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36 Cards in this Set
- Front
- Back
Most common causes of SCI
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1) Vehicular
2) Falls 3) Violence 4) Other 5) Sports |
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Gender ratio of SCI
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Males 80.7%
Age 16-30 is most common |
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Tetraplegia
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Loss of UE and LE motor and sensory function
Caused by damage to cervical spine |
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Paraplegia
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Thoracic or lumbar region
LE loss; loss of trunk control |
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Zone of partial preservation
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Area of motor / sensory function remaining below level of injury
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Most common mechanism of injury for c-spine
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flexion
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Teardrop fracture
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Can cause SCI when broken piece of vertebral body is pushed into spinal cord
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Thoracic SCI - Why is it so rare and what are the most common MOI?
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Surrounded by a lot of soft tissue. There is less motion due to ribs.
MOI - Trauma directly to the area: Gunshot wound, stabbing, falling out of tree |
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Conus medullaris
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Spinal cord ends here at L1/L2. Injury to this area is still upper motor neuron injury.
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Cauda equina
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Lower motor neuron injury.
Saddle parasthesias |
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ASIA key muscle groups
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C5 - Biceps
C6 - Wrist extensors C7 - Elbow extensors C8 - Finger flexors T1 - Finger abductors L2 - Hip flexors L3 - Knee extensors L4 - Ankle DF L5 - Long toe extensors S1 - Ankle PF |
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Central cord syndrome
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Loss of UE > lower extremity
Tends to occur following extension injury to c-spine & is incomplete. |
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Anterior cord syndrome
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Loss of bilateral pain, temp, and motor control
Retain proprioception & light touch |
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Posterior cord syndrome
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Loss of proprioception & light touch
Retain |
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Brown-Sequard syndrome
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Hemisection
Common following penetrating injuries Loss of movement and proprioception ipsilaterally Loss of pain on opposite site |
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Posterior cord syndrome
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Very rare
Caused by compression via tumor or infarction Motor function preserved Sensory lost below level of injury |
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Cauda Equina syndrome
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Injury to L1 and below can cause this.
Lower motor neuron injury, so there will be flaccidity and atrophy, not spasticity. Typically a complete lesion Ambulation is probable due to likely preservation of quadriceps muscles |
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Conus medullaris syndrome
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Injury to sacral cord & lumbar nerve root
Areflexive bowel & bladder function LE motor and sensory loss |
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Areflexive Bowel
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Disruption of the sacral arc causes loss of parasympathetic defecation reflex. Internal anal sphincter remains active, external sphincter is flaccid.
Lower motor neuron injury, usually T10-12 and below No sphincter tone. Managed by timing, fiber intake, and decreased fluid intake |
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Reflexive Bowel
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Sacral reflexes remain intact, but descending input is lost. Reflexive defecation occurs when the rectum fills.
Good sphincter tone, so stool retention is possible Usually injury is higher than T10-12 Managed with digital stimulation program, or suppository |
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Bulbocavernosus reflex
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Used to determine bowel status. Tug on catheter and look for anal sphincter contraction (+).
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Normal bladder physiology
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Pressure increases as bladder fills ->
impulses from stretch receptors sent to sacral cord -> bladder contracts -> impulses to brain to relax the inhibitory signal -> external sphincter relaxes -> voiding |
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Reflexive bladder
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UMN injury, T10-12 and above
Voiding is involuntary and incomplete. External collection devices to measure quantity, intermittent catheterizations, medications. Condom cath, suprapubic catheter |
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Areflexive bladder
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Lower motor neuron injury.
T10-T12 and below. Reflex arc is lost that normally voids urine Bladder overfills and overdistends Overflow and stress invontinence may occur Intermittent catheterization, regular emptying schedule |
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Categories of SCI at discharge
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Incomplete tetraplegia (38.3%)
Complete paraplegia (22.9%) Incomplete paraplegia (21.5%) Complete tetraplegia (16.9%) |
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5 Most common levels of injury
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C5: 14.9% one of the most mobile
C4: 13.6% C6: 10.8% T12: 6.7% C7: 5.3% |
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KAFO vs AFO
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If pt has quadriceps strength of 3+ or greater, they can use AFO instead of KAFO.
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Creating bladder program for reflexive bladder
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- Voiding is involuntary and incomplete
- Adjust oral liquid intake - Assess concurrent medical conditions and current medications - Avoid indwelling catheter because bladder will shrink - Want a low residual urine volume - Use external collection devices and intermittent cath. |
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Creating bladder program for reflexive bladder
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Lower motor neuron injury
T12 or below, or spinal shock Reflex arc is lost, bladder overfills and overdistends Overflow and stress incontinence may occur. - Use regular emptying schedule, keep volume below 500cc |
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Bladder program: functional expectations
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C1-C5: Dependant
C6: Min-Mod Assist for males, max assist-dependant for females C7-C8: min - independant for males, mod to max for females Male paras: ind Female paras: modified ind/min-assist |
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Seating and Mobility
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Identify optimal posture for wheelchair
- Flexible vs non-flexible deformities: correct for flexible, accommodate for non-flexible - Consider pressure distribution - Promote stability |
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Wheelchair seating goal
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Symmetrical, midline posture
Maximum comfort Reduce spasticity Pressure distribution Improve sitting balance and head control as well as volitional control of extremities Allow for ADL completion |
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Ideal pelvic alignment
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Neutral to slight anterior tilt
Level Not rotated |
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Lower extremity alignment in WC
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90 degrees of hip and knee flexion
Neutral ankle DF, inv/ev |
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Hanger / Hanger angle
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Bar that foot plate is attached to
Increasing angle: decreases chair length and turning radius, improves knee flexion angle Decreasing angle: Increases foot/ground clearance |
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Casters
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The small tires
Larger for less rolling resistance, better for rough terrain Smaller for easier turning |