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877 Cards in this Set
- Front
- Back
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What is the incidence of SCI per year per million people
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40 per million; 11,000 new cases per year
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What is the prevelance of SCI?
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250,000
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What is the male:female ration of SCI?
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4:1
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What is the average age of SCI?
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38
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Older than 60 accounts for what % of cases?
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11.5%
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What are the two most common causes of SCI
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MVA follow by falls
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What is the most common sports related SCI cause?
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diving
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What are the two most common causes of SCI in the elderly
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falls then MVA
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What month has the highest incidence of SCI?
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July
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What day of the week is most common for a SCI?
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Saturday
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What is the most common level of injury?
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C5
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What is the most common level of paraplegia?
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T12
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What percent of SCI is incomplete tetraplegia?
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34.1%
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What percent of SCI is complete paraplegia?
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23%
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What percent of SCI is complete tetraplegia?
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18.3%
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What percent of SCI is incomplete paraplegia?
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18.5%
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What is the most common form of SCI injury?
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incomplete tetraplegia
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What marriages survive better, pre or post injury?
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post injury
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Most SCI are single or married?
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single (51%)
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What is the post SCI employment rate?
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25%
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What is a predictor of return to work in SCI?
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ability to drive
also, white, male, younger, educated |
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What level injury in SCI is a predictor of mortality?
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C4
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What social profile is a predictor of mortality?
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poor community integration
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What insurance profile is a predictor of mortality?
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medicaid or medicare
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Which is a predictor of mortality, complete or incomplete neurological?
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complete neurological
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What is the most common cause of mortality in SCI?
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pneumonia
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What are the second and third most common causes of mortality in SCI?
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heart disease then septicemia
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What is the second most common cause of death in SCI younger than 25?
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suicide
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What age range in SCI has the highest suicide rates?
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<25 years old
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What are two leading causes of death in incomplete paraplegia?
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cancer and suicide
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What are the first and second leading causes of death in complete paraplegia?
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suicide, then heart disease
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How many sacral vertabrae?
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5
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How many coccygeal vertabrae?
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4
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How many thoracic vertabrae?
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12
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What is the terminal portion of the spinal cord?
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conus medullaris
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Proprioception from the leg are carried in these fibers?
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fasciulus gracile: medial dorsal columns
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Proprioception from the arms are carried in these fibers.
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fasciculus cuneate: lateral dorasl columns
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What sensations are carried by the spinocerebellar tracts
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muscular position and tone
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Pain and thermal sensation are carried by what fibers?
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lateral spinothalamic
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Neck and trunk movements are carried by what tracts?
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anterior corticospinal tract
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Proprioception from the arms are carried in these fibers.
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fasciculus cuneate: lateral dorasl columns
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What are the main tracts for carrying voluntary muscle activity?
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lateral corticospinal tracts
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What sensations are carried by the spinocerebellar tracts
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muscular position and tone
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Pain and thermal sensation are carried by what fibers?
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lateral spinothalamic
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Neck and trunk movements are carried by what tracts?
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anterior corticospinal tract
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What are the main tracts for carrying voluntary muscle activity?
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lateral corticospinal tracts
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What is the course of the lateral corticospinal tracts starting with the orgin in the brain and transversing 3 structures.
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precentral gyrus
internal capsule medulla oblongata |
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Where do the lateral corticospinal tracts cross over to the contralateral side?
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pyramidal decussation of the medulla
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What percentage range of lateral corticospinal fibers cross over?
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80-90%
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Where do white matter lateral corticospinal tract fibers enter gray matter?
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at the ventral horn
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Where do UMN and LMN synapse?
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Gray matter ventral horn
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In what tracts do the fibers that do not decussate at the pyramidal decussation in the medulla travel?
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ventral corticospinal tracts
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What tracts transmit unconscious proprioception? Are they contralateral or ipsilateral
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spinocerebellar tracts/ipsilateral
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Lateral spinothalamic tracts transmit pain and temperature contra or ipsilateral?
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contralateral
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Where do the lateral spinothalamic fibers synapse?
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dorsal horn of the gray matter
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What is the course through 3 structures of the lateral spinothalamic tracts to the brain?
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thalamus
internal capsule postcentral gyrus of the cerebral cortex |
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Where do lateral spinothalamic tracts cross over?
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within 1-3 segments of entering the cord at the dorsal horn
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A lesion of the lateral spinothalamic tract will result in a ipsi or contralateral loss of pain and temperature?
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contralateral below the level of the lesion
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Cerebellar lesions affecting the spinocerebellar tracts will result in a ipsi or contralateral loss?
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ipsilateral loss
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What sensation is transmitted by the dorsal or posterior columns?
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ipsilateral
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What three senses are transmitted by the dorsal columns?
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proprioceptoin, fine touch, and vibration
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Where do lateral spinothalamic tracts cross over?
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within 1-3 segments of entering the cord at the dorsal horn
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A lesion of the lateral spinothalamic tract will result in a ipsi or contralateral loss of pain and temperature?
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contralateral below the level of the lesion
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Cerebellar lesions affecting the spinocerebellar tracts will result in a ipsi or contralateral loss?
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ipsilateral loss
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What sensation is transmitted by the dorsal or posterior columns?
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ipsilateral
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What three senses are transmitted by the dorsal columns?
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proprioceptoin, fine touch, and vibration
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Where do lateral spinothalamic tracts cross over?
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within 1-3 segments of entering the cord at the dorsal horn
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A lesion of the lateral spinothalamic tract will result in a ipsi or contralateral loss of pain and temperature?
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contralateral below the level of the lesion
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Cerebellar lesions affecting the spinocerebellar tracts will result in a ipsi or contralateral loss?
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ipsilateral loss
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What sensation is transmitted by the dorsal or posterior columns?
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ipsilateral
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What three senses are transmitted by the dorsal columns?
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proprioceptoin, fine touch, and vibration
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Where do fibers of the dorsal column synapse?
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dorsal root ganglion
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Are dorsal column fibers ipsi or contralateral?
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ipsilateral
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Do fibers of the DRG ascend in white or gray matter?
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white
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Where do dorsal column fibers decussate?
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medulla
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Dorsal column axons carrying signals from the sacral and lumbar areas are located in what part of the dorsal column and whtat is this structure called in the medulla?
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medial part of the dorsal column
fasciculus gracilis |
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Dorsal column axons carrying signals from the upper extremity and thoracic areas are located in what part of the dorsal column and whtat is this structure called in the medulla?
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lateral part of the dorsal column
fasciculus cuneatus |
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Fibers of the fasciculus cuneatus and gracilis coalesce to form what structure before ascending higher in the brain?
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medial lemniscus
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Where do fibers of the fasciculus cuneatus and gracilis synapse before forming the medial lemniscus?
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they synapse in the medulla
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Where do medial lemniscus fibers terminate?
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postcentral gyrus of the cerebral cortex
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A lesion of the dorsal column results in an ipsi or contralateral loss?
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ipsilateral
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How many anterior and posterior spinals arteries are there?
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1 anterior/2 posterior
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The anterior spinal artery supplies what portion of the spinal cord?
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anterior 2/3 of the spinal cord
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What arteries supply the posterior 1/3 of the spinal cord?
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posterior spinal arteries
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What is the origin of the posterior spinal arteries?
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vertebral arteries
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The artery of Adamkiewicz arises on the left or right?
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left
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What is the blood supply of the lower 2/3 of the spinal cord?
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Artery of Adamkiewicz
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What is the orgin of the artery of Adamkiewicz?
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intercostal or lumbar artery
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What is the level range where the artery of adamkiewicz enters the spinal cord?
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T6-L3
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What is the watershed area area of the thoracic cord that is most vulnerable to injury when there is low blood flow such as during cross clamping of the aorta?
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T4-6
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What is the primary venous drainage of the spinal cord?
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internal venous plexus
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What level is the most common cervical compression fracture?
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C5
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A unilateral facet dislocation is unstable if what ligament is disrupted?
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posterior ligament
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What is the most common level of a unilateral facet dislocation?
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C5-C6
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A unilateral facet dislocation is noted by what percentage dislocation of the verterbral body?
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<50%
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What is the most common level of bilateral facet joint dislocation in the cervical spine?
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C5-C6
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A unilateral facet disclocation is more likely to be an incomplete or a complete neurological injury?
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incomplete
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A bilateral facet dislocation is more likely to be an neurologically incomplete or complete injury?
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complete
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What is the most common level for a cervical hyperextension injury?
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C4-C5
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A cervical hyperextension injury in the elderly may result in what syndrome?
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central cord syndrome
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What is the most common activity resulting in flexion/axial loading mechanism of injury and what level is most commonly affected?
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diving/C5
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A bilateral facet joint dislocation results in what percentage dislocation of the vertebral body on xray?
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>50%
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What is the MOI of a bilateral facet joint dislocation?
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flexion
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Where is the weakness in a central cord syndrome; UE compared to LE?
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UE weakness>LE weakness
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A central cord syndrom is likely to be incomplete or complete injury?
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incomplete
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What ligament may be disrupted in a hyperextension injury central cord syndrome?
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anterior longitudinal
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What vitamin deficiency can cause of NT SCI?
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B12 deficiency
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What are the two most common etiologies of NT SCI?
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spinal stenosis and spinal cord tumors
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What is the female:male ratio of transverse myelitis?
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4:1 females:males
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What are three predictors of poor outcome in transverse myelitis?
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rapid progression
back pain spinal shock |
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What are the two most common underlying conditions of epidural abscess?
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diabetes
immunocompromise |
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Incidence of radiation myelopathy is correlated with what three metrics?
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total radiation dose
dose fraction length of cord irradiated |
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What syndrome sometimes develops in radiation myelopathy?
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Brown-Sequard
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What are the two primary symtpoms of radiation myelopathy?
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weakness
loss of sensation |
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What percentage of spinal cord tumors are extradural?
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95%
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In what section of the cord are metasteses most common?
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thoracic
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What are the two cardinal symptoms of a spinal cord tumor?
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night pain
supine pain |
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What are the two most common primary spinal tumors?
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ependymoma
astrocytoma |
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What are the 3 most common sources of metastatic spinal tumors?
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lung
breast prostate |
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What is the most common type of NT SCI in over 50 age group (i.e. complete or incomplete)?
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incomplete
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What are the NT SCI FIM scores compared to traumtic SCI FIM scores upon dischage
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the same
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What are 6 indicators of favorable home discharge in NT SCI?
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incomplete
married skin intact bladder/bowel program cognitively intact male |
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What is the most restrictive of the removable cervical collars?
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Minerva
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What is the most restrictive of the non-removable cervical collars?
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Halo
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What is more restrictive SOMI or 4 poster?
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4-poster
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What is the least restrictive cervical collar?
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soft collar
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Name three injuries that are most office complete.
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bilateral facet dislocations
transcanal GSW TL flexion rotation injuries |
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TL flexion rotation injury is most often what type of injury (complete or incomplete)?
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complete
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Falls with underlying cervical spondylosis usually result in what type of injury (complete or incomplete?
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incomplete
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Name three injuries that are most often incomplete?
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falls with underlying spondylosis
non-transcanal GSW unilatateral facet dislocation |
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Where is a Jefferson fx?
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C1
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Are Jefferson fxs usually stable or unstable?
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stable
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What is the orthosis for a Jefferson fx?
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halo
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Does a Jefferson fx usually present with neuro findings?
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no
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Where is a hangman's fx?
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C2 burst fx
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What is a sports MOI for a Jefferson fx?
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football spearing (axial loading)
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What is the MOI for a Hangman's fx?
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deceleration (head hitting windsheild)
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What is the orthosis for a Hangman's fx?
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halo
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Where is a type I dens fx? and what is the tx?
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tip of dens; no tx
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What type of odontoid fx is most common? and where is it?
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Type II - fx through base of odontoid at junction with C2
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What element of the spine are fx'd in a Chance fx?
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spinous process, pedicles, vertebral body
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A Chance fx is most commonly seen at what 3 levels?
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T12, L1, and L2
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What is the MOI in a Chance fx?
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hyperflexion of the thorax
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Are Chance fxs usually associated with neurologic injury?
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No
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What are two MOI of spinal cord injury without radiologic abnormality (SCIWORA)?
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traction in a breech delivery
violent hyperextension or hyperflexion |
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What ratio predisposes to SCIWORA during breech?
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large head:neck ratio
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What is the MOI in an adult SCIWORA?
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fall with hyperextension of the neck
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What syndrome can arise from a adult hyperextension cervical SCIWORA?
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central cord syndrome (UE>LE weakness; C4-5)
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In an adult cervical SCIWORA from a hyperextension fall what structure can narrow the canal by as much as 50%?
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ligamentum flavum
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Paraplegia refers only to injury where?
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thoracic and below
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What are the 3 brain structures that an UMN traverses before going into the spinal cord?
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prefrontal motor cortex
internal capsule brainstem |
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What are 3 UMN finding?
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hyperreflexia
babinski detrusor sphincter dyssynergia |
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What is the origin of LMNs?
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anterior horn cells
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What are 4 classic signs and symptoms of LMN injury?
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hyporeflexia
flaccid weakness muscle atrophy areflexic/hypotonic bladder |
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To perform a SCI classification exam what position is the patient?
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supine
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How many dermatomes are tested in SCI classification?
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28
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An area of skin innervated by the sensory axons within each segmental root is called what?
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dermatome
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What is the sensory control in SCI classification?
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the face
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What type of material is used for light touch testing?
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cotton tip applicator
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Where is the S4-5 dermatome?
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perianal
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What is the sensory of level of an injury?
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Most caudal area with 2/2 pinprick and light touch
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What is C2 sensory?
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occipital protuberance
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What is C3 sensory?
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supraclavicular fossa
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What is C4 sensory?
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Superior AC joint
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What is C5 sensory?
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lateral side of antecubital fossa
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What is C6 sensory?
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Thumb
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What is C7 sensory?
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middle finger
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What is C8 sensory?
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little finger
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What is T1 sensory?
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medial antecubital fossa
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What is T2 sensory?
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apex of axilla
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What is T3 sensory?
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third intercostal space mid-clavicular line
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What is T4 sensory?
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nipple
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What is T5 sensory?
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fifth intercostal space
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What is T6 sensory?
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xiphoid
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What is T7 sensory?
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7th intercostal space
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What is T8 sensory?
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8th intercostal space
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What is T9 sensory?
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9th intercostal space
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What is T10 sensory?
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10th intercostal space
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What is T11 sensory?
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11th intercostal space
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What is T12 sensory?
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inguinal ligament
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What is L1 sensory?
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halfway between T12 and L2
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What is L2 sensory?
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thigh
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What is L3 sensory?
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medial femoral condyle
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What is L4 sensory?
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medial malleolus
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What is L5 sensory?
|
3rd MTP joint dorsum of foot
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What is S1 sensory?
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lateral heel
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What is S2 sensory?
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popliteal fossa
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What is S3 sensory?
|
ischial tuberosity
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What is a myotome?
|
collection of muscle fibers innervated by the motor axons with each segmental nerve
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How many myotomes are tested in SCI classification?
|
10
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What is the C5 muscle/action
|
biceps/elbow flexion
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What is the C6 muscle/action?
|
extensor carpi radialis/wrist extensors
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What is the C7 muscle/action?
|
triceps/elbow extensor
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What is the C8 muscle/action?
|
flexor digitorum profundus/finger flexor
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What is the T1 muscle/action?
|
abductor digiti minimi/small finger abductor
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What is the L2 muscle/action?
|
iliopsoas/hip flexion
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What is the L3 muscle/action?
|
quadriceps/knee extensor
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What is the L4 muscle/action?
|
tibialis anterior/ankle dorsiflexors
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What is the L5 muscle/action?
|
extensor hallicus longus/long toe extensors
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What is the S1 muscle/action?
|
ankle plantar flexors
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What is the muscle score for active movement full range no gravity?
|
2
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What is the muscle score for active movement against gravity?
|
3
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What is the motor level of injury?
|
most caudal muscle = or >3 with the segments above 5/5
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What is the neurological level of injury?
|
most caudal segment with both normal sensory and motor (> or = to 3 with cephalad segments 5/5) on both sides of the body
|
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What is the most caudal cervical level where is there no motor level
|
C4
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A person with a C5 muscle having 2/5 strength with a C4 sensory level has what neurological level?
|
C4
|
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What is sacral sparing?
|
At least voluntary impaired anal sphincter contraction OR intact light touch OR pinprick on either side
OR anal sensation on rectal exam |
|
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Zone of partial preservation (ZPP) is used only with what type of injury, complete or incomplete?
|
complete
|
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What is the ZPP?
|
dermatomes and myotomes caudal to the NLI that remain partially innervated
|
|
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Sacral sparing indicates integtiy of what matter, gray or white? what tracts?
|
white/corticospinal and spinothalamic
|
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What is the impairment of no motor or sensory at S4-5?
|
Asia A complete
|
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Sensory but not motor function is preserved below the neurological level and includes S4-5 is called?
|
Asia B incomplete
|
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Motor function is preserved below the NL and more than half of the key muscles below the NL have a grade of less than 3 is called what?
|
Asia C incomplete
|
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Motor function is preserved below the NL and at least half of key mueslces below the NL have a grade of 3 or more is called what?
|
Asia D incomplete
|
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Motor and sensory functions are normal is called what?
|
Asia E
|
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To receive a grade of Asia C or D the injury must be complete or incomplete?
|
incomplete
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An incomplete injury means there is sparing of one of what two functions?
|
sensory or motor function in S4-5
|
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To receive a grade of Asia C or D the injury must be complete and have one of what other two functions?
|
voluntary anal sphincter contraction
or sparing of motor more than 3 levels below the motor level |
|
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In a region without a myotome, what is the motor level?
|
the same as the sensory level
|
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What is the motor level?
|
> or = to 3 with all above levels 5/5
|
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What is the sensory level?
|
The most caudal level of 2/2 with a 1 or 0 below it.
|
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Motor function preserved below NI can be either what two ASIA scores?
|
C or D
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What determines Asia D?
|
half of muscles below NI are > or = 3
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What determined Asia C?
|
half of muscle below NI are < 3
|
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If no deficits are found at initial testing what is the Asia score?
|
E
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Temporary loss or depression of all spinal reflex activity below the level of the lesion is called what?
|
spinal shock
|
|
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What are two muscle reactions to spinal shock?
|
flaccid and hyporeflexic muscles below the lesion
|
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What are bladder/bowel reactions to spinal shock?
|
paralysis of bladder and bowel
|
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What is a foot sign of spinal shock?
|
delayed plantar response
|
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What is delayed plantar response?
|
Deep pressure over the Babinski area; the toes flex and relax slowly
|
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What is the prognois for a persistent delayed plantar response?
|
poor prognosis for LE recovery
|
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What reflex usually returns within 24 hours after SCI?
|
bulbocavernosus reflex
|
|
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The return of the bulbocavernosus reflex indicates that the injury is UNM or LMN?
|
UMN
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If the bulbocavernosus reflex does not return within 24 hours what type of injury is suspected UMN or LMN?
|
LMN
|
|
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What reflex and its implication is similar to the bulbocavernosus reflex?
|
perianal sphincter reflex - anal wink
|
|
|
List the order of return of reflexes from early return to late.
|
delayed plantar response
bulbocavernosus anal wink |
|
|
Reflexes after SCI begin to return in what time frame?
|
within 24 hours
|
|
|
What is the normal time frame of full restoration of reflexes after SCI? and maximum time?
|
2-3 weeks, but up to 3 months
|
|
|
Reflexes below the lesion, when they return, are hypo or hyper?
|
hyper
|
|
|
What is the most common of the SCI syndromes?
|
Central cord
|
|
|
Central cord syndrome is what % of total SCI?
|
9%
|
|
|
What are 3 signs of central cord syndrome?
|
UE weakness>LE weakness
sacral sensory sparing normal bowel/bladder function |
|
|
Central cord is predominately a gray or white matter injury?
|
white matter
|
|
|
What is the typical demographic and MOI in central cord syndrome?
|
hyperextension injury in senior with cervical spondylosis
|
|
|
In central cord syndrome, what strength recovers first, UE or LE?
|
LE strength recovers first
|
|
|
In central cord, what recovers first, UE proximal or distal muscle strength?
|
proximal
|
|
|
What is a key demographic prognostic indicator of functional recovery?
|
age below 50
|
|
|
A Brown-Sequard is essentially what type of injury to the cord?
|
hemisection
|
|
|
With what MOI is Brown Sequard classically associated?
|
stab injury
|
|
|
In Brown Sequard sensory loss at the level of lesion is ipsi or contra?
|
ipsi
|
|
|
In Brown Sequard motor loss at the level of lesion is ipsi or contra?
|
ipsi
|
|
|
In Brown Sequard what is the type of motor loss paralysis, flaccid or spastic?
|
flaccid
|
|
|
In Brown Sequard there is ipsilateral loss of what sensory functions below the level of lesion?
|
position and vibration loss below the level of lesion
|
|
|
In Brown Sequard position and vibration loss below the level of lesion is ipsi or contra?
|
ipsi
|
|
|
In Brown Sequard what sensory functions are lost contralateral?
|
pain and temperature
|
|
|
In Brown Sequard pain and temperature loss below the level of lesion is ipsi or contra?
|
contra
|
|
|
What are the two most common presenting signs of Brown Sequard?
|
*Contralateral loss of pain and temperature
*Ipsilateral loss of position and motor |
|
|
What columns are preserved in anterior cord syndrome?
|
posterior cords
|
|
|
What type of injury can result in anterior cord, flexion or extension injuries?
|
flexion
|
|
|
What 3 sensations are preserved in anterior cord?
|
proprioception
light touch deep pressure |
|
|
In anterior cord what portion of the cord is affected?
|
anterior 2/3s
|
|
|
What two tracts are usually injured in anterior cord? and what are the symptoms associated with damage to each tract?
|
corticospinal - muscle weakness
spinothalamic - pain/temperature sensitivity |
|
|
Posterior cord syndrome results in primarily what deficit?
|
proprioceptive
|
|
|
What columns are affected in posterior cord?
|
dorsal
|
|
|
What are the two primary deficity in conus medullaris syndrome?
|
areflexic bladder and bowel
areflexic LEs |
|
|
In a high conus lesion what two reflexes are preserved?
|
bulbocavernosus
micturation |
|
|
What is the level of the conus?
|
L1-L2 vertabrae
|
|
|
Injuries below L1-2 can result in what syndrome?
|
cauda equina syndrome
|
|
|
Cauda equina syndrome is a UNM or LMN injury?
|
LMN
|
|
|
What are 4 hallmark signs/symptoms of cauda equina?
|
weakness
atrophy impotence areflexia at ankle and plantar |
|
|
What LE reflex is preserved in cauda equina?
|
knee jerk (L4)
|
|
|
In cauda equina is the bulbocavernosus preserved or absent?
|
absent
|
|
|
Cuada equina has a better/worse prognosis than UMN injuries?
|
better
|
|
|
What is a congenital cause of conus medullaris?
|
spina bifida
|
|
|
What is a orthopedic cause of conus medullaris?
|
T12- L1 fx
|
|
|
Is conus medullaris an UMN or LMN syndrome?
|
LMN
|
|
|
What is the loss of sensory distribution called in conus?
|
saddle
|
|
|
Is conus symmetric or assymetric?
|
symmetric
|
|
|
What are 3 dysfunctions in conus?
|
bladder, bowel and sexual dyfunction
|
|
|
What nerve roots are typically involved with conus medullaris?
|
S1-S5
|
|
|
Is motor in LEs normal or abnormal in conus medullaris?
|
normal
|
|
|
A high conus lesion will result in presence of what reflex
|
bulbocavernosus
|
|
|
Is pain prominent in conus medullaris?
|
no
|
|
|
In conus, the highest and lowest levels of injury are what?
|
T12/L2
|
|
|
Below what level is the injury in cauda equina?
|
below L2
|
|
|
Can lumbar spondylosis be associated with cauda equinus?
|
yes
|
|
|
What three areas of fracture can cause cauda equina?
|
fx below L2
sacral fx pelvic fx |
|
|
What type of paralysis is present in cauda equina? flaccid or spastic
|
flaccid
|
|
|
Is cauda equina an UMN or LMN injury?
|
LMN
|
|
|
Are the deficits in cauda equina symmetric or assymetric?
|
asymmetric
|
|
|
High cuada equina lesions spare functions of what two organs?
|
bladder/bowel
|
|
|
Cauda equina lesions causing bowel, bladder, and sexuaal dysfunction are located at what level range?
|
S3-5
|
|
|
What reflex is absent in sacral cauda equina lesions?
|
bulbocavernosus reflex
|
|
|
In cauda equina are LE reflexes hyper or hypo reflexic?
|
hypo or areflexic
|
|
|
In conus in the EMG normal or abnormal?
|
normal
|
|
|
In conus, motor function is normal unless what level is affected?
|
S1-2
|
|
|
An abnormal EMG in conus medullaris is due to injury in onr or more of what 3 areas?
|
external sphincter
S1 S2 |
|
|
Is the EMG in cauda equina normal or abnormal?
|
abnormal according to the root level involved
|
|
|
C1-4 SCI patients are independent using a power WC in what two areas of ADLs?
|
weight shifts
WC propulsion |
|
|
A C5 quad is absolutely dependent in what two areas?
|
LE dressing
bathing |
|
|
What level quad can drive with adaptations/
|
C5
|
|
|
What level quad is independent in feeding with adaptive equipment after set-up?
|
C5
|
|
|
A C6 quad is independent without assistance or adaptive equipment in what two ares?
|
UE dressing
weight shifts |
|
|
What level quad is independent using manual WC on level surfaces?
|
C6
|
|
|
What level quad is independent in manual WC except for curbs and uneven terrain?
|
C7
|
|
|
What level quad is independent in transfers with or without board for level surfaces?
|
C7
|
|
|
A C8 quad is independent in all areas without equipment except what one ADL area that requires equipment, not including driving with hand control or adapted van?
|
bathing
|
|
|
What level quad in independent in feeding without equipment?
|
C6
|
|
|
T2-S5 paras are absolutely independent in what 3 areas of living?
|
all ADLs
bowel/bladder transfers |
|
|
What level para range can stand in a frame, tilt table or standing WC?
|
T2-9
|
|
|
What is the LE orthosis for a T2-9 para?
|
bilat KAFO
|
|
|
What type of crutches for a T2-9 para?
|
forearm crutches
|
|
|
What level range para is capable of household ambulation with orthoses?
|
T10-L2
|
|
|
What type of braces and crutches are necessary for a T10-L2 para?
|
KAFO with forearm crutches
|
|
|
What level para is capable of community ambulation?
|
L3-S5
|
|
|
What is the highest level, extremely movitivated quad that can live independantly without the aid of an attendant?
|
C6
|
|
|
A C6 living indendently uses what type of kinetic chain, open or closed, to accomplish a transfer?
|
closed
|
|
|
A C6 living independently must stabilize what joint extension to accomplish the transfer?
|
must stabilize elbow extension
|
|
|
What is the usual quad level for acheiving independence?
|
C7
|
|
|
What is the level at which and above are autonomic dysreflexia and orthostatic hypotension considered a risk?
|
T6 and above
|
|
|
A T6 and above para is at risk from what two complications?
|
autonomic dysreflexia
orthostatic hypotension |
|
|
At what level and above is a para unable to self-regulate normal body temperature?
|
T8 and above
|
|
|
A T8 and above para is unable to regulate what body function?
|
body temperature
|
|
|
Where in the brain is temperture regulation controlled?
|
hypothalmus
|
|
|
There is a lack of sympathetic or parasympathetic outflow that causes orthostatic hypotension?
|
lack of sympathetic outflow
|
|
|
Tilting the patient to what degree will trigger orthostatic hypotension?
|
>60 degrees
|
|
|
Autonomic control of heart and blood vessels is located in what thoracic level range?
|
T1-T7
|
|
|
What level range control arterial pressure, tachycardia and vasoconstriction?
|
T1-L2
|
|
|
Hypotension in SCI is due to decreased what?
|
decreased pre-load
|
|
|
What is a positional treatment for orthostatic hypotension?
|
trendelenburg
|
|
|
What is a fluid intake treatment for orthostatic hypotension?
|
increase fluids
|
|
|
What are three pharma treatments for orthostatic hypotension?
|
salt 1gm qid
midodrine florinef |
|
|
What is the class of drug of midodrine?
|
alpha 1 adrenergic agonist
|
|
|
Having orthostatic hypotension puts patient at risk for what other complication?
|
autonomic dysreflexia
|
|
|
AD is due to the loss of what autonomic function?
|
descending central sympathetic control
|
|
|
In the pathology of AD sympathetic receptors are hyper or hyposensative?
|
hypersensitive
|
|
|
What two circulatory parameters increase in AD?
|
cardiac output
blood pressure |
|
|
The AD the brainstem is unable to send messages to the splanchic bed to allow vasoconstriction or vasodilation to decrease BP?
|
vasodilation
|
|
|
In what timeframe after SCI does AD usually occur?
|
2-4 weeks post injury
|
|
|
Classically AD occurs in complete or incomplete SCI?
|
complete, but can occur in incomplete
|
|
|
What is the most common cause of AD?
|
bladder overdistension or infection
|
|
|
The stimulus setting off AD occurs above or below the SCI injury?
|
below
|
|
|
What are two classic symptoms of AD?
|
flushing and sweating ABOVE the level of injury
|
|
|
Name three other typical symptoms of AD?
|
increased BP
constricted pupils headache |
|
|
What is a positional treatment for AD?
|
sit patient up
|
|
|
What is a urinary tx for AD if bladder is suspect as stimulus for AD?
|
remove catheter, straight cath, tx UTI if present
|
|
|
How often should BP be checked in AD?
|
every 2-5 minutes
|
|
|
What are 4 ICU agents used to rx elevated BP in AD?
|
labetolol
nitropaste hydralazine diazoxide |
|
|
What two classes of agents can be used to help prevent AD?
|
beta blockers
alpha blockers |
|
|
What type of anesthesia is recommended for delivery in a T6 or above para?
|
spinal anesthesia
|
|
|
Spinal anesthesia is recommended for labor in a SCI at what level or above?
|
T6 or above
|
|
|
AD predisposes a patient to what heart condition?
|
atrial fib
|
|
|
What type of arryhthmias are more common in AD?
|
re-entrant type arrhythmias
|
|
|
Tachycardia in orthostatic hypotension is due to sympathetic outflow of what baroreceptors?
|
aortic and carotid
|
|
|
What class of med is florinef?
|
mineralcorticoid
|
|
|
Orthostatic hypotension results from a inability of the splanchnic bed to vasodilate or vasoconstrict?
|
vasoconstrict upon assuming upright position
|
|
|
Where is the inhibitor of the parasympathetic sacral micturation center? nuclei and lobes
|
Corticopontine mesencephalic nuclei in the frontal lobesq
|
|
|
What does the inhibition of the parasympathetic sacral micturation center allow?
|
bladder storage
|
|
|
Where is the coordination of bladder contraction and sphincter relaxation?
|
pontine mesencephalic nuclei in the pons
|
|
|
What urinary function occurs in the pons?
|
coordination of bladder contratction and sphincter relaxation
|
|
|
Loss of urinary control in the pons results in what condition?
|
detrusor sphincter dyssynergia
|
|
|
Detrusor sphincter dyssynergia arises out of a lesion in what area (nuclei and location)
|
pontine mesencephalic nuclei in the pons
|
|
|
Pelvic and pudendal nuclei control what micturation center?
|
sacral micturation
|
|
|
What is the function of pelvic and pudendal nuclei?
|
mediate parasympathetic S2-S4 sacral micturation reflex
|
|
|
What area voluntarily controls the external urethral sphincter?
|
motor cortex to the pudendal nucleus
|
|
|
Where is the detrusor nucleus controlling bladder contraction and emptying?
|
intermediolateral gray matter of the sacral cord at S2-4
|
|
|
Bladder contraction and emptying is a sympathetic or parasympathetic function?
|
parasympathetic
|
|
|
What type of receptors cause bladder contraction and emptying in response to parasympathetic action?
|
cholinergic
|
|
|
Where is the origin of sympathetic efferents?
|
T11-L2
|
|
|
What level range are the parasympathetic efferents controlling bladder contraction and emptying?
|
S2-S4
|
|
|
Sympathetic efferents to the bladder synapse on what two receptors?
|
alpha-1 and beta-2 adrenergic
|
|
|
Where are beta-2 adrenergic receptors located?
|
body of bladder
|
|
|
What is the function of beta-2 adrenergic receptors?
|
smooth muscle relaxation allowing bladder to fill
|
|
|
Where are two urinary system locations of alpha-1 receptors?
|
base of bladder and prostatic urethra
|
|
|
What is the function of alpha-1 adrenergic receptors in the urinary system?
|
smooth muscle contraction in the urine and causing storage of urine
|
|
|
What is the origin of the somatic efferents of the urinary system? nucleus and spinal level range
|
pudendal nucleus of S2-S4
|
|
|
What peripheral nerve carries fibers the urinary system?
|
pudendal
|
|
|
What type of muscle does the pudendal nerve stimulate, striated or smooth?
|
striated
|
|
|
What structure does the pudendal nerve innervate?
|
external urethral sphincter
|
|
|
What is the function of the external urethral sphincter?
|
voluntary contraction prevents leakage or emptying
|
|
|
Afferent fiber originate in what 5 structures?
|
detrusor stretch recptors
external anal sphincter external urethral sphincter perineum genitalia |
|
|
What two nerves carry afferents to the sacral cord?
|
pelvic and pudendal nerves
|
|
|
What type fibers in the pelvic and pudendal nerves respond to bladder distention?
|
myelinated a-delta fibers
|
|
|
What fibers are more active following SCI?
|
C-fibers
|
|
|
What two meds in SCI are used to control unihibited contractions, and what type fibers are targeted?
|
capsaicin, resiniferatoxin
C-fibers |
|
|
What type of fibers of what spinal level range are carried by the hypogastic nerve?
|
sympathetic/T11-L2
|
|
|
The internal urethral sphincter in innervated by what nerve?
|
hypogastric
|
|
|
What is the function of the internal urethral sphincter?
|
hypogastric nerve contracts sphinter and promotes urine storage
|
|
|
What nerve and spinal level range innervates the external sphincter?
|
pudendal nerve
S2-S4 |
|
|
Is the control of the pudendal nerve involuntary or voluntary?
|
voluntary -skeletal muscle
|
|
|
Is the control of the hypogastric nerve voluntary or involuntary?
|
involuntar -smooth muscle
|
|
|
In what 4 structures of the urinary system are cholanergic muscarinic receptors located?
|
bladder wall
trigone bladder neck urethra |
|
|
In what 2 urinary structures are Beta-2 adrenergic receptors located?
|
bladder
bladder neck |
|
|
What binds to Beta-2 adrenergic receptors?
|
norepinephrine
|
|
|
What does norepinephrine binding to beta-2 receptors cause?
|
bladder relaxation
|
|
|
In what 2 urinary structures are Alpha-1 adrenergic receptors located?
|
base of bladder
prostatic urethra |
|
|
What molecule binds to alpha-1 adrenergic receptors?
|
norepinephrine
|
|
|
What does norepinephrine binding to alpha-1 adrenergic receptors cause?
|
bladder contraction
|
|
|
Activation of alpha-1 and beta-2 adrenergic receptors originates in sympathetic efferents from what spinal levels through what nerve?
|
T11-L2/hypogastric nerve
|
|
|
Activation of alpha-1 and beta-2 receptors allows what to happen?
|
storage of urine
|
|
|
Activation of what adrenergic receptors allow bladder wall expansion?
|
beta-2 adrenergic receptors relaxes bladder wall to allow storage of urine
|
|
|
Bladder emptying originates in the spinal cord at what level range?
|
S2-4
|
|
|
What "tone" predominates during urination, sympathetic or parasympathetic?
|
parasympathetic
|
|
|
Parasympathetic efferents travel through what nerve to the bladder?
|
pelvic nerves
|
|
|
S2-S4 parasympathetic efferents activate what receptors?
|
cholinergic muscarinic (M2) receptors
|
|
|
In what 4 urinary structures are cholinergic muscarinic receptors located?
|
bladder wall, trigone, neck, and urethra
|
|
|
What neurotransmitter activates cholinergic muscarinic receptors? What does it cause the bladder to do?
|
acetylcholine/contract, causing urination
|
|
|
What receptors are activated (by what neurotransmitter?)upon voiding to cause relaxation of the bladder neck?
|
norepinephrine/beta-2 adrenergic
|
|
|
What 3 parameters are measured during cystometry?
|
sensation
capacity presence of involuntary detrusor activity |
|
|
At what ml is there a sensation of bladder filling?
|
100ml
|
|
|
What sensory parameter controls first urge to void and strong urge to void?
|
proprioception
|
|
|
Functional bladder capacity is the sum of what two measures?
|
voided volume + residual volume
|
|
|
voided volume + residual volume = what
|
function bladder capacity
|
|
|
What is the accepted range of normal bladder capacity?
|
300-600ml
|
|
|
What is the reflex status of a bladder in spinal shock?
|
areflexic
|
|
|
An areflexic bladder retains or voids urine?
|
retains
|
|
|
What is the time frame range of return of bladder reflexes?
|
2-12 weeks
|
|
|
What is the time frame range(in days) for starting an indwelling catheter program post injury?
|
7-15 days
|
|
|
What is the initial fluid restriction (in L/day) of an SCI patient
|
2L/day
|
|
|
At what ml fill range is there a sense of urgency?
|
400-500cc
|
|
|
At what ml fill range is there a sense of bladder fullness?
|
300-400cc
|
|
|
During normal bladder fill does intravesical pressure increase significantly?
|
no
|
|
|
During normal voiding what is the status of the EMG signal?
|
silent
|
|
|
What happens to the intravesical pressure during normal voiding?
|
increases
|
|
|
What happens to the urethral pressure during voiding?
|
decreases
|
|
|
What is a long term possible complication an indwelling catheter?
|
cancer
|
|
|
Intermittent catheterization volumes should be less than what volume (cc)
|
500 cc
|
|
|
What are the two causes of vesicoureteral reflux?
|
bladder wall hypertrophy
loss of vesicoureteral angle |
|
|
Bladder wall hypertrophy and
loss of vesicoureteral angle can cause what phenomenon? |
vesicoureteral reflux
|
|
|
Maintaining bladder volumes <500ml will help prevent what 3 complications of intermittent catheterization?
|
vesicoureteral reflux
hydro-ureter overflow incontinence |
|
|
What is the the basic urinary problem with a LMN bladder?
|
failure to empty
|
|
|
What are the two direct causes of failure to empty bladder? (bladder and sphincter tone characterization)
|
flaccid bladder
spastic sphincter |
|
|
What are 3 spinal cord syndromes resulting in a flaccid bladder/failure to empty problem?
|
cauda equina syndrome
conus medullaris syndrome syringomyelia |
|
|
What is a brain injury cause of flaccid bladder/failure to empty?
|
acute CVA
|
|
|
At what spinal level is the lesion causing failure to empty?
|
sacral micturation center (S2-S4
|
|
|
A LMN/flaccid bladder/failure to empty condition arises out of a peripheral nerve or central innervation problem?
|
peripheral nerve
|
|
|
What is the preferred method of treating flaccid bladder/failure to store?
|
intermittenct catheterization
|
|
|
What maneuver is helpful with LMN flaccid bladder?
|
valsalva
|
|
|
What medicine stimulates cholinergic receptors in the urinary system? What does it help accomplish?
|
bethanocol/voiding
|
|
|
Name 4 drugs that block alpha-1 adrenergic receptors (thus promoting relaxation at the base of the bladder and voiding)
|
alpha-1 blockers:
minipress dibenzyline hytrin cardura |
|
|
The basic functional problem of an UMN bladder is what?
|
failure to store
|
|
|
What are the two direct causes of a UMN failure to store bladder?
|
incompetent sphinter
spastic bladder |
|
|
What neurological disease classically results in a spastic detrusor?
|
MS
|
|
|
What event in SCI is a cause of failure to store?
|
return of urinary reflex arc after spinal shock
|
|
|
What type of brain injury results in a spastic detrusor?
|
subacute CVA
|
|
|
Where is the lesion causing an UMN bladder?
|
above the sacral micturation center at S2
|
|
|
What 3 classes of meds promote storage in a UMN failure to store bladder?
|
alpha adrenergic agonist
direct smooth muscle relaxant anticholinergic |
|
|
What class of med is most commonly used to promote storage in an UMN failure to store bladder?
|
anticholinergic
|
|
|
What are two example of anticholinergic meds used to treat failure to store?
|
detrol
pro-banthine |
|
|
What reflex is absent in LMN failure to empty bladder?
|
bulbocavernosus
|
|
|
In a LMN failure to empty bladder what happens to detrusor pressure as the bladder fills?
|
remains constant
|
|
|
What is the appearance of a LMN failure to empty bladder EMG of the pelvic floor?
|
flat line
|
|
|
In a UMN failure to store bladder there is or there is not suppression of the sacral micturation center?
|
there is no suppression of the sacral micturation center and the bladder fails to store urine and the patient voids prematurely
|
|
|
What is represented by the first burst of activity in a failure to store UMN bladder EMG of the pelvic floor?
|
bulbocavernosus reflex
|
|
|
In a UMN failure to store bladder EMG of the pelvic floor, what is the EMG activity during micturation and what sphincter does this represent?
|
silence/external urethral sphincter
|
|
|
Up to 85% of SCI develop what type of bladder condition?
|
detrussor sphincter dyssynergia
|
|
|
Between what two structures is the injury causing detrussor sphincter dyssynergia (DSD)?
|
Between the sacral micturation center S2-S4 and the pontine micturation center
|
|
|
What 3 conditions can lead to DSD?
|
MS
Central cord syndrome progression of SCI |
|
|
What is the practical result of DSD?
|
failure to empty (similar to LMN bladder)
|
|
|
What is the tone of the detrussor and sphincter in DSD?
|
both spastic
|
|
|
What are the voiding pressures in DSD, high or low?
|
high
|
|
|
What is a complication of DSD?
|
vesicoureteral reflux
|
|
|
In DSD volumes are increased or decreased?
|
volumes are increased in DSD
|
|
|
What is the treatment of DSD?
|
anticholinergic meds such as detrol and pro-banthine
|
|
|
Why treat DSD with anticholinergics?
|
anticholinergics promote bladder wall relaxation and help prevent vesicoureteral reflux
|
|
|
What other class of meds is used to treat DSD?
|
alpha-1 adrenergic blockers
|
|
|
What two classes of meds is used to treat combination bladder (detrussor sphincter dyssynergia)? function of each
|
anticholinergics- relax detrussor
alpha-1 adrenergic blocker- relax sphincter |
|
|
What is a surgical treament for DSD?
|
sphincterotomy
|
|
|
Is the the vesicoureteral valve one-way or two-way?
|
one way
|
|
|
What is the activity of pelvic floor muscles during urination of a patient with DSD? high or low
|
high electrical activity
|
|
|
What is the normal EMG activity of pelvic floor muscles during micturation?
|
silent
|
|
|
During voluntary inhibition of micturation what is the activity of EMG of pelvic floor muscles?
|
high
|
|
|
What is the normal vesicoureteral angle description?
|
oblique
|
|
|
With bladder wall hypertrophy the normal oblique vesicoureteral angle becomes increasingly what angle?
|
perpindicular
|
|
|
A perpindicular vesicoureteral angle renders the valve incompentent true/false?
|
true
|
|
|
What happens when the vesicoureteral valve is incompetent?
|
the valve cannot close during bladder contraction so urine is forced up the ureters to the kidneys resulting in hydronephrosis
|
|
|
Acidic or basic urine inhibits microbial growth?
|
acidic urine inhibits microbial growth
|
|
|
Is assymptomatic bacteruria in an indwelling catherter SCI patient treated?
|
no
|
|
|
Name 3 urine acidifying agents used in SCI prophylactically?
|
vit C
cranberry juice methenamine |
|
|
What SCI patients should not have their urine acidified prophylactically?
|
vesicoureteral reflux
pre-cystocopy or urodynamic procedures urease-producing organisms |
|
|
Name 6 urease producing organisms?
|
klebsiella
pseudomonas proteus providentia e.coli staph epidermidis |
|
|
Abx treatment is started when clean catch specimen show what level of infection(organisms/ml)?
|
100,000/ml
|
|
|
Abx treatment is started when a urine cath shows what level of infection (organisms/ml)
|
100/ml
|
|
|
What are 4 signs that indicate a UTI should be treated?
|
pyuria
fever spasticity neurogenic pain |
|
|
What are the most common earliest changes in a neurogenic bladder?
|
irregular, thickened bladder wall
small diverticuli |
|
|
What are two serious complications of vesicoureteral reflux?
|
pyelonephritis
renal stones |
|
|
What is another common urinary complication of a neurogenic bladder?
|
vesicoureteral reflux
|
|
|
Below what pressure (cm/H2O) is best for draining the neurogenic bladder to help prevent complications?
|
below 40cm/H2O
|
|
|
Ejaculation is under the control of the sympathetic or parasympathetic system?
|
sympathetic
|
|
|
What peripheral nerve manages erections?
|
pudendal
|
|
|
What is the spinal level and spinal structure involved in the erection reflex arc?
|
S2-4/cauda equina
|
|
|
Pre- or post-ganglionic parasympathetic fibers secrete nitric acid?
|
post-ganglionic
|
|
|
In creating an erection what do post-ganglionic parsympathetic fibers secrete?
|
nitric acid
|
|
|
What are the two vascular functions of nitric acid?
|
*relaxes corpus cavernosum
*increases blood flow to penile arteries |
|
|
What spinal levels are involved in ejaculation?
|
T11-L2
|
|
|
Through what nerve plexus do the T11-L2 sympathetic fibers controlling ejaculation travel?
|
hypogastric plexus
|
|
|
What are the 3 structures innervated by T11-L2 sympathetic fibers controlling ejaculation?
|
vas deferens
seminal vesical ejaculatory ducts |
|
|
What percentage of men with complete and incomplete UMN lesions can get reflexogenic erections?
|
>90%
|
|
|
What is more likely, an erection with UMN or LMN injury?
|
UMN
|
|
|
What percentage of men with complete LMN can achieve erection?
|
12%
|
|
|
What percentage of men with incomplete UMN lesions can get erections?
|
50%
|
|
|
Are erections possible with complete UMN lesions?
|
no
|
|
|
What percentage of men with complete LMN lesions can get erections?
|
25%
|
|
|
What spinal levels mediate a reflexogenic erection?
|
S2-4
|
|
|
Are erections more likely with complete or incomplete lesions?
|
incomplete
|
|
|
What class of meds induce erections?
|
phosphodiesterases
|
|
|
What are two available phosphodiesterases?
|
sildenafil
vardenafil |
|
|
A patient with what type of lesion responds best to phosphodiesterases? UMN or LMN injury
|
UMN
|
|
|
What prostaglandin can be used for intracorporeal injections?
|
prostaglandin E1
|
|
|
What 3 classes of meds can be used for intracorporeal injections?
|
prostaglandins
alpha blockers vasodilators |
|
|
What is a risk of intracorporeal injections?
|
priapism
|
|
|
What percentage of men with complete UMN lesions can ejaculate?
|
5%
|
|
|
What percentage of men with complete LMN lesions can ejaculate?
|
18%
|
|
|
What percentage of SCI couples with have successful reproduction?
|
<10%
|
|
|
What is a complication of penile vibratory stimulation?
|
AD
|
|
|
What are three sperm retrieval methods in SCI?
|
penile vibratory stimulation
electroejaculation testicular extraction |
|
|
Electroejaculation can improve the quality of what fluid?
|
semen
|
|
|
Prostatic fluid stasis promotes what quality measure of semen?
|
motility
|
|
|
Sitting with legs together in SCI promotes what thermal condition that decreases the quality of semen?
|
testicular hyperthermia
|
|
|
Leukocytes in the semen reduce what three semen metrics?
|
motility
total count velocity |
|
|
What is the predictive factor for inability of sperm to penetrate ovum?
|
leukocyte concentration
|
|
|
What is the most common biopsy finding of SCI testicles?
|
atrophy of seminiferous tubules
|
|
|
Stimulation afferents of female genitalia is carried by what nerve and mediated at what spinal level?
|
pudendal nerve/S2-4
|
|
|
In a female the efferent parasympathetic fibers invovled with sexual excitation are carried in what nerve?
|
pelvic nerve
|
|
|
Amenorrhea occurs in what percentage of women with a cervical or high thoracic SCI immediately after injury?
|
85%
|
|
|
Amenorrhea occurs in what percentage of SCI women overall?
|
50%
|
|
|
What percentage of high thoracic or cervical SCI experience a return of menses and in what time frame range?
|
50%/6-12 months
|
|
|
What percentage of overall SCI women have a return of menses within 6-12 months?
|
90%
|
|
|
Does SCI affect female fertility?
|
No
|
|
|
What is an SCI risk factor of an IUD?
|
pelvic inflamatory disease - AD
|
|
|
Is the likelihood pregnancy changed with SCI vs normal
|
no
|
|
|
What is a respiratory complication of SCI pregnancy?
|
decreased pulmonary function
|
|
|
What is a general SCI complication of pregnancy?
|
AD
|
|
|
What may be the only sign of SCI labor?
|
AD
|
|
|
What is the spinal innervation range for the uterus?
|
T10-T12
|
|
|
How long should the epidural remain in place after SCI delivery in order to reduce likelihood of AD?
|
12 hours
|
|
|
What are the two plexi of the enteric nervous system?
|
Auerbach's and Meissner's plexi
|
|
|
Where do Meissner;s and Auerbach's plexi lay?
|
between the two layers of the gut smooth muscle
|
|
|
Is Auerbach's primarily motor or sensory?
|
motor
|
|
|
Is Meissner's primarily motor or sensory?
|
sensory
|
|
|
What part of the colon does the vagus nerve innervate?
|
proximal to mid transverse colon
|
|
|
The splanchnic or pelvic nerves innervate what part of the colon?
|
decending colon and rectal region
|
|
|
What is the spinal level range origin of the splanchnic or pelvic nerve?
|
S2-4
|
|
|
The splanchnic and vagus nerves are part of what nervous system?
|
parasympathetic
|
|
|
What is the function of the sympathetics on colonic motility?
|
decreases colonic motility
|
|
|
What nerve serves the sympathetic nervous system in the gut?
|
hypogastric
|
|
|
The hypogastric nerve sympathetic fibers are distributted in the gut by what 3 ganglia?
|
superior mesenteric
inferior mesenteric celiac |
|
|
Is the external anal sphincter smooth or striated?
|
striated
|
|
|
What spinal level range controls the internal anal sphincter?
|
T11-L2
|
|
|
What type of muscle is the internal anal sphincter, smooth or striated?
|
smooth
|
|
|
What nerve innervates the external anal sphincter? What spinal level range?
|
pudendal nerve/S2-4
|
|
|
The internal anal sphincter relaxes or constricts with the filling of the rectum?
|
relaxes
|
|
|
What is the brain defecation center?
|
pontine defecation center
|
|
|
What causes reflex internal anal sphincter relaxation?
|
rectosigmoid distension
|
|
|
Volitional contraction of what muscle allows the opening of the proximal rectal canal?
|
levator ani
|
|
|
The levator ani muscle action to open the canal relaxes what two other striated muscles thus allowing defecation?
|
external anal sphincter
puborectalis muscle |
|
|
An UMN lesion results in a hyper or hyporeflexic bowel?
|
hyperreflexic bowel
|
|
|
In a UMN, hyperreflexic bowel, there is no volitional control to relax what sphincter?
|
External anal sphincter
|
|
|
An UMN lesion results in a reduced ability to sense the urge to defecate, true or false?
|
true
|
|
|
How are stools propelled in UMN lesion?
|
reflex activity
|
|
|
A LMN lesion is one that is below what spinal structure?
|
conus medullaris
|
|
|
A LMN bowel is one that is hyper, hypo, or a- reflexic?
|
areflexic
|
|
|
What bowel function is absent in a LMN or a-reflexic bowel?
|
reflex defecation
|
|
|
What plexus coordinates movement of stool in the colon?
|
Auerbach's or myenteric plexus
|
|
|
What is the practical outcome of a LMN or areflexic bowel?
|
constipation with incontinence due to a flaccid external anal sphincter
|
|
|
What is the tone of a LMN bowel external anal sphincter?
|
flaccid tone
|
|
|
What are the two most common complications of a UMN bowel lacking parasympathetic and sympathetic control?
|
constipation
fecal impaction |
|
|
Constipation and fecal impaction are two complications of what type of lesion? UMN or LMN
|
UMN
|
|
|
Constipation and fecal impaction are two complications of UMN lesion lacking parasympathetic and sympathetic input at what 2 sections of the colon?
|
transverse and descending colon
|
|
|
When does post-injury ileus resolve
|
1 week
|
|
|
What device has been show to effective in promoting peristalsis?
|
TENS
|
|
|
In SCI what agent is used for refractory pseudo-obstruction?
|
neostigmine
|
|
|
What two agents can promote peristalsis post-injury?
|
metoclopromide
erthythromycin |
|
|
What device should be inserted immediately upon SCI and why?
|
NG tube and suction to prevent GI dilation
|
|
|
Surgery or colonoscopy may be indicated if cecum is distended more than how many inches?
|
>12"
|
|
|
What 3 classes of med that slow bowel motility should be avoided in SCI with bowel dysfunction?
|
anticholinergics
opioids tricyclics |
|
|
Bulk-forming agents are more commonly used initially in UMN or LMN lesions?
|
LMN lesions
|
|
|
How do bulk forming agents promote evacuation?
|
by retaining or pulling H2O into the colon
|
|
|
What two substances accumulate in the colon with the use of stool softeners such as docusate sodium?
|
fat and fluid
|
|
|
On what nerve structure does senna (oral stimulant) act and for what effect?
|
stimulates peristalsis by acting on Auerbach's plexus
|
|
|
What are two ways that glycerine suppositories work?
|
draws water into stool and stretches rectal wall
|
|
|
In what two ways do bisacodyl (Dulcolax) suppositories work?
|
stimulates peristalsis
stimulates sensory nerve |
|
|
What two intact reflexes are used to create a bowel program?
|
gastrocolic reflex
anorectal reflex |
|
|
What is the gastrocolic reflex?
|
increased colonic activity 30-60 minutes after a meal
|
|
|
What is the anorectal reflex?
|
relaxation of the internal anal sphincter when bowel contents stretch the bowel wall reflexively.
|
|
|
How is the anorectal reflex leverage in a bowel program?
|
Suppositories and digital stim cause bowel wall to stretch, thereby, through the anorectal reflex, relaxing the internal anal sphincter.
|
|
|
In what direction, clockwise or counterclockwise, digital stim done to promote the anorectal reflex?
|
clockwise
|
|
|
What topical should be used during fecal disimpaction and why?
|
lidocaine gel/to reduce likelihood of AD
|
|
|
What type of meds are used for failure to store bladder (UMN) that may cause constipation?
|
anti-cholinergics
|
|
|
What agent is used short term for GERD in SCI?
|
metoclopramide
|
|
|
When (early or late) after injury is GI bleeding most likely to occur?
|
early
|
|
|
How does sucralfate work?
|
promotes local prostaglandin synthesis
|
|
|
What is the most common cause of emergency abdominal surgery in SCI?
|
cholecystitis
|
|
|
Gallbladder dysfunction is more common in SCI with a lesion above what level?
|
T10
|
|
|
During what month post SCI is pancreatitis common?
|
first month post injury
|
|
|
What two conditions may be suspected if adynamic ileus does not improve in the normal time frame?
|
cholecystitis
pancreatitis |
|
|
What two blood labs are elevated in pancreatisis?
|
lipase
amylase |
|
|
What is superior mesenteric artery syndrome?
|
third portion of duodenum is compressed by the superior mesenteric artery resulting in GI obstruction
|
|
|
What are 4 risk factors for SMA syndrome?
|
supine
rapid weight loss spinal orthosis flaccid abdominal causing spinal hyperextension |
|
|
What are 3 cardinal symptoms of SMA syndrome?
|
postprandial nausea
bloating abdominal pain |
|
|
An upper GI series study showing abrupt duodenal obstruction is diagnostic for what SCI complication?
|
Superior mesenteric artery syndrome
|
|
|
What are three treatments for superior mesenteric artery syndrome?
|
small frequent meals
left lateral decubitus after meals metoclopramide |
|
|
What is the function of metoclopramide?
|
Stimulates GI motility
|
|
|
In general what factor promote development of superior mesenteric arthery syndrome?
|
any force (weight loss, supine, flaccid abdominals, spinal orthosis) that reduces the angle between the SMA and the aorta
|
|
|
What sided renal vein abuts the 3rd part of the duodenum?
|
left renal vein
|
|
|
What is a common metabolic condition in SCI resulting from immobilization?
|
hypercalciuria
|
|
|
Are Vit D and parathyroid hormone involved with hypercalciuria?
|
no
|
|
|
When the efflux of calcium coming out of bones is massive or the glomular filtration rate of the kidneys is reduced, what can result?
|
hypercalcemia
|
|
|
Hypercalcemia is more common in tetra or paraplegia?
|
tetraplegia
|
|
|
What is the percentage range of SCI with hypercalcemia?
|
10-23%
|
|
|
In what week range after injury does hypercalemia occur?
|
4-8 weeks
|
|
|
What is the normal level of serum calcium?
|
<10.5
|
|
|
For what must the serum calcium be corrected?
|
albumin, since serum calcium is protein bound
|
|
|
What can prolonged hypercalcemia cause?
|
nephrocalcinosis
|
|
|
What is the treatment for hypercalcemia?
|
IV normal saline
|
|
|
What is the function of IV normal calcium in the treatment of hypercalcemia?
|
increases urinary excretion of calcium
|
|
|
What is an activity treatmen for hypercalcemia?
|
early mobilization, standing, and ambulation as tolerated
|
|
|
Is dietary restriction of calcium indicated in hypercalcemia?
|
no
|
|
|
What type of Vit D level is low in hypercalemia?
|
1,25-dihydroxyvitamin D
|
|
|
Low 1,25 hydroxyvit D suppresses intestinal absorption of what molecule?
|
calcium
|
|
|
In hypercalcemia, what vitamin intake is restricted?
|
Vit C
|
|
|
What is the medication rx for hypercalcemia?
|
pamidronate
|
|
|
What are the two mechanisms of action of pamindronate?
|
inhibits osteoclast resorption
reduces osteoclast viability |
|
|
How is pamidronate administered?
|
one IV infusion
|
|
|
How quickly does pamidronate reduce serum calcium levels?
|
within 3 days
|
|
|
When (in days) following pamidronate infusion does serum calcium reach its nadir?
|
within 7 days
|
|
|
What med should not be used in hypercalceima since it can cause hypercalcemia?
|
thiazide diuretics
|
|
|
What other meds may be used to treat hypercalcemia?
|
didronel
calcitonin |
|
|
Where does osteoporosis occur in SCI?
|
below the level of the lesion
|
|
|
What percentage of bone is lost within 3 months of SCI?
|
22%
|
|
|
What is the incidence of long bone fracture in SCI?
|
2.5% over 20 years
|
|
|
In what type of injury are long bone fractures more common complete/incomplete; tetra/para
|
complete para
|
|
|
What is the most common cause of fracture in SCI?
|
falls during transfers
|
|
|
What is the most common site of fracture in SCI? Second most common
|
most common:supracondylar femur fractures
second most common: proximal tibia |
|
|
What 3 fracture treatment techniques in normals are not indicated in SCI?
|
surgery, circumferential casting, and external fixation
|
|
|
What are the most difficult SCI fractures to manage?
|
femoral neck and subtrochanteric
|
|
|
What percentage of SCI show insulin resistence?
|
70%
|
|
|
What percentage of SCI have respiratory complications in the first month post-injury?
|
67%
|
|
|
At what spinal level range are respiratory complications most common
|
C1-4
|
|
|
What are the three most common SCI complications?
|
pneumonia
atelectasis ventilatory failure |
|
|
What level SCI has respiratory failure due to diaphragmatic innervation interruption?
|
C3
|
|
|
The innervation of what respiratory muscle is interrupted in a C3 injury?
|
diaphragm
|
|
|
What is the highest C level SCI able to maintain spontaneous ventilation?
|
C4
|
|
|
Above hat level SCI is there a loss of all abdominal and intercostal power?
|
above C8
|
|
|
Intercostal volitional function is lost at what SCI level range?
|
T1-5
|
|
|
In what SCI level range is there a loss of forceful expiration or cough?
|
T5-12
|
|
|
What is the respiratory loss in SCI T5-T12?
|
loss of forceful expiration and cough
|
|
|
What is the leading cause of death in chronic SCI?
|
pneumonia
|
|
|
Name 3 predisposing factors for SCI pulmonary complication?
|
older
obesity hx of lung disease, smoking |
|
|
What side of lung are SCI respiratory complications usually located? Why?
|
left side - main bronchus branches off at 40 degrees making it more difficult to clear secretions, especially with suctioning
|
|
|
Above what SCI level intially requires ventilatory support?
|
above C3
|
|
|
What is the cervical level range of innervation to the diaphragm? Name of nerve
|
C3 C4 C5/phrenic
|
|
|
What test determines damage to the phrenic nerve?
|
EMG of diaphragm or NCS of the phrenic nerve
|
|
|
What are the two criteria determining candidacy for phrenic nerve pacing?
|
phrenic nuclei intact
UMN |
|
|
What is the only test to determine damage to the phrenic nucleus?
|
EMG of the diaphragm
|
|
|
What are three contraindications to phrenic pacing?
|
*denervated diaphragm
*placement prior to 6 months post injury *lung impairment |
|
|
Do SCI patients with phrenic pacing survive longer?
|
yes
|
|
|
What respiratory metric increases with phrenic pacing?
|
arterial oxygenation despite decreased alveolar ventilation
|
|
|
What is respiratory metric is decreased with phrenic pacing?
|
alveoloar ventilation
|
|
|
What are 5 signs of phrenic pacemaker failure?
|
sharp chest pain
shortness of breath erratic pacing |
|
|
What are 5 causes of phrenic pacemaker failure?
|
*diaphragmatic failure
*infection of lung or phrenic nerve *meds (sedative, tranquilizers) *upper airway obstruction *phrenic nerve damage |
|
|
During quiet breathing the diaphragm is responsible for what % of lung volume change?
|
75%
|
|
|
Name 3 inspiratory muscles.
|
diaphragm
external intercostals accessory muscles |
|
|
What muscle contracts during inspiration?
|
diaphragm
|
|
|
What muscle relaxes during expiration?
|
diaphragm
|
|
|
Name 2 expiratory muscles.
|
internal intercostals
abdominals |
|
|
What respiratory metric decreases during acute cervical SCI?
|
FVC
|
|
|
Why does the forced vital capacity decrease 25-30% during an acute cervical SCI?
|
paradoxical respirations
|
|
|
In a cervical SCI what causes the FVC to increase to 50-60% of predicted normal value?
|
intercostal and abdominal spasticy
|
|
|
What is the lung pattern of tetraplegics?
|
restrictive lung pattern
|
|
|
What is the only lung volume that does not decrease in cervical SCIs?
|
residual volume
|
|
|
At what VC is mechanical ventilation considered?
|
VC<1 L
|
|
|
At what cc/kg range can a SCI patient be weaned off a ventilator?
|
15-20cc/kg
|
|
|
Compared to a normal, a cervical SCI with phrenic nerve injury has lung movements that change in what 2 pathological ways during inspiration?
|
diaphragm move up
abdominal wall moves in |
|
|
During inspiration a diaphragm that move up and an abdominal wall that move in indicates damage to what structure?
|
phrenic nerve
|
|
|
In inspiration with an injured phrenic nerve, what is the movement of the chest wall (in or out); what is the movement of the diaphragm (up or down); and what is the movement of the abdominal wall (in or out)
|
chest wall - out
diaphragm - up abdominal wall - in |
|
|
Increased respiratory rate with decreased tidal volume is an indicator of what pending incident?
|
respiratory failure
|
|
|
Inability to count to 15 slowly is indicator of what impending event?
|
respiratory failure
|
|
|
Respiratory failure is evident at what cervcial SCI level?
|
C3
|
|
|
Respiratory failure is evident at what FVC cc/kg body weight?
|
<15 cc/kg body weight
|
|
|
What are 4 indicators of impending respiratory failure?
|
*can't count to 15 slowly
*FVC< 15 cc/kg body weight *C3 or higher SCI *increased respiratory rate with decreased tidal volume |
|
|
What are 5 indicators to initiate mechanical respiration?
|
VC<1 liter
ABG shows decreasing PCO2 or decreaseing PO2 PO2<50 PCO2>50 severe atelectasis |
|
|
Decreasing PO2 or increasing PCO2 are indicators to do what?
|
mechanical venilation
|
|
|
PO2<50 or PCO2>50 are indicators to initiate what?
|
mechanical ventilation
|
|
|
VC<1L is an indicator to do what?
|
mechanically ventilate
|
|
|
Severe atelectasis in an SCI patient is an indication to do what?
|
mechanically ventilate
|
|
|
What are two advantages of a mechanical cough device over a manual cough assist?
|
*clears secretions better
*clears larger mucous plugs better |
|
|
What are two contraindications to a mechanical cough device?
|
bullous emphysema
susceptibility to pneumothorax |
|
|
Strengthening of what muscle can assist in preventing respiratory complications?
|
pectoralis major - clavicular portion
|
|
|
Training in what type of breathing can help prevent respiratory complications?
|
glossopharyngeal breathing
|
|
|
What is the percentage range of sleep apnea in SCI?
|
15-60%
|
|
|
What is the most common type of sleep apnea in SCI?
|
obstructive
|
|
|
There is an increased risk for what 5 conditions with SCI obstructive sleep apnea?
|
hypertension
pulmonary hypertension CHF depression death |
|
|
What is the incidence range of HO in SCI?
|
15-60%
|
|
|
What type of bone is HO?
|
mature lamellar bone - indistinguishable from normal bone
|
|
|
Does HO occur above or below level of injury?
|
below
|
|
|
In order of incidence what are the 4 most common joints affected by HO?
|
hip/knee/shoulder/elbow
|
|
|
What month range post injury is HO most common?
|
1-4 months
|
|
|
What are 5 signs/symtoms of HO?
|
fever
edema erythema decreased ROM heat |
|
|
What is 5 risk factors for HO?
|
spasticity
pressure ulcer completeness of injury younger age prior surgery to joint |
|
|
What study is positive for HO earlier, bone scan or xray
|
bone scan
|
|
|
What is the day range after clinical signs/symptoms of HO appear that xray findings are positive?
|
7-10 days
|
|
|
In HO when does serum alk phos first rise and peaks, in weeks?
|
first rises - 2 weeks
peaks - 10 weeks |
|
|
What 3 blood tests are elevated in HO not specific for HO?
|
alk phos
CPK ESR |
|
|
What are 3 complications of HO?
|
peripheral nerve entrapment
loss of ROM pressure ulcer |
|
|
What is a medication prophylaxsis for HO?
|
etidronate disodium
|
|
|
For what period of time should etidronate disodium be prescribed when used as a treatment for HO?
|
6 months
|
|
|
What is the HO treatment dose of etidronate disodium with normal CPK?
|
20mg/kg/day x 3 months then 10mg/kg/day for 3 months
|
|
|
What is the HO treatment dose of etidronate disodium with elevated CPK?
|
20mg/kg/day for 6 months
|
|
|
What is an indocin dose for the treatment of HO?
|
indocin SR 75mg/day for 6 weeks
|
|
|
What anti-coagulant is used to treat HO?
|
warfarin
|
|
|
What are the two functions of radiation therapy in HO?
|
prevents further HO formation
prevents recurrence after surgery |
|
|
When (months post-inury) should surgery be done for HO?
|
12-18 months post-injury
|
|
|
What must the status of the bone scan be for surgical treatment of HO?
|
normal bone scan
|
|
|
What is Virchow's triad?
|
venous stasis
intimal injury hypercoaguability |
|
|
What are 0 predisposing factors for DVT in SCI?
|
Virchow's triad (venous stasis, intimal injury, hypercoagulability)
LE fractures obesity previous DVT DM PVD older immobility malignancy |
|
|
What is the percentage range of DVT in SCI?
|
47-100%
|
|
|
What are specific SCI risk factors for DVT?
|
complete injury
tetraplegic plegic leg |
|
|
How many more times common is DVT in plegic leg than not?
|
10x more common in plegic leg
|
|
|
When (weeks post-injury) is DVT most common is SCI?
|
first 2 weeks post-injury
|
|
|
When (week range post-injury)does the incidence of DVT in SCI decrease?
|
8-12 post SCI
|
|
|
What is gold-standard study for DVT?
|
venogram
|
|
|
Impedence plethysmography is good at detecting DVTs located where? What is the sensitivity/specificity?
|
above calf
sensitivity: 95% specificity: 98% |
|
|
What is the leading cause of death in acute SCI?
|
Pulmonary embolism
|
|
|
In PE what heart sound is increased?
|
S2
|
|
|
What side of the heart fails in PE?
|
right side
|
|
|
What is the incidence of PE in acute/subacute SCI?
|
7%
|
|
|
Is PE influenced by the degree of level of SCI?
|
no
|
|
|
What is an EKG finding in PE?
|
right axis deviation
|
|
|
What is the EKG finding in a massive PE?
|
right bundle branch block
|
|
|
What are 3 chest xray findings of PE?
|
*wedge shaped opacity
*vascularity *fluid |
|
|
What is the gold standard test for PE?
|
pulmonary arteriogram
|
|
|
What med is used to treat the shock of PE?
|
vasopressin
|
|
|
What are 6 symptoms of PE?
|
Pleuritic chest pain
dyspnea tachycardia fever hemoptysis hypoxemia |
|
|
What are 3 acute treatments for PE?
|
02
heparin vasopressin |
|
|
What is the surgical treatment for PE?
|
embolectomy
|
|
|
What 3 metrics are improved by external mechanical compression?
|
reduced stasis
improved fibrinolysis improved venous return |
|
|
Ruling out a DVT must be done if compression devices are not applied within how long (hours) of SCI injury?
|
>72hours
|
|
|
What low weight molecular heparin is used for DVT prevention, and at what dose?
|
enoxaparin 30mg sq BID
|
|
|
What is the typical dose of unfractionated heparin in SCI DVT prevention?
|
5000 u BID
|
|
|
When using adjusted dose unfractionated heparin, what should PTT be in relation to control (xcontrol).
|
1.5x control
|
|
|
What is a SCI-specific indication for IVC filter?
|
high level complete tetra with poor cardiopulmonary reserve
|
|
|
Until what hospitalization milestone should DVT prophylaxis continue in incomplete SCI?
|
discharge from hospital
|
|
|
Until when (in weeks post injury) should DVT prophylaxis be continued in an uncomplicated complete motor SCI?
|
8 weeks post injury
|
|
|
Until when (in weeks post-injury or what hospitalization) should DVT prophylaxis be continued in SCI patients with complete motor AND other risk factors?
|
12 weeks post injury or discharge from rehab
|
|
|
What device is not a substitute for prophylaxis?
|
IVC filter
|
|
|
What is the heparin dose to treat DVT?
|
5000 units IV bolus then 1000 u/hr
|
|
|
What is the preparation of constant 1000 u/hour infusion heparin for DVT treatment?
|
25,000 units heparin in 250 mL D5W at 10cc/hour
|
|
|
At what level in relation to control (xcontrol) should the PTT be maintained for heparin treatment of DVT?
|
1.5-2 x control
|
|
|
How long should coumadin be maintained after heparin treatment in documented proximal DVT?
|
6 months
|
|
|
How long is IV heparin maintained in acute DVT treatment?
|
5-10 days
|
|
|
What technique can be used in SCI for cardiovascular conditioning?
|
functional electrical stimulation
|
|
|
Functional electrical stim in SCI increases what three muscle metrics?
|
increases muscle mass, bulk, and endurance
|
|
|
What are two general uses of functional electrical stim?
|
*avoid complications of muscle inactivity
*produce extremity motion for functional activities |
|
|
What percentage range of SCI patients are functionally disabled by pain?
|
18-44%
|
|
|
What two pain scales are used in SCI?
|
bryce ragnarsson
IASP |
|
|
The IASP and bryce ragnarsson scales classify pain based on what two characteristics?
|
location
clinical presentation |
|
|
What joint is the most common location for pain in chronic SCI?
|
shoulder
|
|
|
Is pain more common in tetra or para SCIs?
|
tetra
|
|
|
Use of what device is associated with shoulder pain in SCI?
|
wheelchair use
|
|
|
Shoulder pain in SCI is associated with what ADL?
|
transfers
|
|
|
Physical therapy in SCI shoulder pain is focused on stretching what muscles shoulder and strengthening what shoulder muscles?
|
*stretching anterior shouler muscles
*strengthening posterior muscles |
|
|
What shoulder muscles become hypertrophied and contracted due to wheelchair use?
|
external rotators
|
|
|
What is the percentage range of neuropathic pain in SCI?
|
60-70%
|
|
|
Is there a severity or SCI level correlation with neuropathic pain?
|
no
|
|
|
What are the two peak age range groups for neuropathic pain?
|
30-39 and >50 years old
|
|
|
What fraction of SCI develop UE compression neuropathies?
|
2/3rds
|
|
|
What are the most common SCI neuropathies?
|
median and ulnar
|
|
|
Ulnar and median neuropathies are more common in tetras or paras?
|
paras
|
|
|
What is the incidence percentage range of carpal tunnel syndrome in SCI paras?
|
21-65%
|
|
|
What is the incidence percentage of bilateral UE nerve compression in SCI?
|
25%
|
|
|
What is the most common cause of progressive myelopathy after SCI?
|
syringomyelia
|
|
|
What phenomenon occurs in the spinal cord at the level of injury?
|
cavitation
|
|
|
What is the direction (caudal or cephalad) of the post-inury spinal cord cavitation?
|
cephalad
|
|
|
What percentage of SCI develops syringomyelia?
|
8%
|
|
|
What is the time frame (in months post-injury) that syringomyelia develops?
|
2 months
|
|
|
What imaging study first detects syringomyelia?
|
MRI
|
|
|
In what matter (gray or white) does the syrinx develop?
|
gray
|
|
|
Where in the spinal cord does the syrinx develop?
|
in the gray matter between the dorsal horns and posterior columns
|
|
|
What is the most common sign of syringomyelia? What type of activity provokes the symtoms?
|
pain/cough, sneezing, strain, etc.
|
|
|
Coughing or straining in what position provokes syringomyelia pain?
|
sitting
|
|
|
What is the earliest sign of of syringomyelia? Second earliest?
|
loss of DTRs/ascending sensory level loss
|
|
|
What is the gold-standard imaging study for syringomyelia?
|
MRI with gadolinium
|
|
|
Name 7 signs/symptoms that may indicate syringomyelia?
|
*more or less spasticity
*AD *loss of reflex bladder *worsening OH *new Horner's syndrome *reduced respiratory drive *diaphragmatic paralysis *cranial nerve dysfunction |
|
|
What is the general activity restriction in those with syringomyelia?
|
avoid activities that increase intra-thoracic/abdominal pressure
|
|
|
What are two indications for surgery in syringomyelia?
|
progressive neurological loss
intractable pain |
|
|
What percentage of SCI patients with treated syringomyelia experience recurrence of symptoms?
|
50%
|
|
|
What two conditions in SCI result from arthropathy of joints with impaired pain and proprioception?
|
charcot joints
charcot spine |
|
|
What is the goal of surgical interventions in tetraplegics to improve functional mobility?
|
to improve motor function by 1 level
|
|
|
When post-injury (months) are surgical interventional commenced?
|
12 months
|
|
|
What does the grade of 0-Cu predict?
|
sufficient proprioception to allow hand function without visual cues
|
|
|
Muscles being transferred generally lose how much strength?
|
loss of 1 grade of strenght i.e. 4 to 3
|
|
|
What are the muscles and direction of tendon transfer for a C5 quad?
|
brachioradialis to ECRB
|
|
|
A C5 quad who shows improved lifting of objects, feeding and grooming, and hygeine tasks indicates what type of tendon transfer has taken place?
|
brachioradialis to ECRB
|
|
|
A deltoid to triceps tendon transfer is performed on what level quad?
|
C5
|
|
|
What function does a brachioradialis to ECRB transfer improve?
|
wrist extension
|
|
|
What function does a deltoid to triceps transfer provide?
|
elbow extension
|
|
|
What 8 functions does a deltoid to triceps transfer improve?
|
stabilize sitting
stabilize transfer reach overhead against gravity grooming hygeine pressure relief writing speed feeding |
|
|
Stabilize sitting,stabilize transfer, reach overhead against gravity, grooming, hygeine, pressure relief, writing speed, and feeding are all improved in what level quad with what tendon transfer?
|
C5 with a deltoid to triceps transfer
|
|
|
What level SCI undergoes a Moberg key grip procedure?
|
C6
|
|
|
What 4 functions are improved with a Moberg key grip procedure?
|
grooming
eating writing desktop skills |
|
|
What level SCI undergoes a brachioradialis to flexor pollicus longus transfer?
|
C6
|
|
|
What procedure in a C6 is preferable to a Moberg key grip procedure?
|
brachioradialis to flexor pollicus longus
|
|
|
What procedure restores a lateral pinch, in what SCI level?
|
brachioradialis to flexor pollicus longus/C6
|
|
|
A posterior deltoid to triceps transfer is done in what SCI level?
|
C6
|
|
|
What procedure in a C6 is done prior to hand reconstruction?
|
posterior deltoid to flexor pollicus longus
|
|
|
Rerouting of biceps around radial neck is done for what SCI level?
|
C6
|
|
|
What procedure corrects supination contracture of forearm? for what SCI levels is it done?
|
rerouting of biceps around radial neck/C5 or C6
|
|
|
What procedure is done to restore thumb flexion? for what level SCI?
|
brachioradialis to flexor pollicus longus
C7 |
|
|
What procedure is done to restore finger flexion? for what level SCI?
|
extensor carpi radialis longus (ECRL) or flexor carpi ulnaris (FCU) TO flexor digitalis profundus (FDP)
C7 |
|
|
What level SCI is appropriate for restoration of thumb and finger flexion?
|
C7
|
|
|
What device is used in a C8 to improve a claw hand?
|
lumbrical bar
|
|
|
What does a lumbrical bar do? In what SCI level is it used?
|
prevents hyperextension of MCPs/ C8
|
|
|
How long (range of months) are the tendon transfered extremities immobilized?
|
1-3 months
|
|
|
What two techniques are used in tendon transfer rehab?
|
biofeedback
electrical stimulation |
|
|
Neuroprosthesis device is appropriate for what level SCI?
|
C5 or C6 tetras
|
|
|
How does a neuroprosthesis function?
|
movement of contralateral shoulder activates opposite hand grasp
|
|
|
Spasticity appears as what post-injury phenomenon resolves?
|
spinal shock
|
|
|
What appears when spinal shock resolves?
|
spasticity
|
|
|
What is the incidence percentage range of concomitant TBI and SCI?
|
25-60%
|
|
|
What are 5 risk factors for TBI with SCI?
|
*mechanism of injury
*loss of conciousness *higher neurologic level *post-traumatic amnesia *initial Glasgow Coma Scale |
|
|
A "sympathetic storm" in a patient with TBI and SCI is often heralded by what phenomenon?
|
transient elevation of blood pressure
|
|
|
When does depression usually occur in SCI (month post-injury)?
|
within first month post-injury
|
|
|
What percentage range of SCI patients experience depression?
|
20-45%
|
|
|
How many times greater is the SCI suicide rate accounting for age and gender?
|
5x
|
|
|
During what year range post-injury is suicide most common?
|
1-5 years
|
|
|
In what type of SCI is suicide higher, complete or incomplete?
|
incomplete
|
|
|
In what SCI age group is suicide the highest?
|
youngest age group
|
|
|
What is the rate (percentage) of PTSD in SCI?
|
20%
|
|
|
What are two risk factors for PTSD in SCI?
|
anxiety
depression |
|
|
Substance abuse in SCI increases what behaviour while intoxicated?
|
risk taking
|
|
|
What percentage of acute/chronic SCI develop pressure ulcers?
|
acute: 25%
chronic: 80% |
|
|
What is the second most common etilogy for rehospitalization in SCI?
|
skin issues
|
|
|
A full thickness tissue loss with exposesd bone, tendon, or muscle is what stage ulcer?
|
Stage IV
|
|
|
What is a stage IV ulcer?
|
full thickness tissue loss with exposed bone, tendon, or muscle
|
|
|
A non-blanchable erythema of a localized area usually over a bony prominence is what stage ulcer?
|
Stage 1
|
|
|
What is a stage I ulcer?
|
non-blanchable area of erythema over a bony prominence
|
|
|
What is a stage II ulcer?
|
partial thickness loss of dermis or dry shallow ulcer
|
|
|
A partial thickness loss of dermis or a dry shallow ulcer is what stage ulcer?
|
Stage II
|
|
|
What is a stage III ulcer?
|
full-thickness destruction through dermis into subcutaneous tissue. Fat may be visible, but bone, tendon, or muscle are not exposed; may include tunneling
|
|
|
A full-thickness destruction through dermis into subcutaneous tissue. Fat may be visible, but bone, tendon, or muscle are not exposed; may include tunneling is what stage ulcer?
|
Stage III
|
|
|
In National Pressure Ulcer Advisory Panel terminology, what is a deep tissue injury?
|
purple area of discolored skin due to underlying soft tissue damage from pressure or shear, but the wound bed cannot be visualized
|
|
|
Where are the 4 most common pressure ulcers in the first two years of SCI?
|
sacrum
ischium heels trochanters |
|
|
After what time frame (years after injury) does the most common site of ulcer change to ischial tuberosities?
|
after 2-years post injury
|
|
|
Where is the most common site of injury in SCI 2 years after injury?
|
ischial tuberosities
|
|
|
In children up to 13 where is the most common site of ulcer development?
|
occiput
|
|
|
What are the two most important risk factors for pressure ulcers?
|
pressure
shear |
|
|
What are two SCI specific risk factors for pressure ulcers?
|
higher level of SCI
greater severity of SCI |
|
|
What are 3 social risk factors for pressure ulcers in SCI?
|
non-employment
lower education alcohol and tobacco use |
|
|
What are 2 constitutional risk factors for pressure ulcers in SCI?
|
anemia
poor nutrition |
|
|
Above what mmHg does soft tissue ischemia take place?
|
>70mmHg
|
|
|
How long and exceeding what pressure in mmHg does tissue ichemia take to occur when over a bony prominence?
|
2 hours; >70mmgHg
|
|
|
What is the supracapillary pressure?
|
>70mmHg
|
|
|
Pressure >70mmHg for over 2 hours results in what?
|
occlusion of dermis microvessels, causing tissue ischemia
|
|
|
What structure is more susceptible to tissue ischemia than skin?
|
muscle
|
|
|
What force removes the corpus striatum(stratum corneum) of skin?
|
shearing force
|
|
|
Friction or shearing forces remove what layer of skin?
|
corpus striatum or stratum corneum
|
|
|
Skin ischemia results is what in the surrounding tissues?
|
hyperemia
|
|
|
Shear mechanically separates what two skin layers?
|
separates the epidermis from the basal cells
|
|
|
How often should repositioning be done?
|
every 2 hours
|
|
|
During sitting how often should there be pressure relief?
|
every 20-30 minutes
|
|
|
What stage ulcers MAY require surgical debridement?
|
Stage III
|
|
|
What metabolic steriod is used in the treatment of pressure ulcers?
|
oxandrolone
|
|
|
Name two appetite stimulants used in SCI?
|
marinol
megace` |
|
|
As the wound becomes cleaner, the strength of the cleaning solution should become stronger or weaker?
|
weaker
|
|
|
Below what pressure (psi) is used for pulsitile irrigation of pressure ulcers?
|
<15 psi
|
|
|
What type of dressing is used for heavy exudate ulcers?
|
calcium alginate
|
|
|
What 3 types of dressings are used for mild exudate ulcers?
|
hydrocolloid
polyurethane foam saline gauze |
|
|
What is the only recommended ulcer treatment modality?
|
electrical stimulation
|
|
|
Electrical stim for ulcer improves what three metrics?
|
circulation
granulation decreased bacterial count |
|
|
What are 3 contraindications to electrical stim in pressure ulcer treatment?
|
cellulitis
pacemaker metal ions |
|
|
What is the most common surgical intervention for pressure ulcers?
|
musculocutaneous flap (including muscle and blood vessels)
|
|
|
What is the shape of a rotation flap?
|
semi-circular
|
|
|
What is the shape of a transposition flap?
|
rectangular
|
|
|
What is the shape of the defect that a rotation flap fills?
|
triangular
|
|
|
Post flap, what is the initial period of strict bed rest (week range)?
|
3-4 weeks
|
|
|
Post flap surgery, what is the starting period (minutes) for sitting after the 4 week period of strict bed rest?
|
15 minutes daily and increase by 15 minutes BID
|
