T3 Scheper Rehab Sci Tbi

Front 1

What is the prevalence of spinal cord injury in the US?

Back 1

250,000-300,000

Front 2

What is the m:f ration for spinal cord injury?

Back 2

4:1

Front 3

What is the most common level of spinal cord injury at hospital discharge?

Back 3

C5

Front 4

What is the most common reason of spinal cord injuries?

Back 4

motor vehicle accidents

Front 5

Describe ASIA classification of injuries.

Back 5

A: complete injury (no sensory or motor under lesion)
B: sensory but no motor fxn @ S4-S5
C: motor fxn preserved under LOI & >50% of them have <3/5 strength.
D: motor fxn preserved below LOI & @ least 50% >3/5
E: NL

Front 6

Where does the spinothalamic tract cross & what is its main fxn?

Back 6

Pain & temp sensation. Crosses: ventral white matter of cord, ascending one level as they cross.

Front 7

What is the fxn and where does the ascending dorsal white columns cross?

Back 7

Fxn: proprioception, light touch.
Cross: medulla (via medial lemniscus) then go to thalamus

Front 8

Where does the descending corticospinal fibers cross & what is the main fxn?

Back 8

Cross @ medulla-->become lateral corticospinal tract. Small pt don't cross & descend in anterior corticospinal tract.

Front 9

What are the symptoms of anterior cord syndrome?

Back 9

Variable loss of motor & pain/temp w/ preserved proprioception & light touch.
Prognosis for motor recovery is poor.

Front 10

What are the causes of anterior cord syndrome?

Back 10

retropulsed disk/vertebral fragments, aortic clamping during surgery, lesions in anterior spinal artery

Front 11

What is the most common incomplete injury?

Back 11

Central Cord Syndrome

Front 12

What are the symptoms of someone w/ central cord syndrome?

Back 12

UE > LE weakness & sacral sparing. These pts are 'walking quads'==>50% ambulate

Front 13

How does one get central cord syndrome?

Back 13

They're cervical level lesions (not much room around there so easy to get pinching & older pts get cervical canal narrowing, cord compression also anterior & posterior w/ bulging ligamentum flavum)

Front 14

What are the causes of Brown-Sequard syndrome?

Back 14

stab wounds, tumors

Front 15

What are the symptoms of Brown-Sequard syndrome?

Back 15

Hemisection of cord causes ipsilateral motor loss & proprioception, contralateral (spinothalamic tracts cross over) loss of pain/temp. Prognosis for ambulation is 90%.

Front 16

What symptoms do you get with conus medullaris syndrome?

Back 16

Saddle anesthesia + bladder/anal sphincter/erectile dysfunction due to S2-S4.
-Reflexes: hyporeflexic: anal (S2-4), bulbocavernosus (S2-4), ankle DTR (S1,S2) b/c LMN problem.
-Poor prognosis for recovery

Front 17

What is traumatic conus?

Back 17

L1/L2 fracture of disc herniation--accompanied by injury to lumbosacral N roots & LE weakness.

Front 18

What is Cauda Equina Syndrome?

Back 18

Neural Canal compression (similar to traumatic conus syndrome) w/ fractures of pelvis/sacrum/spine below L2. LMN purely (areflexia, radicular pain, flaccid paralysis).
-Presents like multiple radiculopathies.

Front 19

What is the clinical pictures of Cauda Equina syndrome?

Back 19

Purely LMN promblem: bladder/bowel areflexia & erectile dysfxn, saddle anesthesia, flaccid LE weakness, radicular pain, reflexes may be lost, some regeneration/sprouting is possible.

Front 20

What is syringomyelia?

Back 20

Gradual enlargement of fluid-filled cyst in central cord at level of injury.
50% prevalence, 5% neurologic decline esp in cervical spine.

Front 21

How do you treat syringomyelia?

Back 21

Diuresis, positioning; tapping is only temporary, syrinoperitoneal shunting is possible.

Front 22

What are the symptoms of syringomyelia?

Back 22

Weakness, numbness, respiratory decline, & pain expands rostrally, caudally.

Front 23

What is Virchow's triad of DVT?

Back 23

Stasis, Intimal injury (vasoactive amines), hypercoagulability (altered clotting factors)

Front 24

When are you at highest risk of getting a DVT?

Back 24

In 1st 2 weeks post injury.

Front 25

What treatment should be done for DVT in spinal cord injuries?

Back 25

12 wks of prophylactic treatment of complete injury, 8 wks for incomplete injuries.

Front 26

How is DVT diagnosed?

Back 26

Duplex ultrasonagraphy.

Front 27

What is in a differential diagnosis of DVT?

Back 27

HO, infection, dependent edema, fracture, hematoma.

Front 28

Where are pressure ulcers most commonly found?

Back 28

Sacrum & ischium, trochanters, heels.

Front 29

What is the tx for pressure ulcers?

Back 29

necrotic tissue debridement, UV light, laser radiation, U/S, hyperbaric O2, Estim, proteins, vitamins C,A, Zinc.

Front 30

What are risk factors for pressure ulcers?

Back 30

Incontinence (skin maceration), age, elevated temperatures, nutritional deficits, insensate skin (pt can't feel pain or temp)

Front 31

What is the mechanism of forming pressure ulcers?

Back 31

Pressure & SHEAR. 70 mm Hg for 2 hrs-->ischemia, even less w/ added shearing forces.

Front 32

How is heterotopic ossification diagnosed?

Back 32

bone scan, XR, Alk Phos (serum marker for bone growth);

Front 33

How is heterotopic ossification treated?

Back 33

ROM, biphosphonate, NSAIDS, surgery.

Front 34

What is heterotopic ossification?

Back 34

Medullary & cortical bone forming around jts-->deposition of periarticular bone typically below LOI-->may limit ROM, fuse joints, alter positioning, increase pressure ulcer risk (b/c of inc Ca around the jts)

Front 35

What are the symptoms of immobilization hypercalcemia?

Back 35

Lethargy, fatigue, nausea, cramping, polydipsia. Eventually osteopenia below LOI, increase in bone resorption in first 6 months, exceeding kidney excretion ability.

Front 36

Patients with upper cervical injuries are at increased risk of developing what condition?

Back 36

Acute & chronic pneumonia (b/c can't clear out secretions)

Front 37

In someone w/ an upper cervical injury, in what position should they be in to increase their vital capacity?

Back 37

Supine, abdominal binder in upright (to prevent stretching of abdomen & dropping of diaphragm.)

Front 38

Complication after SCI that results in increased BP, bradycardia, and profuse sweating above the lesion?

Back 38

Autonomic Dysreflexia

Front 39

What is the most common levels involved and causes of Autonomic Dysreflexia?

Back 39

T6 & above. Bladder distention, UTI, bowel impaction, pressure ulcer, ingrown toenails.

Front 40

With neurogenic GI complications, whats the difference between UMN and LMN bowel?

Back 40

UMN: longer transit times, peristalsis altered, increased sphincter tone; LMN: slowed stool propulsion, external anal sphincter (EAS) tone lost which causes impaired urge

Front 41

Related to GU spinal levels, explain S2-4 and T10-L2

Back 41

Sympathetic (T10-L2) relaxation; Parasympathetic (S2-4) detrusor contraction.

Front 42

What are the GU effects of a suprasacral SCI?

Back 42

DSD (detrusor sphincter dyssynergia) lack of sphincter relaxation during bladder contraction (urinary retention and reflux into kidneys causing kidney failure).

Front 43

Compare complete vs incomplete sexual dysfunctions from SCI in men?

Back 43

complete: reflexogenic erections, no psychogenic erections, rare ejaculation; incomplete: both reflexogenic/psychogenic erections, ejaculation more common. Infertility is common (retrograde ejaculation)

Front 44

What are negative predictors of motor recovery?

Back 44

hemorrhage and length of cord edema on MRI

Front 45

what are the different types of head trauma injuries?

Back 45

traumatic brain injury = head injury = head trauma: closed or penetrating (dura compromised) head injury, focal or diffuse (missile injuries), and nontraumatic brain injury

Front 46

what are three causes of nontraumatic brain injury?

Back 46

hypoxic ischemic encephalopathy (HIE), toxic, infectious

Front 47

What is the leading cause of death in children and elderly >75

Back 47

TBI

Front 48

What are risk factors for TBI?

Back 48

low SES, drugs/EtOH, history of TBI, MVA, falls (children, elderly), violence (20-50yo)

Front 49

What are pre-injury predictors of recovery from TBI?

Back 49

employment status, educational level, hty substance abuse, age < 60

Front 50

What are post-injury predictors of recovery from TBI?

Back 50

effect on cognitive, behavioral, social support, litigation (all effecting employment outcome)

Front 51

In severe, moderate, and mild, what is the % mortality and % recover to moderate disability?

Back 51

severe >50% mortality, ~30% recover to moderate disability; moderate <10% mortality, ~70% recover; mild ~95% recover.

Front 52

What are and where do contusions occur?

Back 52

hemorrhagic bruises on gyri. Frontal or temporal lobes.

Front 53

Coup vs. Contra-Coup. How injured? Where is the brain damage?

Back 53

Coup - moving object (damage: directly underneath); Contra-coup - moving head (damage: occurs on opposite side of impact)

Front 54

Which primary injury would not be seen on CT (requires MRI) and hallmark is shearing of corpus callosum?

Back 54

Diffuse Axonal Injury

Front 55

What would occur in late primary injury?

Back 55

cascade of glutamate/aspartate release; enzyme-linked Ca channels; increased enzymatic activity -> "self destruct"

Front 56

What would be the tx for secondary injury with ICP > 20mmHg?

Back 56

mannitol, hyperventilation, hypertonic Na, hypothermia, craniotomy, craniectomy

Front 57

What are measuring systems for recovery?

Back 57

MMSE, Functional Independence Measure (self-care, hygiene), Rancho Los amigos scale (more neuromuscular than cognitive)

Front 58

What is the difference in seizure tx at the >24hrs after a TBI?

Back 58

>24hrs need anticonvulsants. Immediate sezures w/in 24hrs tx, but not related to chronic

Front 59

How long and what drugs would you use for AED prophylaxis?

Back 59

2 wks at most. Carbemazepine, valproic acid better than phenobarbitol or phenytoin

Front 60

What is the type of hydrocephalus commonly found in TBI patients?

Back 60

Generally communicating/non-obstructive (defect CSF reabsorption)

Front 61

Define hydrocephalus ex vacuo

Back 61

A hydrocephalic condition resulting from the loss or atrophy of brain tissue.

Front 62

What are the neuromuscular complications from TBI with UMN syndrome?

Back 62

spasticity, contractures, movement disorders (rigidity, tremor, ataxia, myoclonus, ballism, chorea), weakness

Front 63

What drug would best tx UMN syndrome in TBI patients?

Back 63

Dantrolene

Front 64

What drug would be used to treat movement disorders in UMN syndrome?

Back 64

Dopamine agonists

Front 65

What is the difference in HO between TBI and SCI patients?

Back 65

TBI: UE=LE. Whereas SCI: hips/knees

Front 66

How would you tx HO in TBI pt?

Back 66

Etidronate, NSAIDs, radiation, surgery when "cool" on bone scan

Front 67

What is the difference between vegetative state and coma related to sleep?

Back 67

Coma has no sleep/wake cycles in transient state; Vegetative state has sleep/wake cycles

Front 68

What is of concern in moderate TBI pt recovery?

Back 68

structured sensory integration. Control of agitation and restlessness (electrolyte imbalances, seizures, sleep disturbances, MSK injury & pain, Posttraumatic hydrocephalus, environmental overload)

Front 69

Which drugs would you use for least effect on sleep architecture?

Back 69

Trazadone, Ambien, Chloralhydrate

Front 70

What drugs would you use and avoid for agitation?

Back 70

r/o medical causes FIRST, then adjust env stimuli. Stay away from sedatives and antipsychotics. AEDs, central antihypertensives, Bblockers, stimulants