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33 Cards in this Set
- Front
- Back
3 keys to rehab success w/ individuals after SCI
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1. Know the injury
2. Be a movt. expert 3. Foster autonomy and control |
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Direct vs. indirect SCI
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Direct: penetrating: gun shot, knive, open fx
Indirect: stretch, bruise, laceration |
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Associated injuries with SCI
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TBI = 25% w/ cervical SCI
chest and extremity fx's |
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predisposing Risk factors for SCI
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osteoporosis, ankylosis spondylitis, stenosis, OA, RA
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Examples of non-traumatic SCI
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Tumors, extradural or intramedullary neoplasms, transverse myelitis (inflam at segment level), syringomyelia (cyst)
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Secondary SC tissue injury
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Ischemia (inj of BVs), wallerian degeneration, excitotoxicity (Ca2+ influx), inflammation, apoptosis (oligodendrocytes)
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Fxts affectd AT and BELOW neurological level
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Vol motor = LMN at level of injury and UMN at levels below
Sensory = anastetia at level and changes or loss below level ANS - sexual, resp, temp, cardiac |
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What is affected when the gray matter is damaged?
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primary afferents entering to synapse in SG, and LMN in anterior horn
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Responsibility and path of dorsal columns
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Fine touch, vibration, proprioception, deep pressure
Crosses in medulla at sensory decussation = ipsilateral loss |
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Responsibility and path of STT
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Pain, temp, crude/light touch
Cross at SC level in Ant commissure and synapses in SG |
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What type of loss do you have to CST with damage to one side of spinal cord?
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Ipsilateral, bc it crosses at the motor decussation in the medulla
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What type of losses will you have with Brown Sequard Syndrome?
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Ipsilateral loss of Dorsal columns and CST (one side will lose vol motor and fine touch, vibration proprioception while the other side loses pain, temp, crude touch)
Contralateral loss of STT |
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What type of losses will you have with Anterior Cord Syndrome?
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CST and STT because these are more anterior. Dorsal columns will be fully or partially spared resulting in proprioception, vibration, and fine touch)
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What will be disrupted in Central Cord Syndrome for each of the 3 main tracts?
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STT and CST will lose cervical first
Dorsal columns will lose sacral first Fine touch, prop, will be lost in a distal to proximal fashion Motor and pain/temp/crude touch will be lost in a proximal to distal fashion |
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Neurological level
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Lowest level with normal motor and sensory bilaterally (3/5 motor)
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ASIA definition of normal mo. fxt
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3/5 at level and 5/5 above
Lowest level to test as a 2 (normal) for sensory |
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How do you determine complete vs. incomplete SCI?
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Incomplete will have sacral sparing: preserved fxt in lowest sacral segments S4 and S5 = anal mucocutaneous sensation and anal sphincter contraction
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Zone of partial preservation
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Preservation below neurological level - spontaneous
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Describe ASIA A through ASIA E
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A: Complete SCI - no sacral sparing
B: Incomplete SCI - Only need sensory from S4 and S5 C: Incomplete SCI - Sensory and motor below neurological level with less than 3/5 mmt in half of mm D: Incomplete SCI - sensory and mo. below neurological level w/ greater than 3/5 mmt in half of mm E: Normal mo and sensory |
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Cauda Equina vs. Conus Medullaris Syndromes
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CMS: T12-L2 injury: flaccid paralysis of LEs
CES: Injury L2 and below |
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How long is spinal shock and what is it characterized by?
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a few days to 6-8 weeks
Areflexia, no sensory or mo., no ANS |
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Pattern of spinal shock resolution
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Sacral reflex - DTR - cutaneous reflex - ANS
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Neurological return. How?
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Return of motor and/or sensory - not spasticity
Nerve root return: recovery and regeneration... possibly remyelination, resolution of hemorrhage, vasoconstriction, and edema. Also plasticity. Spinal Cord Tract Return: uncommon |
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Two types of plasticity
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Spontaneous: left to it's own devices... afferents begin to remodel, snyaptic sprouting
Activity dependent |
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4 prognostic factors associated with recovery from SCI
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1. ASIA score at time of admission (within 7 days of SCI)
2. Presence of early mo. return in mm initially testing 0/5 3. Mo. fxt at 1 month after injury 4. Pin prick sensation at time of initial exam |
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4 general goals for first 72 hours in acute mgt of SCI
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1. Stabilize neck and spine (surg or non-surg)
2. Prevent secondary complications from SCI 3. Ensure adequate ventilation, oxygenation, and circularion and that no other issues are going on 4. Rehab and d/c planning - where are they going next |
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What tests/imaging is done at the hospital and in what order when a patient arrives?
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1. Stabilize neck/spine (pre-hospital)
2. Ensure adequate vent, oxygenation, and circulation 3. Assess consciousness and CN test (TBI?) 4. Assess sensory, motor, reflexes 5. CT or MRI 6. Fracture mgt (surg or non-surg) |
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Medicinal interventions to minimize secondary neurologic injury follwing SCI?
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Corticosteroids and Systemic hypothermia to decrease inflammation
Ganglioside GM-1 given after 8 hours to help protect against additional N cell death and also stimulate axon spraeding and prevent apoptosis |
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3 goals for mgt of vertebral fractures
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1. Re-alignment
2. Decompression 3. Stabilization |
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Difference between surgical and non-surgical mgt of vertebral fractures.
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1. Re-alignment = traction vs. open reduction/internal fixation
2. Decompression = traction vs. removing bony fragments, soft tissue sxs, foreign bodies impinging 3. Stabilization - cages/halos vs plates/rods/screws/bone grafts |
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Types of orthoses for cervical injuries
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1. Halo - bolts in skull mounted to plastic chest vest
2. Minerva brace - Plastic peice extends from chin to chest 3. Collars - not effective for unstable fxs |
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Types of orthoses for thoracolumbar injuries
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1. TLSO - turtle clam shell
2. Jewett brace - not appropriate for unstable spines |
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Prognostic indicators of neurological return (laundry list)
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Age, previous level of function
finances Associated injuries and secondary injureis Support system ASIA level (70% of A's become B's, 50% of B's become C's, most C's and D's will be AMB) Less than 5% of completes walk again MMT of mm intially testing 0 Pin prick sensation at time of injury |