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exam 4

neuro teri

TermDefinition
vertebral colum 8 cervical, 12 thorasic,5 lumbar, 5 sacral, 3-5 coccygeal (30 spinal cord segments)
spinal menings pia mater (innermost layer), arachnoid layer (subarachniod space contains csf), dura mater ( outermost layer, sensory nerve endings)
cuada equina "horse tail" ends at L1 (are periphreal nerves in spinal cord)
what happens with a sci Above L1 upper motor neuron signs, spasticity and hyper-reflexia
what happends with sci below L1 damage the periphjreal nerves of cauda equina, lower motor neuron signs, flaccidity and hyporeflexia
what are the componets to grey matter composed of neuron cell bodies and dentrites. has three regions dorsal horn( sensory nerve fibers), lateral horn (cells of autonomic neurons), ventral horn ( cells of motor neurons)
what are the componets of white matter contains columns of axons ascending tracts (afferent) carry sensory info to the brain. descending tracts (efferent) carry motor signals from the brain to body.
what are the four major ascending tracts doral columns, lateral spinothalamic, anterior spinothalamic, spinocerebellar.
dorsal columns two piont discrimination, vibration, conscious proprioception
lateral spinothalamic pain, temperature
anterior spinothalamic tracts light touch, pressure
spinocerebellar unconscious propioception, conveys info to cerebellum, tension and position of tendons and muscles
what are the descending tracts lateral corticospinal tracts, anterior corticospinal tracts,reticulospinal tracts, vestibulospinal tracts.
lateral corticospinal tracts responsible for voluntry movement, connect motor portions of brain to muscles, injury causes ipsilateral paralysis or paresis.
anterior corticospinal tracts primarily innervates upper exremity muscles, does not cross medulla
reticulospinal tracts fibers originate from brainstem, controls rythmic gait patterns, communicates with ans, helps inhibit muscle tone.
vestibulospinal tracts helps control balance, damage results in ataxia and balance problems.
quadriplegia (tetraplegia) all four limbs affected
paraplegia lower extremities affected
hemiplegia one side of body affected
monoplegia one extremity affected
complete sci no motor or sensory function below level of injury, no anal sensation.
incomplete sci any motor or sensory function below level of injury, anal sensation.
C1-C4 effects neck stability and mobility
C3-C5 effects diaphragm, ventilator dependent
C5-T1 effects upper extremities, tetraplegia
T1-L5 effects trunk muscles, intercostals, accessory respiratory muscles.
L2-S4 lower extremities, paraplegia
S2-S4 effects sphincter control, sexual function,
Brown-Sequard Syndrome Lesion to ½ the spinal cord, Ipsilateral side: motor paralysis and loss of proprioception, Contralateral side: loss of pain, temperature, and touch sensation
Central Cord Syndrome “Reverse paralysis,Motor and sensory loss is greater in the upper extremities
Anterior Cord Syndrome Complete motor paralysis, Paralysis and loss of pain, temperature, and touch sensation; proprioception is preserved
Cauda Equina Syndrome Flaccid paralysis, Bowel and bladder problems, Usually with fractures below L2, Better prognosis for recovery
dermatome sensory region of the skin innervated by a nerve root
Age: : 58% SCI’s occur in persons 16-30 years of age
Gender : 82% male
C5 Elbow flexors (biceps, brachialis)
C6 Wrist extensors (extensor carpi radialis ,longus ,and brevis)
C7 Elbow extensors (triceps)
C8 Finger flexors (flexor digitorum profundus) to the middle finger
T1 Small finger abductors (abductor digiti minimi)
L2 Hip flexors (iliopsoas)
L3 Knee extensors (quadriceps)
L4 Ankle dorsiflexors (tibialis anterior)
L5 Long toe extensors (extensor hallucis longus)
S1 Ankle plantarflexors (gastrocnemius, soleus)
mmt 0-total paraliysis, 1-palpable or visible contraction, 2-active movement gravity eliminated, 3-movement against gravity, 4-movement against resistance, 5-movement against full resistance.
Treatment Involving C1 to C4 Self-directed care, PROM including abduction protocol, mouthsticks, communication/ recreation, w/c selection (team), environmental control units (ECU), work, school, etc.
Treatment Involving C5 Self-directed care, PROM, AAROM including abduction protocol, ADL, communication/ recreation, w/c selection (team), Splinting, dorsal wrist supports, long opponens, resting hand, ECU,
abduction protocol supine, pillow behind scapula, shoulder abducted 90 degrees, elbows extended, forearms supinated, wrist neutral.
Treatment Involving C6, C7, & C8 treatment for higher level injurie, Tenodesis training, Electrical stimulation to wrist extensors for muscle re-education, Simple Homemaking, Driving
how long can bowel management take two weeks to a month
reasons for bowel management Prevent constipation and impaction, Prevent autonomic dysreflexia, Prevent bowel accidents
Reflexive bowel empty upon reflex if the colon is full associated with T12 and above easier to train
A-Reflexive bowel sphincter remains open can be trained with consistency
bladder management UMN (spastic bladder) Injuries above T12 Muscle spasms cause spontaneous voiding, LMN (flaccid or neurogenic bladder) Injuries T12 and below muscles of the bladder will not contract or spasm
Foley catheter always drains the bladder, so the bladder does not fill greatest risk of UTI
ICP - Intermittent Catherization Program catheterized every 4-6 hours using the sterile or clean technique urine output should not exceed 400-500 cc as preferred method due to decreased risk of UTI’s
condom catheter) also allows the bladder to always drain less risk of UTI than Foley catheter
Suprapubic catheter placed through the abdomen into the bladder easy to self-manage, especially for women.
FIM scale 1-7 , dependant, max, mod, min, supervised, mod ind, independent.
Autonomic dysreflexia LIFE THREATENING!!! (may be seen in persons with injuries above T4-T6*), dysreflexia may occur with injuries above T5
symptoms of autonomic dysreflexia •Pounding headache •Anxiety •Perspiration •Flushing •Chills •Nasal congestion •Sudden, severe elevation in blood pressure •Bradycardia
Treatment of Autonomic Dysreflexia •Sit individual up if they are supine; do not leave individual alone!Check and remove anything restrictive •Check catheter tubing for kinks - •Check catheter bag •Monitor blood pressure •Check for abdomen distention, provide bowel program •Check f
PNS Somatic nervous system - voluntary, Autonomic nervous system - involuntary
Somatic nervous system - voluntary Input from sensory organs in muscles, tendons, and joints Output from skeletal muscles
Autonomic nervous system - involuntary Sympathetic Parasympathetic Input from internal receptors Output to smooth muscles/glands
motor axons pass into the ventral roots before uniting with the sensory axons to form the mixed nerves., Motor neurons ("Efferent") - moving toward muscle, organ
sensory axons pass into the dorsal root ganglion where their cell bodies are located and then on into the spinal cord itself, Sensory neurons ("Afferent") - moving away from muscle, organ
spinal nerves 31 pairs "mixed"
decreased vital capacity limited chest expansion due to weakness or paralysis of secondary respiratory muscles
What are the spinal nerve roots that comprise the brachial plexus? C5,C6,C7,C8, T1
In your spinal cord, what kind of tract is located aneteriorly? Motor
In your spinal cord, what kind of tract is located dorasally? Sensory
Sensory axons go to what after leaving the spinal cord? Doral root ganglion
motor axons go to what after leaving the spinal cord? ventral roots
What is the exception to the rule that each signal travels to the brain and back down for output spinal reflex
Created by: 1114124408