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Phys Rehab SCI Exam

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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