Spinal Cord Injury

Front 1

What is the most common cause of SCI?

Back 1

-Traumatic

-MVA

Front 2

A partial or complete paralysis of all four extremities, trunk, and pelvic organs resulting from lesions of the cervical cord is known as _____________ and results from an injury to the ____________?

Back 2

-Tetraplegia (Quadriplegia)
-C-Spine

Front 3

T or F:
Nearly all patients are released to a home setting?

Back 3

TRUE: 88%

Front 4

In general: the most common site for injuries is where?

Back 4

-Junctions between Levels:

Front 5

Secondary SCI include? (4)

Back 5

-Crush
-Hemorrhage
-Edema
-Infarction

Front 6

T or F:
Glutamate and Glycine are good and assist with healing following initial SCI?

Back 6

FALSE:
***Sets off cascade of biochemical and cellular events
-Nerve cell death
-Demeylination of axons
-Triggers inflammation response

Front 7

What accounts for improvement in function in Humans since regeneration does not occur?

Back 7

-Neuroplasticity

Front 8

What is one of the first and most important signs to determine if spinal shock is resolving?

Back 8

Sacral reflexes:
-Bulbocavernosus Relfex
-Anal "wink" reflex

Front 9

Initial clinical symptoms of SCI include? (3-4)

Back 9

-Loss of movement or sensation
-chest wall weakness
-Spinous process deformity
-Inadequate ventilation

Front 10

This is the standard drug given following SCI to improve outcome.

Back 10

-Methylprednisolone (MP)

Front 11

T or F:
Initial/Immediate surgery can be controversial?

Back 11

TRUE:
- Some believe the injury needs to run its course before initial surgery

Front 12

Although they are not commonly used anymore, how long is a HALO device worn?

Back 12

-approx 12 wks

Front 13

KEGEL QUESTION:
-What challenges with mobility will patients with orthoses have?

Back 13

-Cervical orthoses limit ability to see the ground
-TLSO – can’t flex waist past 90°
-“top heavy”
-Rolling, supine to sit, lower body dressing, transfers

Front 14

What are some of the common Autonomic dysfunction symptoms?

Back 14

-Cardiovascular System
-Temperature control
-Respiratory System
-Bowel and Bladder
-Sexual

Front 15

Signs of Hypothermia?

Back 15

-Irritability
-Mental confusion
-hallucinations
-lethargy
-clumsiness
-slow respiration
-slowing of heartbeat

Front 16

About what level do we begin to think about problems with thermoregulation?

Back 16

-Level T6

Front 17

People with complete spinal cord lesions above what level cannot breathe independently?

Back 17

C4

Front 18

What is the little rhyme to remember level of assistance?

Back 18

C3-4-5, Keep the guy alive

Front 19

What nerve innervates the diaphragm?

Back 19

Phrenic Nerve; C3-5

Front 20

Excessive sympathetic nervous system activity, elicited by noxious stimuli below the lesion is known as?

Back 20

-Excessive sympathetic nervous system activity, elicited by noxious stimuli below the lesion

Front 21

Autonomic Dysreflexia is seen in patients with a level of _______ and above?

Back 21

-T6

Front 22

What will the patient with Autonomic Dysreflexia report?

Back 22

-Patient reports pounding HA
-Become very anxious
-Flushing of the skin and profuse sweating above level of lesion
-Goosebumps below level of lesion
-Tell you they really don’t feel good!!

Front 23

What vital changes are seen with Autonomic Dysreflexia?

Back 23

-Abrupt increase in BP
-Decrease in HR

-APPEARS FLUSH

Front 24

T or F:
Autonomic Dysreflexia is not a medical emergency?

Back 24

FALSE

Front 25

What do you do if a patient has Autonomic Dysreflexia?

Back 25

-SIT THEM UP!!!
-Remove noxious stimuli
-Keep checking vitals

Front 26

WHAT IS THIS?
Extreme fall in BP and decrease in HR on assuming an upright position due to loss of sympathetic vasoconstriction and muscle pumping action for blood return.

Back 26

-Orthostatic Hypotension

Front 27

How do you treat Orthostatic Hypotension?

Back 27

-If patient faints  recline and elevate legs
**This will encourage venous return to the heart
-Ace wraps, abdominal binders, TED hose: designed to improve venous return

Front 28

___________ ______________ occurs in a large number of SCI due to LE paralysis and blood vessel damage.

Back 28

-Pulmonary Embolism
DVT

Front 29

UMN signs are more severe with _____________ SCI?

Back 29

-Incomplete

Front 30

KEGEL QUESTION:
-What critical interventions should be implemented in the acute phase of rehabilitation to prevent development of pressure sores?

Back 30

-Positioning, turning schedule and nutrition are critical.

Front 31

What are the benefits to Boots and special air mattresses?

Back 31

-May help to prevent pressure sores, more specifically in the acute stages.

Front 32

Sudden loss of ROM, swelling, local heat, erythema and nonseptic fever are common signs of what?

Back 32

-Heterotopic Ossification

Front 33

What can be done to help decrease the likelihood of Renal Calculi

Back 33

-Vigorous hydration, early mobility, especially dynamic WB activities.
-TILT TABLE

Front 34

This type of pain is commonly seen below the level of the lesion and involves electric burning pain in dermatomes?

Back 34

-Neutopathic Pain

Front 35

______________: pain evoked by a non-noxious stimulus, such as light touch, that does not normally evoke pain.

Back 35

-Allodynia

-ALLodynia, ALL touch hurts

Front 36

What is one technique to help control or overcome allodynia?

Back 36

-desensitization techniques

Front 37

Anticonvulsants and Tricyclic Antidepressants are commonly used to treat what type of pain?

Back 37

-Neuropathic Pain

Front 38

What are some common psychosocial problems that individuals with SCI may face?

Back 38

-Depression, suicidal thoughts
-Financial issues
-Relationship changes

Front 39

_______________: sulcal arteries arising from ASA supply central portion of SC.
a) Centrifugal system
b) Centripetal system

Back 39

A)

Centripetal supplies dorsal horns and columns and peripheral WM

Front 40

What is the main blood supply to the inferior spinal cord and has variable origins from the level of T9 to L3?

Back 40

-Artery of Adamkiewicz

Front 41

Which type of tract lesion/injury results in sensory loss in a dermatomal distribution?

Back 41

-Segmental Signs

Front 42

Vertical tract signs result in what types of deficits?

Back 42

-Sensation loss below lesion level
-Muscle paresis with hyperreflexia
-autonomic losses: of BP, pelvic viscera, thermoregulation.

Front 43

Brown-Sequard results from what?
Describe injury

Back 43

Front 44

KEGEL: FILL IN THE BLANK

Segmental Signs:______________

Vertical Tract Signs: ___________voluntary motor control, conscious proprioception, and discriminative touch loss; ____________ pain and temperature loss (~2 segments below lesion).

Back 44

-IPSILATERAL
-IPSILATERAL
-CONTRALATERAL

Front 45

What is a common MOI for an anterior cord syndrome?

Back 45

-HYPER FLEXION INJURY

Front 46

KEGEL: FILL IN THE BLANKS

Caused by trauma to:__________ and/or___________
Decreased_______________________ sensation below the lesion.
Paralysis
Intact____________________________

Back 46

-to anterior cord or anterior spinal artery
-pain and temp sensation below lesion level
-light touch and proprioception

Front 47

Central Cord Syndrome occur with _______________ injury in a person with _______________ ______________

Back 47

-Hyperextension
-Spinal Stenosis

Front 48

KEGEL: FILL IN THE BLANKS

Damage to _______ part of spinal cord, usually at _______levels.
Greater motor impairment in the _____ than in the _____ extremities (CST fibers).
___________ pain and temperature loss in a ____ distribution at level of lesion (crossing ST fibers).

Back 48

-Central
-Cervical
-Upper than in the Lower
-Bilateral
-Cape Distribution

Front 49

Posterior Cord Suyndrome results from what types of conditions?

Back 49

-Posterior Artery occlusion
-Tumor
-Disc compression

Front 50

KEGEL FILL IN THE BLANKS:

Damage to ____________
Sensory Loss:_________________
Preservation of:________________________________________
Wide-based step gait

Back 50

-DORSAL COLUMN
- Descriminative touch and proprioception
-Pain and Temp sensory function and motor function

Front 51

Cauda Equina Syndrome experience motor and sensory loss where?

Back 51

-BUTT HOLE

Front 52

KEGEL FILL IN THE BLANKS

Injury________damaging lumbar and/or sacral ___________ (LMNs).
Sensory impairment and flaccid paralysis of________________________________________

Back 52

-L1 or below
-Nerve roots (LMNs)
-leg muscles, bladder, bowels and sexual function.

Front 53

What are two differences between the signs present with Cauda Equina and Conus Medullaris?

Back 53

-Conus Medullaris may have spasticity of distal LE
-May have Babinski Sign

Front 54

What is often the first sign that a lesion is incomplete?

Back 54

-SACRAL SPARING

butt hole wink ;)

Front 55

T or F:
Designation of a spinal lesion is determined by Neurological level alone?

Back 55

FALSE:
-2 criteria:
The neurological level of injury
Whether injury is complete or incomplete

Front 56

What is needed to classify a muscle as "normal"?

Back 56

-“Normal” refers to muscle grade of 3/5 or above

Front 57

T or F:
Neurological level of injury is the most caudal segment with normal SENSORY and MOTOR function bilaterally?

Back 57

-FALSE
normal sensory AND / OR motor function on both sides of the body.

Front 58

To be a complete lesion, at what level must there be no motor or sensory function?

Back 58

S4 & S5

BUTT WINKER TEST

Front 59

What is the term for a patient who has a C7 lesion, but has some sensation in the thoracic spine?

Back 59

-Zone of Partial Preservation

Front 60

KEGEL EXAMPLE:

M LT PP
C5 5 2 2
C6 3 2 1
C7 2 1 1
C8 0 0 0
T1 0 0 0
T2-L1 0 0 0
L2 0 0 0
L3 0 0 0
L4 0 0 0
L5 0 0 0
S1-5 0 0 0

Motor Level = ??
Sensory Level = ??
Neurological Level of Injury (NLOI) = ??
Zone of Partial Preservation = ??
ASIA classification?

Back 60

Motor Level = C6
Sensory Level = C5
Neurological Level of Injury (NLOI) = C5
Zone of Partial Preservation = C6-C7
ASIA classification = A

Front 61

What are some common conditions a patient with ASIA A might experience?

Back 61

-Autonomic Dysreflexia
-Decreased sweating
-Orthostatic Hypotension

Front 62

If a patient has normal light touch, but deminished/absent pin prick below the level of a lesion. What syndrome might you expect?

Back 62

-ANTERIOR CORD

Front 63

What are some factors that could increase or decrease the Prognosis of SCI?

Back 63

-Age
-Level of lesion
-Ventilator use

Front 64

T or F:
Central cord and Brown-Sequard have a better prognosis that Anterior cord?

Back 64

TRUE

Front 65

What are two factors that increase likelihood of ambulation?

Back 65

-touch and pinprick intact below lesion level
->3/5 quad strength 2 months post injury

Front 66

After a SCI, Explain how sensory input is INTACT below the level?

Back 66

-THINK REFLEXES
-The sensory information is still going from the limb to the SC, but is unable to go all the way back to the brain.
-Reflexes can still be used below lesion level

Front 67

T or F:
A person with a C6 complete injury can send a signal from the brain telling the leg to move?

Back 67

TRUE:
They can send the signal, but it will not work because the SC lesion will block transmission.

Front 68

T or F:
A person with a SCI cannot trigger reflexes below the level of the lesion?

Back 68

FALSE:
They can be triggered and in many instances they will be heightened due to the lack of other input to inhibit or block them.
(hyperreflexia)

Front 69

List the muscle with the lesion level:
Biceps:
Wrist Extensors:
Diaphragm:
Finger Flexors:
Triceps:
Abdominals:
Gastroc:
Anterior Tib:
Quad:

Back 69

Biceps: C5
Wrist Extensors: C6
Diaphragm: C345
Finger Flexors: C8
Triceps: C7
Abdominals: T5-12
Gastroc: S1
Anterior Tib: L4
Quad: L23

Front 70

What would the Neuro level be for a patient with Sensory T3 and lowest motor tested is C8?

Back 70

T3 would be the Neuro level because you can not test the motor of the thoracic levels.

Front 71

What areas of the body would you use to test proprioception?

Back 71

-Index finger
-Big Toe

Front 72

What ashworth grade would be given for No increased tone?

Back 72

Zero

Front 73

Give 3 S/S of a suspected DVT?

Back 73

-Swelling
-Pitting edema
-Redness
-Pain

Front 74

What clinical test can be performed for a suspected DVT?

Back 74

-Girth Measurement

Front 75

What should be discussed from the beginning and included with notes/goals?

Back 75

-discharge plans and destination

Front 76

What is one part of treatment that is very important for discharge from acute care to any setting?
THEY MUST HAVE WHAT?

Back 76

-Upright Tolerance

Front 77

What are two areas in which you want to decrease ROM with a SCI?

Back 77

-Low back extensors
-Finger flexors

Front 78

What is the name for a grip in which the finger flexors are tight, and useful for patients?

Back 78

-Tenodysis grip?? spelling?

Front 79

Name three areas in which you would want to increase ROM?

Back 79

-Hamstring
-Shld Ext
-Shld ER

Front 80

In order to transfer on an uneven surface, What movements/strength is needed?

Back 80

-Shoulder ABD and FLEX

Front 81

Uneven transfers require shoulder _________ and must have ___________

Back 81

-Extension
-Triceps

Front 82

How often should position changes occur?

Back 82

-15-20 min

Front 83

Symptoms of Autonomic dysreflexia include?

Back 83

in order:
-increased BP
-Decreased HR
-Anxious
-Headache
-Sweating

Front 84

What is the key different symptoms for Orthostatic hypotension when compared to autonomic dysreflexia?

Back 84

-DECREASED BP

Front 85

symptoms of Orthostatic Hypotension include

Back 85

-feel dizzy
-faint
-blurry vision
-dec. hearing

Front 86

Treatment for orthostatic hypotension and autonomic dysreflexia?

Back 86

-ORTHO: lay down and elevate feet
AUTO:sit up and remove irritant

Front 87

How does spasticity differ in patients with SCI?

Back 87

-It tends to radiate or travel up and down the cord causing a full body reaction to a stimulus applied to the feet.

Front 88

Who has worse spasticity, complete or incomplete injuries?

Back 88

Incomplete

-Those with cervical and upper thoracic lesions have worse spasticity

Front 89

What type of orthosis would most likely be needed for a T10-11 injury?

Back 89

-Knee-Ankle-Foot Orthosis

Front 90

What would the Neuro injury level be to require a Hip-Knee-Ankle-Foot Orthosis?

Back 90

T1-T9

Front 91

Based on the evidence that the CNS is plastic, and the spinal cord is capable of learning with minimal supraspinal input is the definition of what?

Back 91

-Recovery-Based Therapy

Front 92

What are the four principles that guide locomotor training? (4)

Back 92

-Maximize Load
-Optimize sensory input
-Optimize kinematics
-Maximize recovery/Minimize compensation

Front 93

T or F:
assistive devices are very beneficial when maximizing load for locomotion?

Back 93

FALSE:
-AD can be detrimental to recovery.
-AD’s do not allow trunk rotation and unweight the limbs

Front 94

How can you optimize sensory input?

Back 94

-use appropriate hand contact and sequencing.

Front 95

How would you Optimize appropriate kinematics?

Back 95

-ensure hip extension
-use arm swing
-trunk rotation

Front 96

T or F:
Gait deviations are compensatory?

Back 96

TRUE:

Front 97

During which phase of gait would the therapist assist by triggering medial HS and anterior tib?

Back 97

-At toe off and through swing phase

Front 98

What would you trigger during initial contact and stance? (2)

Back 98

-Quadriceps tendon
-achilies?

Front 99

A patient who has no motor or sensory below the level of lesion would be ASIA ___?

Back 99

-A

Front 100

What is the Key difference between ASIA C & ASIA D?

Back 100

-ASIA C has less than 1/2 of major muscles while ASIA D has greater than 1/2

Front 101

Does the change from ASIA levels indicate an improved potential for recovery?

Back 101

-NO.

-Recovery does not equal AIS conversion. Remember, recovery is the return to normal function …ASIA is a classification based on changes in impairments of strength and sensation …it has nothing to do with recovery.

Front 102

Distance gains were greatest with _______________ training?

Back 102

-OVERGROUND

Front 103

What type of innervation is used to URINATE, DEFICATE, & SEX?

Back 103

-Parasympathetics

Front 104

What are the two phases of normal bladder function?

Back 104

-filling
-voiding

Front 105

Lesions of the CONUS MEDULLARIS cause ___________ bladder.

Back 105

FLACCID

-non reflex LMN
-due to flaccidity, trouble with voiding urine is noted

Front 106

Frequent and rapid voiding is caused by an UMN lesion is known as a ___________ _______________.

Back 106

Spastic bladder / REFLEXIVE

Front 107

What are the symptoms of HYPOreflexia/areflexia of the detrusor?

Back 107

-Stess incontinence with laughing and coughing.
-dribbling
-high residual volume

Front 108

How does a Detrusor-Sphincter dyssynergia present?

Back 108

-Both the detrusor and external sphincter are spastic. Both contract simultaneously and little urine can come out.

Front 109

Cystography is ??

Back 109

radiograph with the bladder filled with a contract medium

Front 110

What causes hydronephrosis?

Back 110

-Obstruction of any part of the urinary tract causing kidneys to swell

Front 111

Describe Vesicoureteral reflux?

Back 111

Backflow of urine back into the ureters and into the kidneys

Front 112

How does SCI affect giving birth in women?

Back 112

-Increase risk of UTI
-High risk of Autonomic Dysreflexia
-Pressure Sores
-C-Section frequently required

Front 113

T or F:
The ability for men to be fertile and produce children is affected after SCI?

Back 113

TRUE:
-Higher % of dead sperm or less mobile (why??)
-Increased difficulty with ejaculation

Front 114

___________ ________________ _______________ uses vibration to induce ejaculation in men with a SCI

Back 114

Penile Vibratory Stimulation (PVS)

Front 115

What is one common risk with both Penile vibration and rectal probes to induce ejaculation?

Back 115

-The risk of inducing autonomic Dysreflexia

Front 116

T or F:
Both men and women experience the same type of orgasm both pre and post SCI?

Back 116

FALSE:
-While women typically experience the same type of orgasm, men do not.
-The is due to sensory loss

Front 117

What are two sexual aids for men?

Back 117

-Viagra
-Pumps

Front 118

Which of the two types of erection is a result of direct stimulation to the genital area?
a) Reflexogenic erection
b) Psychogenic erection

Back 118

A) Reflexogenic
-from direct stimulation of the genital area. Involves a reflex arc between the genital area and parasympathetic fibers from S2-S4 cord segments

Front 119

Penile/Clitoral erection is a result of which nervous system?

Back 119

-Parasympathetic
-Pelvic Nerve

Front 120

The sympathetic nervous system is never good because ?

Back 120

it causes you to lose an erection.
"whiskey dick"

Front 121

Upon arousal, Both men and women experience a __________ in HR, BP and RR?

Back 121

-INCREASE

Front 122

Which muscle pulls the rectum superior and forward, in essence, closing it off?

Back 122

-Puborectalis muscle

Front 123

What is the purpose of the Intrinsic nervous system in relationship to bowel mobility?

Back 123

-Coordinates colonic wall movement and advancement of stool through the colon.

Front 124

The sympathetic nervous system is "fight or flight", therefore it is responsible for ________________ the colon.

Back 124

-RELAXING
-you cant poop when you are fighting DUH

Front 125

A diagram

Back 125

pic

Front 126

What three things work together to keep you from pooping?

Back 126

-Internal Anal Sphincter
-External Anal Sphincter
-Puborectalis muscle

Front 127

Which sphincter can we control to prevent pooping with coughing?

Back 127

-External anal sphincter
striated muscle continuous with pelvic floor; proximal to anus.

Front 128

If in doubt with Pee, Poop or Sex, which spinal cord segments do you guess?

Back 128

-S2-S4

Front 129

Internal Anal sphincter is activated but what?

Back 129

Stretch receptors in the Anal canal

Front 130

Damage to an UMN can result in what type of bowel?

Back 130

-Spastic/reflexive
-There is no direct damage to the reflexes, therefore they can still be used to defecate.
-Spasticity may cause constipation due to spastic external anal sphincter and pelvis floor

Front 131

A lesion directly do the ___________________ ________________ will result in a flaccid/areflexic bowel?

Back 131

-Conus Medullaris
-may cause fecal incontinence and slowed bowel motility

Front 132

What type of pharmacological treatment may be used to increase motility? (basic)

Back 132

-Colonic Stimulants

Front 133

What type of pharmacological treatment may be used for a patient with spastic bowel syndrome? (basic)

Back 133

-Stool softners

-Assistive techniques: Valsalva maneuvers, push-ups, abdominal massage, leaning forward

Front 134

A patient with a flaccid bowel syndrome may require what?

Back 134

-Manual evacuation (disempaction) of the stool in the upright or side-lying position (every other day)

-Firm, formed stool is required to prevent fecal incontinence and to be manually evacuated easily.

Front 135

A successful bowel program follows the S.E.L.F. model?

Back 135

S: Schedule
E: Exercise
L: Liquids
F: Food

Front 136

How much liquid intake is given for a successful SELF program?

Back 136

-8-9 (8oz) glasses to prevent constipation.

Front 137

What type of food is recommended for a patient with SCI?

Back 137

-Foods high in fiber

Front 138

Chart

Back 138

Front 139

Chart 2

Back 139

Front 140

Chart 3

Back 140