic nervous system causing a sudden elevation in BP. Common causes can include distented or full bladder, kink or blockage in the catheter, bladder infections, pressure ulcers, extreme temperature changes, tight clothing, or even an ingrown toenail.
Treatment of Autonomic Dysreflexia The first reaction to this medical crisis is to cvheck the catheter for blockage. The bowel should also be checked for impaction. A patient should remain in a sitting position. Lying a patient down is contrainindicated and will only assist to further elevate blood pressure. THe patient should be examined for any other irritating stimuli. If the cause remains unknown, the patient should receive immediate madical attention.
Deep Vein Thrombosis DVT results from the formation of a blood clot that becomes dislodged and it is termed an embolus. This is considered a serious medical condition since the embolus may obstruct a selected artery. A patient with a SCI has a > risk of developing a DVT due to the absence or decrease in normal pumping action by active contractions of muscles in the LE's. Homan's sign is a special test designed to confirm the presence of a DVT should include prophylactic anticoagulant therapy, maintaining a positioning schedule, range of motion, proper positioning to a void excessive venous stasis, and use of elastic stickings.
Symptoms of DVT Swelling of the lower extremity, pain, sensitivity over the area of the clot, and warmth in the area.
Treatment of DVT Once a DVT is suspected there should be no active or passive movement performed to the involved LE. Bed rest and anticoagulant thereapy are usually indicated. Surgical procedures can be performed if necessary.
Ecotopic Bone Ecotopic bone or heterotrophic ossification refers to the spontaneous formation of bone in the soft tissue. It typically occurs adjacent to larger joints such as the knees or the hips. Theorys regarding etiology range from tissue hypoxia to abnormal calcium metabolism
Symptoms of Ecotopic Bone Early sxs include edema, decreased ROM, and increased temperature of the involved joint.
Treatment of Ecotopic Bone Drug intervention usually involves disophoshates that inhibit ecotopic bone formation.PT and surgery are often incorporated into treatment. PT must focus on maintaining functional ROM and allowing the pt. the most independent functional outcome possible
Orthostatic Hypotension Orthostatic hypotension or postural hypotension occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone. Venous pooling is fairly common during the early stages of rehabilitation. A decrease in systolic BP > 20 mmHG after moving from a supine position to a sitting position is typically indicative of orthostatic hypotension
Symptoms of Orthostatic Hypotension Complaints of dizziness, light-headedness, nausea, and "blacking out" when going from horizontal to a vertical position
Treatment of Orthostatic Hypotension Monitoring vital signs assists with minimizing the effects of orthostatic hypotension. The use of elasticstockings, ace wraps to the LE's and abdominal binders are common. Gradual progression to a vertical position using a tilt table is often indicated Drug intervention may be indicated in order to increase BP.
Pressure Ulcers A pressure ulcer is caused by sustained pressure, friction, and/or shearing to a surface. THe most common areas susceptible to pressure ulcers are the coccyx, sacrum, ischium, trochanters, elbows, buttocks, malleoli, scapulae, and prominent vertebrae. Pressure ulcers require immediate medical intervention and can significantly delay the rehabilitation process.
Symptoms of Pressure Ulcers A reddened area that persists, an open area
Treatment of Pressure Ulcers Prevention is of greatest importance. A patient should change position frequently, maintain proper skin care, sit on an appropriate cushion, consistently weight shift, and maintain proper nutrition and hydration. Surgical interverntion is often necessary with advanced pressure ulcers
Spasticity Spasticity can occasionally be useful to a patient with a SCI, however, more oftenn serves to interfere with functional activities. Spasticity can be enhanced by both internal and external sources such as stress, decubiti, UTI, bowel or bladder obstruction, temperature changes, or touch.
Spasticity Symptoms Increased involuntary contraction of muscle groups, increased tonic stretch reflex, excessive deep tendon reflexes
Spasticity treatment Medications are usually administered to reduce the degree of spasticity. (Dantrium,Baclofen, Lioresal). Aggressive treatment includes phenol blocks, rhizotomies, myelotomies, and other surgical intervention. PT intervention includes positioning, aquatic therapy, weight bearing, functional electrical stimulation, range of motion, resting splints, and inhibitive casting
Corticosteroid Agents Administered within 8 hours after injury to prevent overall decline in white matter within the cord. Allows for enhanced blood flow and reduces post-traumatic ischemia Examples: Methylprednisone, GM-1*, Dexamethasone, Decdron *GM-1 is a complex acidic glycolipid administered with methylprednisone to enhance recovery
Anti-spasticity Agents reduces tension in the muscles Examples: Baclofen, Lioresal, Valium
Anticonvulsant Agents treatment of neurogenic pain Example: Gabapentin
Tricyclic Antidepressants treatment of neurogenic pain Example: Amitriptyline, Pamelor, Sinequan
Parathyroid Hormone promotes new bone formation and an increase in bone mineral density Example: Teriparatide
Biphosphonate Agents Prevent demineralization and SCI-induced osteoporosis Example: Didronel, Aredia
Agents for Bladder Program Example: Minipress, Ditropan
Agents for Bowel Program Example: Ducolax, Pericolace, Glycerine
Anti-bone Resorption Agents Treats hetertrophic ossification through inhibiting bone resorption and formation prevents ossification Example: Didronel, Fosamax
Anticoagulation Agents prevents DVT Example: Coumadin, Heparin
SCI Examination -past medical history -History of current condition -Social history (caregiver support) -Medications -Living Environment -Systems Review -Cognitive Assessment -Skin Assessment -Sensory Examination -Motor Examination -ASIA impairment scale -Respiratory Assessment -Cough -Chest Expansion -Accessory Muscle Use -Vital Capacity -ROM -Pain -Mobility skills
SCI Intervention -Positioning -Family/caregiver teaching -Respiratory Training -Assisted cough and secretion cleaarance -Breathing Exercises -WC, cushion, and orthotic prescription -Pressure Releif -ROM -Motor function retraining -Mobility training -Gait training (T9 and lower)
SCI Goals -maximize functional mobility based on level of injury. -Maximize respiratory function -Attain functional ROM for all joints -Maximize strength of all available muscle groups -Maximize patient/caregiver competence with: -Pressure Releif -Positioning -Range of Motion -Strengthening -WC management
Cauda Equina Injury Aterm used to describe injuries that occur below the L1 level of the spine. A cauda equina injury is considered to be a LMN lesion
Dermatome Designated sensory area based on spinal segment innervation
Myelotomy A surgical procedure that severs certain tracts within the spinal cord in order to reduce spasticity and improve function
Myotome Designated motor areas based on spinal segment innervation
Neurectomy A surgiacla removal of a segment of a nerve in order to reduce spasticity and improve function
Neurogenic Bladder The bladder empties reflexively for a patient with an injury above the level of S2. The sacral reflex arc remains intact
Neurologic Level THe lowest segment (most Caudal) of the spinal cord with intact strength and sensation. Muscle groups at this level must receive a grade of fair
Nonreflexive Bladder THe bladder is flaccid as a result of a cauda equina or conus medullaris lesion. The sacral reflex arc is damaged
Paraplegia A term used to describe injuries that occur at the level of the thoracic, lumbar, or sacral spine
Rhizotomy A surgical resection of the sensory component of a spinal nerve in order to decrease spasticity and improve function
Sacral Sparring An incomplete lesion where some of the innermost tracts remain innervated. Characteristics include sensation of the saddle area, movement of the toe flexors, and rectal sphincter contraction
Spinal Shock A physiological response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. Spinal shock presents with total flaccid paralysis and loss of all reflexes below the level of injury
Tenotomy A surgical release of a tendon in order to decrease spasticity and improve function
Tetraplegia (quadriplegia) A term adopted by the American Spinal Cord Injury Association to describe injuries that occur at the level of the cervical spine
Zone of Perservation A term used to describe poor or trace motor or sensory function for up to three levels below the neurlogic level of injury
Autonomic Dysreflexia Symptoms High BP, severe headache, blurred vision, stuffy nose, profuse sweating, goosebumps below the level of the lesion, and vasodilitation(flushing) above the level of the lesion