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63 Cards in this Set
- Front
- Back
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What level does autonomic dysreflexia usually occur in? |
T6 and above |
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What is autonomic dysreflexia? |
Pathological autonomic life threatening reflex |
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How does autonomic dysreflexia work? |
Afferent input from stimuli reach lower SC (low thoracic and sacral areas) and initiate a mass reflex response resulting in elevation of BP. Vasomotor impulses can't pass site of lesion to help. |
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Symptoms of autonomic dysreflexia |
HTN Bradycardia (slow HR) Headache Profuse sweating ^ Spasticity Restlessness Vasoconstriction below lesion Vasodilation above lesion Constricted pupils Nasal congestion Runny nose Piloerection (goose bumps) Blurred vision Rise in SYS BP 20-30mmHg |
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What do you do if pt displays s/s of autonomic dysreflexia during tx? |
1. Know s/s 2. Notify nurse/physician 3. Look for noxious stimuli 4. Sit/stand pt 5. NO LAYING DOWN 6. Loosen tight clothes 7. Monitor BP and pulse 8. Question pt of possible triggers (usually starts w urinary sys) 9. Check catheter 10. When was last bowel 11. Check for noxious stimuli on body 12. Educate pt! |
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What setting would you use the glasgow coma scale? |
Acute setting or in emergency situations NOT in rehab bc they would have already had one |
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Glasgow 3 response scores |
Motor Verbal Eye opening Scores add up to 3-15. <8=SEVERE; 9-12=mod; 13-15=mild |
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C2 key mms |
Head and neck |
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C3 key mms |
Diaphragm |
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C4 |
Possible tetraplegia/quadriplegia |
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C5 key mms |
Elbow flexors (biceps) and deltoids Can't extend elbow bc triceps are not innervated |
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C6 key mms |
Wrist extensors NOT important to stretch finger/wrist flexors bc pt can loose ability to grasp objects |
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C7 key mms |
Elbow extensors (triceps) |
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C8 key mms |
Finger flexors |
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T1 key mms |
Small finger ABDuctors |
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T2-T6 key mms |
Chest mms |
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T7-T12 key mms |
Abdominal mms |
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L2 key mms |
Hip flexors |
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L3 key mms |
Knee extensors |
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L4 key mms |
Ankle DFs |
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L5 key mms |
Long toe extensors |
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S1 key mms |
Ankle PFs |
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S2 key mms |
Bowel and bladder |
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S4 key mms |
Sexual function |
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What levels would require mechanical ventilation? |
C1-C4, w recovery they are likely to breath on their own |
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C1-C3 WC |
Power WC by sip and puff |
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C4 WC |
Pt should be able to operate a power WC (chin cup, chin control, mouth stick) Must have sufficient ROM to operate chin control |
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C5 WC |
Power and manual WC |
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T1-T8 WC |
Manual |
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Drive I |
C6 (w adaptive controls) |
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Transfers and Dressing/ADLs |
C7 |
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Living I |
C8 |
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Ambulation I |
L1-L3 L3 I community ambulation |
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Functional Activities, Gait I |
L4-L5 |
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Tetraplegia/quadriplegia happens in what part of the spine? |
Cervical |
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Paraplegia happens in what part of the spine? |
Thoracic |
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ASIA A |
Complete - no motor/sensory function |
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ASIA B |
Incomplete - sensory but not motor |
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ASIA C |
Incomplete - motor preserved below neurological lvl, mms = 3 |
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ASIA D |
Incomplete - motor preserved below neurological lvl, mms = >3 |
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ASIA E |
Normal |
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Rancho I |
No response |
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Rancho II |
Generalized response
Inconsistent and nonpurposeful reactions |
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Rancho III |
Localized response
Specific and inconsistent reactions Follows simple commands |
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Rancho IV |
Confused-agitated
Bizarre and nonpurposeful behavior Verbalization is incoherent/inappropriate Short attention span ***Lacks short/long-term memory*** |
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Rancho V |
Confused-inappropriate
Follow commands consistently Harder commands=less meaningful reaction Short attention span Verbalization is inappropriate/confabulatory Can't learn new tasks ***Memory is severely impaired*** |
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Rancho VI |
Confused-appropriate
Relies on cues to meet goals Follows simple directions Past memories are more in depth
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Rancho VII |
Autonomic-appropriate
Appropriate and oriented Robot-like Minimal-no confusion Impaired judgement |
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Rancho VIII |
Purposeful-appropriate
Good memory Req supv once new tasks are learned |
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Caregiver assistance with coughs |
Assist by performing modified Heimlich w a downward and upward direction to the cough effort |
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Orthostatic hypotension symptoms |
Blurred vision Ringing in ears Light-headedness Fainting
Happens in pts w auto. dys. |
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Brown-sequard Syndrome |
Clinical features are asymmetrical On same/ipsilateral side as lesion = paralysis and sensory loss On opposite/contralateral side = damage to spinothalmic tracts = loss of p! and temp |
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Ant. Cord Syndrome |
Proprio., light touch, and vibratory senses are preserved |
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Central Cord Syndrome |
Varying degrees of sensory impairment occur but tend to be less severe than motor impairments |
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Dorsal/Post. Cord Syndrome |
Lose ability to perceive proprioception and vibration. The ability to move and perceive p! remains in tact. |
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Ascending Dorsal Column
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Proprioception
Vibration sensation Discriminatory touch To postcentral gyrus |
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Ascending Anterolateral
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Spinothalmic, spinoreticular, and spinotectal
Pain Temp Crude touch Skin->thalmus |
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Ascending Dorsal and Ventral
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Spinocerebellar
Unconscious proprioception Spinal cord->ipsilateral cerebellum |
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Descending Lateral Corticospinal
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Voluntary movmt
Medulla->contralateral side of spinal cord |
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Descending Medial Vestibulospinal
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Positioning of head and neck
Bilateral down cervical spine only |
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Lateral and Medial Vestibulospinal
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Balance and posture
Ear->brain->mms |
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Descending Medial Reticulospinal
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Posture
Balance Autonomic gait Reticular formation->trunk and proximal limbs |
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Descending Rubrospinal
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Movement of limbs
Midbrain->lat spinal cord |
