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211 exam 1
Assessment of Spinal Cord Injury
| Question | Answer |
|---|---|
| most common cause of SCI worldwide | trauma |
| __plegia is more common than ____plegia | tetra, para |
| ____ injury more common than ____ injury | Incomplete, complete |
| Incidence is highest among _____ and those older than ___ | young adults, 65 |
| formal name for ASIA scale | ISNCSCI |
| what does ISNCSCI stand for? | International Standards for Neurological Classification of Spinal Cord Injury. |
| 2 classifications of motor incomplete are based on the ____ preserved below the LOI | muscles |
| what is the ASIA scale testing? | the strength of nerve functioning |
| how quickly should the ISNCSCI be done after injury? | 24 hours is gold standard, within 72 hours |
| when will ISNSCI be repeated? | upon admit/discharge to rehab (both ideally) Again 3 months- 1 year out of injury by OP physiatrist or SCI board certified neurologist/neurosurgeon Ideally- follow by a primary PT and completed 1x/year after that. |
| we are testing the ____ not the ____ | nerve root, muscles we want to pick the muscle that is most innervated by that nerve root |
| NLI | Lowest segment (most caudal) with BOTH normal sensation and motor control on BOTH sides |
| sensory level | The lowest segment (most caudal) with normal sensation on BOTH sides for BOTH sharp/dull and light touch |
| motor level | Lowest segment (most caudal) with key muscle scoring 3 or higher BILATERALLY with key muscles rostrally (above) 5/5. |
| skeletal level | Radiographic level of greatest vertebral damage. **NOT necessarily the same as the ISNCSCI |
| complete SCI | Total paralysis with loss of sensation from a complete interruption of all the ascending and descending tracts below the level of injury. NO Sensory/motor function preserved in S4-S5 |
| incomplete SCI | Has some remaining sensory or motor function below the level of injury Sensory &/OR motor function present at S4-S5 |
| Grades of incomplete injury | B-D, grade A is complete injury |
| grade A (complete) | no sensory or motor function is preserved in the sacral segments S4-S5 |
| grade B (sensory incomplete) | Sensory but NOT motor function is preserved below the NLI and includes the sacral segments S4-S5 AND no motor function is preserved more than three levels below the motor level on either side of the body |
| grade C (motor incomplete) | Motor fn preserved at most caudal sacral segments for voluntary anal contraction OR the patient meets criteria for sensory incomplete status and some sparing of motor fn more than three levels below the ipsilateral motor level on either side of the body. |
| grade D (motor incomplete) | motor incomplete with at least half of key muscle functions below the NLI having muscle grate > 3. |
| grade E (normal) | graded normal in all segments and the patient had prior deficits. |
| sensory assessment for S4/5 | Sensation to light touch and sharp/dull superficially Deep sensation to pressure |
| motor assessment for S4/5 | Voluntary anal (sphincter) contraction |
| Spinal shock | immediate pathological loss of all spinal cord function caudal to the level of injury which lasts hours to several weeks after the initial spinal cord injury. |
| signs and symptoms of spinal shock | Flaccid paralysis below the level of injury Loss of reflexes Loss of autonomic function Absent bowel and bladder dysfunction |
| most SCI pts improve ____ within a year after their injury | one spinal level |
| why do new SCI pts have orthostatic | mm are not pumping blood back up to heart, sympathetic and parasympathetic NS are not regulating due to spinal shock |
| how long can spinal shock last? | varies, lasting from hours to weeks, even to months! Recovery is a gradual process in which neurons slowly regain their excitability. |
| first clinical sign of recovery from spinal shock | return of the bulbocavernosus and anal reflexes. When patient’s reflexes return, a state of hyperreflexia and spasticity can occur. |
| The completeness of SCI is not fully determined until ____ resolves. | spinal shock |
| If no motor or sensory function returns after spinal shock resolves, the SCI is considered ____ | complete. |
| Zone of partial preservation | may see dermatomes and myotomes below the neurologic level that remain partially innervated |
| what medications can help with orthostatic hypotension | Midodrine (increases vascular tone) Florinef (increases blood volume) |
| respiratory considerations for SCI | Coordination of breathing muscles (diaphragm, accessory mm, intercostals, & abdominals) LOI above T12 may have all above involved Quad coughing? |
| what puts skin at risk for injury after SCI? | Increased risk for pressure injuries Impaired sensation -> decreased sensation of need for weight shift Skin and circulatory changes make skin vulnerable to damage trophic changes in the skin |
| how to decrease risk of skin breakdown after SCI | Skin checks 2x/day recommended Pressure Relief: Weight shifts every 20 minutes for 2 minutes |
| In SCI ____ reflexes are impaired | autonomic |
| Fewer ____ concentrations with SCI in supine position | norepinephrine |
| SCI will often have ____ dysfunction (regulated by the parasympathetic nervous system) | Baroreceptor |
| SCI will have Reduced ____ and smooth muscle vascular tone | muscle mass |
| treatment options for orthostatic hypotension | Teds, ace wraps, and/or abdominal binder Functional Electric Stimulation Medications |
| goals for SCI bladder management | preserve upper urinary tract function, avoid CAUTI, and prevent autonomic dysreflexia will have indwelling catheter in new SCI |
| bladder management in acute care | No voiding trials will be completed as this population will not spontaneously void, and will not feel bladder distension or urge to void |
| bladder management in rehab | Plan for discontinuation of indwelling catheter once patient transitions to inpatient rehab for straight cath training or other bladder options. |
| bowel management for SCI | Natural gastrocolic reflex (20 min after eating the first meal of the day), warm fluid, and gravity are the best bowel stimulators consistency is key to developing routine for rest of pts life |
| stimulating normal digestion for SCI | eat then 20 min, may use a suppository if needed, after it is placed if possible use a commode/ have the patient in an upright sitting position. perform dig stim 10-20 seconds every 5-10 min four times until stool is expelled |
| will dig stim work for those with absent rectal reflexes | stool will need to be manually expelled from these patients daily |
| what time of day should bowel program be done? | when they would “normally” have had a BM (prior to injury) We want to do it at a time convenient to their daily schedule Ex: at night if they don’t have time in the morning, or maybe they want to get up early and do it before work/school etc. |
| Daily ____ will become routine In order to maximize function and independence | ROM |
| ROM areas to focus on with paras | neutral ankle ROM, hamstring ROM, hip flexors, hip rotators (IR and ER), and Hip adductors/abductors |
| ROM areas to focus on with tetras | Add shoulder ROM (flexion, abd/add, extension, ER, & IR); elbow extension, forearm pronation/supination, wrist extension + finger flexion (tenodesis) |
| why do SCI pts need to keep their back tight? | helps with head to hips ratio for transfers |
| what level SCI does AD affect? | T6 and above |
| precautions for AD | Pay attention/ask your patient what their ”normal” BP range is post-injury. |
| Heterotopic ossificans | Formation of bone in soft tissues around joints can be caused by over agressive ROM |
| table 24 and 25 | |
| why is prone a good position for SCI pts? | helps them get out of flexed/ stooped posture, helps with respiration and strengthening for posterior shoulder girdle, skin protection/pressure relief |
Created by:
bdavis53102
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