Neuro: Ch 3 In Book

Front 1

What is the order of acute medical management after SCI

Back 1

1. Establish adequate ventilation, oxygenation, and circulation
2. Assess LOC & CN function
3. Voluntary Motor, Sensation, and reflexes evaluated
4. X-ray
5. CT scan and MRI
6. Surgery

Front 2

What are the benefits of a CT scan vs an MRI

Back 2

CT Scan: Reveal fx that aren't evident in X-ray so used when there is contd suspicion of spinal column injury despite negatvie x-ray

-MRI--provides superior visualization of spinal cord compression
-Also shows changes in ligamentous, hematologic, and IV discs after SCI

Front 3

When should a pt be given methylprednisone?

Back 3

Within 8 hrs of injury in a complete or incomplete SCI--must be a blunt SCI not penetrating

Front 4

When is non-surgical skeletal traction indicated

Back 4

When x-ray reveals vertebral angulation or subluxation in the cervical spine

-Bed positioning in a stryker bed may be indicated if damage occurs in the lower thoracic of lumbar regions

Front 5

Give the indications for SC surgery

Back 5

1. Unstable Fx
2. Fracture will not reduce non-sx
3. Deteriorating Neurological status
4. Contd Cord Compression
5. Gross Spinal Malalignment

Front 6

Name aspects of a proper skin care program

Back 6

1. Examine pressure areas
2. Teaching/Doing positional changes every 2 hrs
3. Manage bowel/bladder so skin doesnt stay wet and breakdown
4. Proper transfers and bed mobility
5. Proper Cushioning and Posture in WC
6. Proper Mattress--Air mattress

Front 7

Describe Osteoporosis in SCI pts

Back 7

Amt of BMD lost is proportional to disuse---thus complete SCI are most problematic

-Initially a strong decrease in BMD that cannot be contained d/t immobility while waiting for injured spine to heal and lack of overall pt mobility

Front 8

What is used to Dx Osteoporosis

Back 8

DEXA Scan--give after 4 yrs bc BMD won't change much after this amt of time

Front 9

What does osteoporosis place pt's @ constant risk for

Back 9

-Fx with simply/light trauma

-Looks for redness, swelling, brusing as signs of fx

Front 10

Can we stop or reverse Osteoporosis with PT

Back 10

Difficult to stop early loss in BMD but we can help maintain & slightly reverse BMD after initial loss with 3 methods:
1. Loading LE with Standing Frames
2. BWS Treadmill Training
3. Functional Electrical Stimulation

Front 11

Why is the tardieu scale more beneficial than the ashworth

Back 11

Muscular changes are detected by slower limb mvmts and neural changes are detected by faster limb mvmts---since the tardieu scale assesses spasticity at 3 different speeds it provides a more in depth examination

Front 12

What are the 2 ways clonus is measured

Back 12

1. Frequency of beating (how many per second)
2. Duration of clonus

-Sustained clonus is when duration lasts longer than 10 seconds

Front 13

What are the 3 common types of involuntary contractions with spasticity

Back 13

1. Clonus
2. Extensor Spasm
3. Flexor Spasm

Front 14

How much motion must be lost for a contracture to occur

Back 14

10 degrees

Front 15

Explain the benefit of the SCATS tool for spasticity measurement

Back 15

The
clinical scales most widely used by clinicians, in particular the
Ashworth Scale and the MAS, classify spasticity as a singlejoint, velocity-dependent resistance to movement. Although
these scales provide valid estimates of spastic hypertonia, their
reliability has been questioned.
10,20,21
In addition, multijoint
flexor and extensor spasms, which are prevalent in SCI, are not
accounted for in the Ashworth Scale and MAS. The SCATS is
a more comprehensive clinical scale for spastic hypertonia in
SCI that includes measurements of multijoint spastic motor
behaviors

Front 16

Who can get spasms--who reports them more often and when throughout the day

Back 16

Complete or Incomplete SCI pts can get spasms

-Incomplete SCI pts report them more and the spasticity decreases significantly throughout the day

Front 17

What are 3 things PTs can do to affect spasticity

Back 17

1. PROM
2. Prolonged Positioning
3. Strengthening--WB, BWS Treadmill, FES

Front 18

How is a contracture defined

Back 18

At least a 10 degree loss of motion in a limb

Front 19

What are common descriptors of neural pain

Back 19

Burning, unrelenting, shooting, constant

Front 20

How will a pain from a nerve root present

Back 20

In a dermatomal or segmental pattern

Front 21

What are possible causes of neural pain at the level of the lesion

Back 21

1. Nerve Root damage
2. SC Tracts damaged in the area
3. Cauda Equina Syndrome--neural pain in lumbosacral area
4. Syringomyelia

Front 22

Describe a syringomyelia

Back 22

Cyst developing in the cavity that the original lesion occurred

-Fluid Filled cyst that grows over time
-Pt will initially lose pain and temperature in specific area b/c of tract affected
-Pt will report dull ache in the region of the initial lesion that doesnt go away

Front 23

What types of pain may exist below the level of the lesion

Back 23

1. MS pain
2. Visceral Pain--refer

-Often perceived differently

Front 24

What causes the immediate loss in BMD leading to osteoporosis after SCI

Back 24

1. Lack of mechanical loading via WB forces
2. Lack of muscle activity causing a further loss of mechanical loading on the bones

Front 25

Risk Factors for Osteoporosis

Back 25

-Women
-ASIA A or B (motor complete injuries
-Paraplegia Flaccid Paralysis

Front 26

Describe characteristics related to spasticity after SCI: Two main things reported and what causes them

Back 26

1. Stiffness/Resistance to motion
-Changes to muscle structure(myoplastic hyperstiffness)
-Changes to tonic stretch reflex (spastic hypertonia)

2. Involuntary Contractions
-Changes to the phasic stretch reflex (Clonus, hyperreflexia)
-Changes to multisegmental cutaneous reflex arcs (Extensor and Flexor Spasms)

Front 27

What are options for stopping an extensor spasm

Back 27

-Gentle rocking of the limb or gentle rotation
-Getting the limb into a flexed position--flexing knee and hip or rolling over

Front 28

What are options for stopping a flexor spasm

Back 28

-Aggressive stretch of the hip flexors in prone position
-Knowing the stimulus causing the withdrawal and eliminating it

Front 29

Are are extensor spasms and Clonus measured differently than flexor spasms

Back 29

Ext Spasms and Clonus are measured in duration of response and flex spasms are measured by the amt of flexion in the limb

Front 30

How do different types of SCI relate to each other in regarding to spasticity progression throughout the day

Back 30

-Cervical Incomplete: spasticity decreases throughout the day
-Cervical Complete: spasticity increases throughout the day
-Thoracic SCI: whether complete or incomplete stays at relatively same levels throughout the day

Front 31

Which type of SCI pt does spasticity affect more negatively

Back 31

Spasticity is reported as problematic much more commonly in incomplete SCI patients

Front 32

Which types of spasms are more commonly problematic?

Back 32

-Extensors (interfere with transfers)

-Flexor spasms can be problematic though as this can commonly wake pts up from sleep

Front 33

Describe some characteristics of nocioceptive pain

Back 33

-Occurs with stimulation of somatic or visceral nocioceptors
-Often in association with trauma, disease, or inflammation--not normally from a motor or sensory deficit
-Can be described as dull, aching, or stabbing
-Usually tender to palpation over site of pathology--or if MS origin pain with mvmt of that region

Front 34

Give characteristics of neuropathic pain

Back 34

-Neuropathic pain is usually located in or adjacent to an area of sensory disturbance
-Usually described as numbness or paresthesia, burning, electric, shooting
-Pain often occurs in the absence of stimulation--and minor stimulation such as light touch can often cause exaggerated responses
-

Front 35

What are possible causes of neuropathic pain above the level of the lesion

Back 35

1. Compressive Mononeuropathies
2. Complex Regional Pain Syndrome

Front 36

What are causes of neuropathic pain below the level of the lesion

Back 36

1. Spinal Cord Trauma
2. Ischemia

Front 37

Where musculoskeletal nocioceptive pain normally located after SCI

Back 37

In the region of preserved sensation above but close to the lesion--affecting muscles, bones, joints, IV discs.
-Usually related to a movement or position

Front 38

What are the 3 main causes of MS pain post SCI

Back 38

1. Fx/ Dislocation
2. Chronic Overuse
3. Muscle Spasm

Front 39

How do pts with paraplegia vs tetraplegia sense visceral pain differently

Back 39

Depending on location of the lesion--pts with paraplegia will interpret visceral pain similar to people with no SCI
-Tetraplegia pts will experience much more generalized, vague pain and have difficulty localized the origin

Front 40

What are the 3 main causes of visceral pain

Back 40

1. Autonomic Dysreflexia
2. Infection
3. Obstruction

Front 41

Describe types of neuropathic pain above the lesion in SCI

Back 41

-Pains that are not specific to SCI such as CRPS and pain d/t peripheral nerve compression
-CRPS more commonly affects the UE d/t WC use or transfers

Front 42

Describe neuropathic pain at the level of the lesion

Back 42

-Presents in a dermatomal pattern within two segments above or below the level of the injury
-Alloydynia or hyperasthesia of the affected dermatomes often occurs
-Can be d/t damage at the nerve roots or spinal cord itself

Front 43

Describe pain typical of nerve root damage

Back 43

-Unilateral
-Suggested by characteristics such as increased pain in relation to spinal movement

Front 44

What are typical characteristics of a syringomyelia

Back 44

-Delayed onset segmental pain
-Rising level of sensory loss
-Loss of pain & temperature sensation is typical
-Constant, burning pain with allodynia

Front 45

Describe injury to the Cauda Equina characteristics

Back 45

-Pain @ lower lumbar and sacral regions
-Burning, stabbing, hot
-Constant pain that may fluctuate with autonomic activity

Front 46

What are 3 possible etiologies for pain with cauda equina syndrome

Back 46

1. SC may have lost inputs, leading to changes in central connectivity and neuronal activity that could cause pain
2. The damaged roots of cauda equina could be spontaneously active and generate signals that are interpreted as pain--inflammation in the area may limit the normal movement of the nerve roots and lead to mechanical irritation of the roots with very slight movements
3. Peripheral stimuli could lead to abnormal activity at the site of axonal injury

Front 47

Give Characteristics of Below Lesion pain

Back 47

-AKA Central Pain
-Characterized by sensations of burning, aching, stabbing, or electric shocks with hyperalgesia
-Often develops sometime after the injury
-Normally constant pain but may fluctuate with factors(sudden or jarring movements) other than movement or position

Front 48

How are complete and incomplete injuries different with below level lesions

Back 48

-Complete and Incomplete SCIs are associated with diffuse, burning pain that appears to be associated with the STT damage
-Incomplete injuries are more likely to have an allodynic component d/t sparing of tracts conveying touch sensations

Front 49

How should we treat the psychological aspects of pain

Back 49

-Psychological factors should be recognized as existing but considered as a contribution which may act to modify any of the previously described types of pain rather than psychogenic pain as an entity on its own

Front 50

Should we always assume psychogenic pain if we cannot reproduce pain in the region that symptoms are reported

Back 50

No. Neuropathic pain below the level of the lesion is very real and painful

Front 51

What will lead one to expect nocioceptive MS pain

Back 51

Pain will be related to position, activity, movement, or somatic tenderness

Front 52

What is the key ? to ask to decide if pain is neuropathic or nocioceptive

Back 52

Is pain localized in a region of normal sensation

Front 53

Give 4 possible causes for neuropathic pain at or above the lesion

Back 53

1. Peripheral Nerve Lesion--sensory/motor deficit shown on nerve conduction study
2. Nerve Root Compression--shown on imaging
3. Syringyomyleia
4. CRPS--present like autonomic S/S

Front 54

What is one treatment method for Nerve Root Compression or a Peripheral Nerve Lesion

Back 54

Surgical Decompression

Front 55

What are pharmacological options to treat neuropathic pain @ and below the lesion

Back 55

1. Gabapentin
2. Tricyclic antidpressants alone or in combination with Tramadol(weak opiod)
3. Opiods (If others dont work)

-These drugs are options for all types of neuropathic pain except autonomic CRPS(except antidepressants can be used)

Front 56

What is one conservative treatment shown to be an effective adjunct for neuropathic pain management

Back 56

Exercise

Front 57

Why are UEs so commonly injured with SCI patients

Back 57

1. Repetative Overuse
2. Excessive Loading
3. Improper Mechanics

Front 58

What are 4 main causes of wrist pain

Back 58

1. Carpal Tunnel
2. Guyon's Canal (Ulnar N entrapment)
3. Wrist/Hand Tendinitis
4. Wrist/Hand Arthritis

Front 59

What re 4 causes of elbow pain in SCI pts

Back 59

1. Cubital Tunnel (Ulnar N compression)
2. Lateral epicondylitis
3. Bursitis
4. Arthritis

-Elbow pain is least common

Front 60

4 Main causes of shoulder pain

Back 60

1. Impingement
2. Ad Capsulitis
3. Osteoarthritis
4. RC damage
5. Dislocations

Front 61

What is the clinical significance of UE issues in SCI population

Back 61

Injuries interfere with independence, work, ect

-Healing time causes immobility which can bring on secondary complications

Front 62

What are some of the key risk factors that need to be managed will to maintain UE function and health

Back 62

1. Task Analysis--vary tasks and number of repetitions to limit stress
2. Ergnomic Analysis--alignment of joints during tasks including WC propulsion, WC posture, & functional mobility tasks using the UE
3. Avoid Shld Flexion with IR--causes Impingement
4. Motion Analysis--mechanics of functional mobility tasks and overhead activities
5. ROM and Strength in opposing muscle groups
6. Equipment Review
7. Body Wt of client
8. Environment review--adapt to limit demands on UE

Front 63

What are important muscle groups to keep from getting tight and important groups to keep strong to maintain UE function

Back 63

-Focus on length maintenance in adductors and IR's

-Focus on strength in ER's, abductors, scap stabilizers, & depressors