NDT Final
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
1190550002
Popular Physical Therapy sets