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Phys Rehab SCI Exam
| Question | Answer |
|---|---|
| What diseases can cause SCI? | tumors, syringomyelia, MS, ALS, Guillian-Barre, poliomyelitis |
| What are two congenital causes of SCI? | meningomyelocele and spina bifida |
| What are circulatory causes of SCI? | surgery, aneurysms |
| What types of trauma cause SCI? | MVA, gunshot, stab, falls, sports, diving |
| Complete injury results in: | total paralysis and loss of sensation below level of injury |
| Incomplete injury results in: | some preservation of sensory and/or motor below level of injury |
| central cord injury | greater UE sensory loss and paralysis because UE nerve tracts are centrally located |
| Brown-Sequard Syndrome | when one side of spinal cord is injured |
| Anterior Spinal Cord Injury | paralysis and loss of sensation EXCEPT proprioception |
| Cauda Equina Injury | sensory and motor deficits; peripheral nerve injury which has a chance to recover (below L 2) |
| Characteristics of spinal shock | 24 hours to 6 weeks long; prone to low blood pressure and hypothermia; loss of sensation, flaccid below level of injury - includes reflexes and bowel/bladder |
| recovery from spinal shock | sensation loss continues, muscle spasms may occur ** Above T 12 spastic bowel/blader; below T 12 flaccid bowel/bladder |
| spastic bowel/bladder | characterized by reflex emptying |
| flaccid bowel/bladder | characterized by fullness that cannot be emptied except with help |
| Stages of decubuti | 1. reddened skin (within 30 min); 2. reddened area does NOT blanche (necrosis has begun); 3. blister/ulcers appear; 4. underlying tissue/bone destroyed |
| prevention of decubuti | relieve or eliminate pressure points + protect vulnerable areas |
| Decubuti/pressure sore risk | Pt cannot feel pressure or shearing or presence of pain/heat; loss of blood supply to area due to pressure causes skin breakdown; bony prominence |
| Injury level dependent on ventilator | C1 to C3 |
| head, neck and breathing control | C4 |
| some shoulder and some elbow flexion | C5 |
| some wrist extension | C6 |
| some elbow extension and some hand | C7 |
| all UE but hands may be weak | C8 |
| some trunk (general region) | thoracic |
| all trunk plus some leg: hips (general region) | lumbar |
| more leg: knee to ankle | sacral |
| What does the level of SCI indicate? | the last fully functioning spinal nerve |
| How often should pressure relief be done for paraplegia? | at least every 20 to 30 minutes |
| When is immobilization used in treating paraplegia? | in the first few weeks |
| What is a trunk orthosis? | Used initially to help support during acute and subacute phase. Physician will tell us when to remove. |
| Complications of SCI | sensory loss, decreased vital capacity, osteoporosis, orthostatic hypotension, autonomic dysreflexia, spasticity, heterotopic ossification, bowel and bladder control, sexual function |
| symptoms of autonomic dysreflexia | immediate pounding headache, anxiety, perspiration, flushing, chills, nasal congestion, hypERtension, bradycardia |
| autonomic dysreflexia | life threatening reflex action of autonomic nervous system that occurs in injuries above T6 |
| treatment for autonomic dysreflexia | upright position, remove restrictive clothes, abdominal binders, elastic stockings (to lower BP); drain bladder (check catheter); monitor BP call nurse ASAP |
| performance components in SCI | motor (pain, muscle tone), sensation, trunk control, LE abilities [if TBI also visual percept and cog] |
| ADLs to consider in SCI | toileting/cath, adaptive equip, home/school/work, pre-vocational, adaptive driving, home assessment, assistive tech |
| How often pressure relief paraplegia? | every 20 to 30 minutes |
| w/c pressure relief techniques paraplegia | lean, w/c pushup, lean forward |
| paraplegia trunk stability: when reaching | hold onto back of chair, lean on table |
| quadriplegia pressure relief schedule | at least every 20 minutes |
| How can quad use hands? | tenodesis movement |
| What level of SCI commonly has pain in shoulders? | C4-C7 |
| Dorsal splint | resting hand splint that allows feedback on volar side |
| Name 5 splints for quadriplegia | dorsal splint, tenodesis splint, long opponent splint, short opponens splint, wrist cock-up splint |
| When do you use long opponens splint? | use if minimal wrist movement, poor wrist extension of 10-20 degrees (C5) |
| When do you use short opponens splint? | use if wrist extension has F+ strength; it actually stops at wrist |
| What does flexor hinge splint do? | grasp and release by controlling wrist movement, either via wrist AROM or externally powered |
| How does quadriplegic use wrist cock-up splint? | use with universal cuff if pt has NO wrist extension |
Created by:
ota2012
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