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NPTE: SCI
Review of Spinal cord Injuries & Treatment
| Question | Answer |
|---|---|
| Lumbar Level of Most Common SCI | L1-L2 |
| Define Spinal Shock | Temporary phenomenon that occurs after trauma to SC in which cord ceases to function below lesion; usually resolves within 24 hrs of injury |
| Designation of spinal level | Defined as the most caudal level of SC that exhibits intact sensory & motor function; muscles must have grade 3+/5 strength |
| Define Complete Lesion | Total & permanent functional disruption of SC more than 3 segments below level of lesion |
| Define Incomplete Lesion | SC is not totally disrupted at level of injury; preservation of some function more than 3 levels below lesion |
| Describe presentation of Brown-Sequard Lesion | Hemisection of cord; IPSI motor weakness/paralysis, loss of proprioception, two-point touch and CONTRA loss of pain & temperature |
| Describe presentation of Anterior Cord Lesion | Results from ant trauma to SC or ant spinal artery; loss of motor function & pain & temperature below level of lesion |
| Describe presentation of Central Cord Lesion | Most common cause hyperext injuries; effects UE sensation & motor function with normal LE function |
| Describe presentation of Posterior Cord Lesion | Very rare; deficits of stereognosis, proprioception, 2-point discrimination; Ataxic gait with wide BOS |
| Describe presentation of Cauda Equina Lesion | Injury below L1 segments: Sensory loss, paralysis, loss of B/B function; bc damage to peripheral nerve roots regeneration possible |
| The Diaphragm is innervated by which nerve & it's cord segments. | Phrenic Nerve; C3-C5 |
| General effects on Respiratory System following SCI | Decreased Tidal Volume & Vital Capacity; accessory muscles of inhalation may be used more |
| General effects on Cardiac System following SCI | When symp input lost, parasym input remains causing bradycardia, peripheral vasodilation, & hypotension |
| Pressure relief guidelines to prevent pressure sores | Should take place 3-4xs/hr OR every 15-20 minutes regardless of material under pt |
| The most common cause of death following SCI is due to... | Respiratory dysfunction |
| Techniques to prevent DVTs in SCI population | A regular turning program, PROM exercise, elastic stockings & proper positioning of LEs |
| Define Autonomic Dysreflexia | A medical emergency characterized by increase in BP, bradycardia, pounding HA, profuse sweating, and anxiety |
| What is the most common cause of Autonomic Dysreflexia? | Bladder Distention |
| Immediate things to do if pt is experiencing Autonomic Dysreflexia | Check bladder drainage system & open up if necessary. If lying flat, pt should be brought to sitting position to lower BP. |
| Treatment for Postural/Orthostatic Hypotension | Slow progression to vertical while monitoring vitals, use of compression stockings & abdominal binder to minimize effects of hypotension |
| Key muscles in C1-C3 injury | Face & Neck muscles |
| Clinical picture of pt with C1-C3 injury | Capable of talking, mastication, sipping, blowing; Protable ventilator or phrenic stimulator, power "tilt-in-space" WC with mouth control & seatbelt for trunk control |
| Key muscles in C4 injury | Diaphragm & Trapezius |
| Clinical picture of pt with C4 injury | Capable of respiration & shoulder elevation; Chin control WC, adaptive eating equipment, head and mouth stick etc, limited feeding & ADLs, uses glossopharyngeal breath to cough |
| Key muscles in C5 injury | Biceps, Brachialis, Brachioradialis, Deltoids, Infraspinatus, Rhomboids, & Supinator |
| Clinical picture of pt with C5 injury | Power chair with hand controls for community, manual WC with rim projections 200-300 ft indoors, mobile arm supports to assist UEs, needs assistance for manual cough |
| Key muscles in C6 injury | Extensor carpi radialis, Infraspinatus, Lats, Pec Major, Serratus Ant, Teres Minor |
| Clinical picture of pt with C6 injury | Manual WC with projections or friction hand rims, May require power WC for community, can drive auto with hand controls, Tenodesis grip, uses manual cough ind |
| Key muscles in C7 injury | Extensor pollicus longus & brevis, Extrinsic finger extensors, Flexor carpi radialis, Triceps |
| Clinical picture of pt with C7 injury | Capable of elbow ext, wrist flex, finger ext; Manual WC for community with some difficulty on rough terrain, able to get WC in/out car, button hook may be necessary for dressing |
| Key muscles in C8 injury | Extrinsic finger flexors, flexor carpi ulnaris, flexor pollicus longus & brevis |
| Clinical picture of pt with C8 injury | Capable of full use UEs except intrinsic mm of hand; Ind at home except with heavy work, May need tub seat, grab bars etc for full ind at home, Manual WC, Able to work in building free of barriers |
| Key muscles in T1-T5 injury | Top half of intercostals, long back extensors, intrinsic finger flexors |
| Clinical picture of pt with T1-T5 injury | Capable of full use UEs, improved trunk control & resp reserve, Standing table for physiological standing, Manual WC, able to wheelie & participate in WC sports |
| Key muscles in T6-T8 injury | Long muscles of back including sacrospinalis and semispinalis |
| Clinical picture of pt with T6-T8 injury | Capable of improved trunk control, increased respiratory reserve; Ind in swing-to gait parallel bars with Bilat KAFOs & walker/crutches; WC for community amb |
| Key muscles in T9-T12 injury | Lower abdominals & all intercostals |
| Clinical picture of pt with T9-T12 | Capable of incr endurance & improved trunk control; Ind floor-WC transfers, swing-to/thru gait with bilat KAFOs & forearm crutches level surfaces, may be ind home amb, may use WC for community & energy conserv |
| Key muscles in T12-L3 injury | Gracilis, Iliopsoas, QL, Rectus femoris, & Sartorius |
| Clinical picture of pt with T12-L3 injury | Capable of hip flex, ADD, & knee ext; Ind home ambulator, Ind swing-to/thru or 4point with bilat KAFOs & forearm crutches level surfaces, WC for energy conserv, may be ind n community |
| Key muscles in L4-L5 injury | Lowback mms, Medial hamstring(weak), Post Tib, Quadriceps, Tib Ant |
| Clinical picture of pt with L4-L5 injury | Capable of strong hip flex, knee ext, weak knee flex, improved trunk control; Ind home ambulators, can be community ambulators, may use WC for convenience or energy conserv |
| Cord segments of Abdominal Innervation | T5-T12 |
| Cord Segments of Intercostal Innervation | T1-T12 |
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zimrizzle
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