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NDT Final

lowest (most caudal) neurological segment with both normal motor & sensory function is what? Neurological Level of Injury
up to 3 neurological segments at the point of damage to the SC where there is frequently some preservation of motor &/or sensory function is what? Zone of Injury
no preservation of any motor &/or sensory function below the zone of injury is what kind of injury? Complete Injury
If patient has no contraction or sensation or anal sphincter muscle when finger inserted, are they complete or incomplete? Complete
Preservation of any motor &/or sensory function below the zone of injury, which includes sacral sensory sparing is what kind of SC injury? Incomplete Injury
Impairment or loss of motor &/or sensory function in the cervical neuro segments 2ndary to damage of neural elements within SC is? Tetraplegia (current term) or Quadriplegia
Impairment or loss of motor ∨ sensory function in the thoracic, lumbar, or spinal canal. Includes cauda equina & conus medullaris injuries, but not root abulsion/peripheral n injury outside neural canal. Paraplegia/Paraparesis
If a person receives a SC injury at level T1 or below, they are termed what? Paraplegic
ASIA- No sensory or motor function in sacral segment S4-5. May have sensation up to S4-5 A= Complete
Preservation of sensation below the level, extending through S4-5. No mvmt beyond zone of injury. B= incomplete (Motor Complete & Sensory Incomplete)
Preservation of motor function, with majority of key mm below leve of injury having MMT <3. C= incomplete (Motor useless)
Preservation of motor function with majority of key mm below level of injury having MMT 3 or more. D= incomplete (Motor useful)
Recovery of normal motor & sensory function E= Normal (Complete Recovery)
What syndrome includes an injury through sacral cord & lumbar n roots traversing the neural canal with areflexic bladder, bowels & LEs? Conus Medullaris Syndrome
What syndrome includes an injury below the conus to lumbosacral n roots within the neural canal with areflexic bladder, bowels & LEs? Cauda Equina Syndrome
What syndrome includes a dissociation in degree of motor weakness with lower limbs stronger than upper limbs & sacral sensory sparing? (Usually arms more involved than legs) It is often from a blunt force. Central Cord Syndrome
What syndrome is a modified hemisection of SC & involves ipsilateral paralysis & contralateral sensory loss? Brown-Seguard Syndrome
What occurs when nerve signals try to go up & can't, so they go down, then back up, leading to peripheral artery constriction, & thus escalation of BP? Autonomic Dysreflexia
Symptoms of Autonomic Dysreflexia Sweating & flushing above LOL; Pound HA & Nausea (KEYS); Elevated BP; Goosebumps & chills without fever; Blurred vision; Anxiety
What do you do with a patient experiencing autonomic dysreflexia? Sit them up (lower BP)!; Check catheter (unkink if necessary); Loosen clothing, remove abdominal binder/ted hose; Ask about bowel/check for increased distention; If still unresolved, call EMS!
Respiratory Issues of SCI pts Need encouragement for breathing ex's; watch changes in breathing due to increased risk of infection; if they "feel a catch", stop what you're doing & call MD asap!
Orthostatic Hypotension in SCI pts Decreased BP; Use of ted hose, abdominal binder, medication, lay pt down with legs elevated; slowly elevated patient over time
What occurs when there is growth of bone in a muscle near a joint? Heterotrophic Ossification
Is heterotrophic ossification reversible? No, once it occurs, it can't be taken out!
S/sx of Heterotrophic Ossification Swelling; Warmth; Decreased ROM of extremity; Fever
S/sx of pulmonary embolism (EMERGENCY) Shortness of breath; feeling a catch when breathing; chest pain/pressure; decreased BP; increased HR; feeling of impending doom
S/sx of DVT (if noted, pt needs medical attn asap!) Swelling to extremity; Pain; Low-grade fever; Warmth
Where are the areas selective tightness is desired? Finger flexers; Thumb webspace; Low back extensors
Why is selective tightness desired? Muscles need to be tight to have a functional "quad body"
How many hours of therapy does a patient have to tolerate in in-patient rehab? 3 hours/day
What is the leading cause of death after SCI? Pneumonia/respiratory conditions
Nerve roots/muscles for inspiration T1-12 intercostals/accessory mm C2-T1
Why are abdominal binders utilized? Increased VC; assistance with venous return; Cosmesis
Exhalation (Passive & Active) Passive- Normal breathing; Active- cough, speak, sing, exercise
How can a patient's airway be cleared after an SCI? Suction; Assisted cough; Self-assisted cough; Postural drainage
Abdominal Thrust (assisted cough) Heimlich Type- push in & up at diaphragm Contraindications: PEG tube; abdominal surgery; pregnancy; IVC filter; fractured ribs
Lateral/costophrenic assist (assisted cough) Hands on lateral costal martin- push in & squeeze while pt breathes out/coughs Contraindications: flail chest; fractured ribs; pregnancy; osteoporosis
Which muscles are needed to roll over in bed? Pecs & Ant/Post delts
Turning in bed should be done how often? Every 2 hours
How often should pt shift weight while sitting in a w/c? Every 15 mins & hold 7-10 secs
Bladder: T12 & above; small capacity with occasional spasms; spastic sphincter; indwelling/suprapubic options; intermittent cath (every 4-6 hrs) Reflexive (Spastic)
Bladder: T12 & below/spinal shock; Flaccid sphincter; Large capacity; Incontinent with valsalva/increased intra-abdominal pressure; Catheter (every 4-6 hrs) Areflexive (Flaccid)
Bowel: 1-2 days; meds-softeneres; suppositories; diet- high fiber & fluid Reflexive Bowel (Spastic Sphincter)
Bowel: 1-2 days; Flaccid sphincter (DO NOT stretch with dig stim); Meds- avoid softeners; Suppositories; Diet- high fiber & fluids Areflexive Bowel (Flaccid Sphincter)
Techniques to use with Reflexive Bowel Dig stim; Position with knees higher than hips; Side to side lean; Assist with ant/post weight shifts, depression lifts, credea massage, hot drinks/timing after meals
Techniques to use with Areflexive Bowel Manual evacuation; Valsalva; Positioning- knees higher than hips, side to side lean; Assist with ant/post weight shifts, depression lifts, Cerdea massage, hot drinks/timing after meals
What are specifications for an at-home ramp? For every 1" in rise, 12" run recommended
Doorway specifications Straight entry- 32" Turn entry- 36"
S/sx spinal shock No reflexes; Flaccidity; Loss of sensation/mvmt below LOL; Lasts several hours-several weeks; Early resolution=good
Bulbocavernosus Reflex If (+), spinal shock is over. If (+) without sensory/motor return, esp in perianal region, spinal shock has decreased but usu this means there is a complete lesion
Another name for autonomic dysreflexia is... Hyperreflexia
Why does autonomic dysreflexia happen? Acute noxious stimulus below LOL--massive reflex response--increased BP, pounding HA, bradycardia, profuse sweating above LOL, vasodilation above LOL, increased spasticity, restlessness, constricted pupils, nasal congestion,goosebump, blurry vision
Why does postural hypotension happen? CAUSED by loss of sympathetic vasoconstriction. ENHANCED by lack of muscle tone-- peripheral venous & splanchnic bed pooling--decreased cerebral blood flow & decreased venous return to heart--lightheadedness, dizziness, fainting. +/- pitting edema
Postural hypotension more common in which areas of lesion? Cervical/Thoracic
Impaired Temperature Control with SCI Below LOL can't shiver; No vasodilation/constriction in response to heat/cold; no sweating-excessive compensatory diaphoresis above LOL; INcomplete lesions- spotty areas of localized sweating BLOL
What level of injury loses phrenic n. completely? C1-C2/3; must use ventilator or phrenic n simulator
Major pulmonary complications with SCI? Bronchopneumonia & Pulmonary Embolism
Altered breathing patterns with SCI Flattening of upper chest wall, decreased chest wall expansion, dominant epigastric rise during inspiration
Relaxation of diaphragm occurs when? Expiration; Negative intrathoracic pressure moves air into lungs
Spasticity with SCI BLOL after spinal shock; increases during first 6 mos
What will increase spasticity? Moving affected limbs too quickly; Pain; Noisy environment; Distractions; Various temp changes; Psych issues
When is spasticity helpful? Slight weight-bearing; Assisting with xfers
Most frequent bladder/bower medical complication in early rehab is? UTI
Bladder is what during spinal shock? Flaccid
Bladder with a lesion within cord above conus medullaris? Spastic (reflexive) bladder
Spastic (reflexive) bladder Contracts & reflexively empties in response to certain filling pressures
Spastic (reflexive) bladder is aka what? UMN Bladder
Bladder with lesion of conus medullaris (cauda equina) Flaccid (Areflesive/Non-reflex) bladder
Flaccid Bladder No reflex activity of detrusor muscle; empty by increasing intra-abdominal pressure using valsalva or manually compressing lower abdomen (Crede)
Flaccid (Areflexive) Bladder is aka what? LMN Bladder
Bladder Program for reflex bladder Intermittent catheterization & restriction of fluid intake
Bladder Program for areflexive bladder Timed voiding; establish intake & voiding schedule
Use what with a reflexive bowel? Suppositories & dig stim
Use what with a non-reflexive bowel? Straining with available muscle & manual techniques
Male erectile capacity greater in UMN lesions & INcomplete SCI
Reflexogenic Erection (Male) External stimulation of genitals/perineum. Needs intact reflex arc.
Psychogenic Erection (Male) Cognitive activity; reflex arc not rquired
Ejaculation-Males Higher incidence with LMN, esp with low LOL; better with INcomplete lesion
Which sex has affected fertility with SCI? Males; female fertility is unaffected
Female sexual response with UMN Psychogenic response lost; sexual arousal occurs through reflexogenic stimulation
Female sexual response with LMN Psychogenic responses but no reflexogenic responses
When does menstruation return? 1-3 mos post-injury, regardless of LOL or complete/incomplete
Pregnancy in females with SCI can get pregnant but not perceive labor pains; this could trigger autonomic dysreflexia
2 most influential factors in developing pressure sores Loss of sensation & Inability to move
Loss of vasomotor control causes pressure sores why? Lowering of tissue resistance to pressure
Spasticity causes pressure sores why? shearing forces b/t surfaces
Pressure sores from skin maceration occurs why? Exposure to moisture (usu urine)
Nutritional deficiencies can lead to pressure sores how? Low serum K+ & anemia
DVTs according to Barb loss of normal pumping action in LE mm; increases with age & prolonged pressure on body parts; loss of vasomotor tone & immobility
DVTs most frequent when? first 2 months
Prolonged pressure on body parts leads to? Damaged blood vessel wall; precipitates initiation of clotting mechanism = DVT
Loss of vasomotor tone & immobility? Venous stasis, sepsis, hypercoagulability & trauma
Contractures are due to what? Paralysis + spasticity, faulty positioning, HO, edema
Contractures commonly seen in what positions? Hip- flexion, adduction, IR Shoulder- flexion/extension, IR, adduction
HO is what, in relation to joint & capsule? Always extra-capsular & extra-articular
Early s/sx of HO? swelling; decreased ROM; erythema; local warmth near joint; (-) X-ray initially
Does surgery prevent recurrence of HO? No!
Traumatic Pain As body heals, subsides. May need to be immobilized for injuries other than just SCI; +/- analgesics, TENS
Nerve Root Pain May arise from damage or/near site of cord damge= sharp, stabbing, burning, shooting. Follows dermatomes. Most common in cauda equina injuries. Drugs; +/- TENS; Possible surgery.
Spinal Cord dysesthesia Peculiar, painful sensation BLOL; diffuse & NOT follow dermatomes; Occurs in parts that otherwise lack sensation; Decrase over time except with cauda equina injuries. Handle limbs carefully!
Musculoskeletal Pain usually involves what joint? Shoulder, occurs above LOL
Musculoskeletal pain due to what usually? Faulty positioning ∨ inadequate ROM
Osteoporosis & Renal Calculi Changes in Ca2+ metabolism--osteoporosis BLOL & development of renal calculi. Following SCI, net loss of bone mass b/c rate of resorption>rate of new bone formation. Increased fractures first 6 mos.
Treat osteoporosis & renal calculi with what? Good diet & wt bearing
Created by: 1190550002
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