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35 Cards in this Set

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Why are SCI pts more prone to skin breakdown?
Sensory impairment = prolonged pressure
Skin collagen degradation
Dec peripheral BF
Shear forces (transfers)
Prolonged exposure to moisture
Atrophy
3 components of skin care after SCI
Procedural
Education
Coordination
What type of procedural interventions will you perform for skin care?
Skin inspection
Pressure relief
Exercises to enhance CV fitness
What will you educate a pt on for proper skin care post SCI?
Avoiding shear, friction, blunt trauma, and exposure to heat
Clothes, shoes, orthoses fit properly
Skin clean and dry
Balanced diet
B&B
How/who/what will you coordinate with for skin care?
Equipment to relieve pressures and disperse force
Communicate wiht primary physician
Etiology and time frame of osteoporosis post SCI
Loss of collagen and Ca from bones, most evident in the first few months after SCI and lasting for about 4 years
Due to loss of mm action and WB, as well as circulatory, endocrine, and immune changes
What type of pt is most likely to develop severe osteoporosis?
ASIA A and B with flaccid paralysis (as opposed to spasticity)
Amt. of loss is proportional to their disuse
Location of osteoporosis post SCI?
Distal femur and proximal tibia
NOT SPINE
S/S of fractures?
Redness, swelling, bruising, displacement/deformity
Difference in bone mass between Paras and Quads?
Para = inc in UE bone mass
Tetra = inc or dec in UE bone mass depending on use
Can osteoporosis be prevented or reversed in the SCI pt?
No, prolonged standing, treadmill trng, and FES make be helpful later on to slow the progression, but early on nothing has been effective in reversing/preventing the devolopment
Tx for osteoporosis?
WB, treadmill trng, FES
Balanced diet with adequate protein
Biphosphonates (Fosamax)
What does the SCATS exmaine that the MAS and Tardieu do not? Why is this important?
Multijoint flexor and extensor spasms, which makes it a more comprehensive clinical scale for spastic hypertonia in SCI = more fxt measure
Imp b/c dif types of spasm interfere with functional mobility in dif ways.
How are clonus, flexor and extensor spasms triggered?
Clonus = rapid stretch (stretch reflex)
Flexor = cutaneous withdrawl reflex
Extensor = EXT at the hips: inc excitability of the interneuronal circuitry normally used for inc limb stiffness during standing/AMB
How does clonus, and flex/ext spasms interfere with function?
Clonus - W/c and transfers
Flexor - Sleep, bed mobility, transfers
Extensor - most discomfort and greatest interference with fxt during transfers and W/c propulsion
How can tx be altered for pts with clonus, flex/ext spasms>
Equipment prescription (W/C)
Prescibing footwear based on forces on foot (withdrawl reflex)
Alternative transfer techniques
Pharmacological interventions
How do you perform the SCATS for each type of spasticity?
Clonus - rapid DF
Flex - pin prick supine
Ext - Flex hip/knee 90 deg and EXT hips
2 types of resistance to motion
Myoplastic hyperstiffness
Spasticity (neural)
How do you perform the Tardieu?
3 speeds, slower than gravity, gravity, faster than gravity
How do you perform MAS?
Only at speed of gravity
Looking at where there is a catch and resistance
What is the Penn Spasm Frequency Scale?
Self report measure of frequency of reported mm spasms used to quantify spasticity
Conclusion of PRISM measure
Spasticity-related interventions need to be aimed at what matters most to the pt
Interventions to treat spasticity (nothing proven for long term benefit)
1. Positioning (maintenancy of mm length)
2. ROM/stretching (possible plastic changes of CNS or mm)
3. WB (decreased excitability due to influence of cutaneous and joint receptor input)
4. Strengthening (balance of agaonist/antagonist)
5. ESTIM (to contralateral mm = reciprocal inhibition)
6. Cold/heat (slow nerve conduction)
7. Slinting/orthoses (long-term stertch)
Difference in acute vs. chronic pain in SCI in terms of origin
Acute is usally due to MSK or visceral pain
Chronic pain often lasts once the injurious stimulus is no longer present
What is neuropathic pain caused by?
Direct damage to the NS. Constant, unrelenting, burning, shooting, electric pain.
Due to N and N root issues (dermatological pattern) or actual SC, pathway, or tracts
Usually below the lesion
Common causes of pain ABOVE lesion?
Typical things - MSK, visceral (if viscera exists above lesion), CRPS
Common causes of pain BELOW lesion?
MSK
Syringomyelia
Neuropathic pain
Common causes of pain BELOW lesion?
Central pain syndrome
Visceral or neuropathic
Drugs for spasticity? And pain...
Baclofen, valium, zanoflex, gabapentin (neurotin), dantrium
All CNS depressants except dantrium!
Tx for pain post SCI?
Treat what you can
Psychological tx
What is syringomyelia?
Cyst that can develop in cavity where original lesion occures - central symptoms. Effects crossing STT first = changes in pain/temp in segmental region of inj. Can progress to compress A-mn and maybe even dorsal columns
How do we manage UE injury after SCI?
Mechanics, ROM/stretching, Strengthening
What type of injury reports greater dec in fxt due to spasticity?
Incomplete injuries b/c they have more function in the first place... so they notice it more
When is stiffness/spasticity the msot for 1. C-sp complete 2. Th-sp either 3. C-sp incomeplete
1. Worse at night (spasticity)
2. same all day
3. Worse in morning (stiffness)
How do you get clonus to stop? Ext spasm?
Clonus - slowly WB thru limb or lift limb up
EXT - Get into flexion or gentle rocking in IR and ER