Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
N SCI
notes from lecture
| Term | Definition |
|---|---|
| sci causes- traumatic | falls, violence & sports related |
| non-trauma | congenital-spina bifida, tumor, vascualar (hemorrhage or clot), protruding disc, infection (transverse myelitis), neurological dx, jt subluxation 2nd to RA/OA, severe scoliosis |
| quadriplegia, quadriparesis, tetraplegia | injury to cervical region of spine |
| paraplegia, paraparesis | injury to thoracic spine, usually have UE funtion |
| level of lesion | ways to remember what functional impairment pt is at. different levels- usually determined by dermatome test- most caudel segment w/ normal sensory & motor function. 3/5 =normal |
| oblique injuries | some mm innervated by more than one segment-look for lowest level w/function |
| complete | sensory & motor function absent below level of injury & also S4 & S5 |
| incomplete | some sensory or motor function below level of injury & also in S4 & S5 |
| Brown Sequard | one side- like stabbing or gunshot wound- motor, proprioception & vibration lost on ipsilateral (same) side, on contralateral (opposite side)- pn & temp perception lost |
| ant cord syndrome | front- cv flex injury- sudden jerk to head-lose motor, pn & temp bilaterally-proprioception & vibration intact |
| post cord syndrom (dorsal column syndrome) | rare-lose proprioception & vibration bilaterally-tumor or vascular cause |
| central cord syndrome | caused by hyperext or compression injury- have more deficit in UE than LE-typically have bowel, bladder & sexual function intact-most common |
| SCI incomplete classifications | sacral sparing, cauda equina, root escape |
| sacral sparing | intact perianal sensation, can flex big toe, rectal sphincter control |
| cauda equina | below L1 vertebra-incomplete or motor neuron lesion |
| root escape | return of some nerve root function- peripheral nerve not spinal cord function |
| SCI damage - boney | fx, subluxation, dislocation, most common: C1 & C2, C5-C7, T12-L2-spinal cord larger in those areas and have more rotation so not as stable |
| SCI damage- tissue damage | compression, stretch, tear, shear, transection (prob that includes destruction of gray and white matter). secondary-inflammation, edema, hemorrhage |
| SCI damage mechanisms flex/rotation | usually cv area-most common MVA- head goes fwd & turns-rupture post spinal lig & disc- cork transection usually-usually complete lesion |
| SCI damage mechanisms flexion | result of head on MVA or getting hit in back of head- stretches post ligament & usually causes ant compression fx-often incomplete |
| SCI damage mechanisms hyperextension | from being rear ended or if fall & hit chin- ruptures ant longitudinal lig & disc- results in central cord inj |
| SCI damage mechanisms compression | diving or falling-causes compression fx- burst fx |
| SCI clinical pic/ below the level of lesion | loss of voluntary mm control, spasticity, loss of sensation, respiratory, autonomic, loss of bowel & bladder control S2,3,4, sexual dysfunction |
| spasticity | increases w/cv injury or incomplete- ext tone dominant, synergies, rx same as other spasticity |
| respiratory | C1-3 phrenic nerve (diaphragm not functioning), ventilator, internal/external intercostals (need for inspiration-may or may not have, depends on level of lesion), forced exp/cough (ext intercost, abd), accessory breathing, trauma, infection |
| autonomic | sypethetic instability, vasodilation/ constriction, sweating |
| loss of bowel & bladder control S2,3,4 | bladder spastic or flaccid (initially flaccid due to spinal shock), bladder trning (goal-free of cath) |
| bladder trning indwelling | suprapubic (inserted thru abd wall), leg bags. trning may be intermittent. |
| crede maneuver | application of manual pressure over bladder to empty |
| emptying schedules | inj abv S2 spastic-bladder empties reflexively bc sacral reflex intact/injury S2,3,4 flaccid- requires manual |
| bowel- S4 & S5 innervate bowels | may need suppositories, hi fiber diet, adequate fluid intake, digital stimulation |
| male sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) | reflex erection, poor ejaculation, poor fertility |
| female sexual dysfunction (will see this @ S2,3,4 & anything above-upper motor neuron lesion) | mensis preserved, fertility preserved, C-section |
| SCI Clinical Pic Secondary Complications (partial list) | pressure sores, respiratory (ventilator, tracheostomy, need RT, postural drng, infection, not much coughing), urinary, UTI (most common recurring prob), loss of kidney function (kidney failure & stones), contractures, osteoporosis |
| SCI Clinical Pic Secondary Complications (autonomic dysreflexia) | injury abv T6, sudden severe HTN 2nd to: bladder distention, bowel impaction, pressure sore, kidney malfunction, abn position of body part, pn |
| S&S of autonomic dysreflexia | severe HA, restless, HTN, decreased HR, c/o chest tightness, face flushed, pupils constricted, blurred vision, runny nose, sweating, chill bumps (piloerection), vasodilation above, constriction below |
| Rx of autonomic dysreflexia | ID cause (often kinked/blocked cath or position) and rx, monitor BP, sit up, notify medical staff-may require medication to decrease BP |
| SCI Clinical Pic Secondary Complications (cont) | orthostatic HTN, hetertrophic ossification, DVT's, sharp acute pn & chronic pn, phantom pn, pn from overuse, reaction to disability |
| Hetertrophic ossification | bone dev in soft tissue, most likely in hip, pn w/mvmt, acute inflammation, fever, get x-ray to look for extra bone, rx w/didronel, keep moving, sx |
| emergency care | ID possible SCI & immobilize |
| skeletal tx | (CV)- halo-12 weeks, special bed (stryker, rotobed) bed they can lay in & be turned (strapped in-can go all the way to prone) |
| CV brace | halo x 12 wks, don't adjust screws or take off, leads to rigid cv collar- may or may not have, depends on severity |
| Thoracic/lumbar brace | body jacket x 3 months (like a shell)- precautions-bed flat- if sitting up, need jacket on, tee shirt under, log roll, monitor for pressure sores |
| SCI acute management sx | fusion/bone graft, decompression laminectomy, ORIF w/ Harrington rods, wires, screws |
Created by:
jessigirrl4
Popular Physical Therapy sets