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NDT Final
| Question | Answer |
|---|---|
| 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 |
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