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PHTH 521 > SCI > Flashcards

SCI Flashcards

1
Q

What are the three most important concerns as a SCI pt?

A
  1. Sexual function
  2. Walk
  3. Bowel and bladder
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2
Q

SCI is a ___ incidence and ____ cost event.

A

low; high

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3
Q

SCI rarely occur in isolation, ___% have another major injury, 15% being a head injury.

A

75

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4
Q

SCI = males __% of the time, mean age being early ____.

A

80; 30

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5
Q

Are non-traumatic or traumatic more common?

A

non-traumatic

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6
Q

Is tetraplegia or paraplegia more common?

A

tetraplegia

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7
Q

________ = impairment in motor and/or sensory function of the LE’s.

A

paraplegia

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8
Q

________ = impairment in motor and/or sensory function that results in the parietal or total loss of use of the limbs and torso.

A

quadriplegia

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9
Q

After age 45 most common cause of SCI is ______.

A

falls

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10
Q

What are the 3 ways that the SCI can be damaged?

A
  1. Concussion
  2. Contusion
  3. Laceration
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11
Q

Excessive _______ causes 50% of SCI in younger adults.

A

flexion

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12
Q

Excessive _________ more common mechanism of injury in older individuals.

A

extension

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13
Q

With violent movement, SC vertebrae can _____, scatters bony fragments.

A

burst

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14
Q

First ____ hours = necrotic death of axons that were damaged.

A

18

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15
Q

Lesion then progressives both up and down the cord, as far as ___ segments.

A

4

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16
Q

Immune response in SCI pathology trigger _______.

A

apoptosis

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17
Q

________ injury = structural damage occurring instantly after the event.

A

primary

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18
Q

_______ injury = more extensive injury can occur if the spine is not immediately immobilized.

A

secondary

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19
Q

Often a small rim of spared _____ and ____ remains, preserving this is key for recovery of function.

A

tissue; axons

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20
Q

Secondary injury = ________cascade that happens after injury.

A

pathophysiologic

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21
Q

In secondary injury, what 3 things occur?

A
  1. Ischemia
  2. Hypoxemia
  3. Edema
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22
Q

In secondary injury, necrosis can be triggered by excitotoxic changes (________ toxicity) and can continue for weeks.

A

glutamate

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23
Q

Less than ___% of cord supports locomotion so sparing even a very small portion is key.

A

10

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24
Q

Prevention of _______ appears to have large beneficial clinical consequences.

A

edema

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25
Q

___________ = reduces firing rate as a result of trauma to oligodendroglial cells

A

demyelination

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26
Q

Demyelinations triggers degeneration about the lesion and along the __________ tract.

A

corticospinal

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27
Q

Scar tissue formation can impede _______ regeneration.

A

axonal

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28
Q

Grey matter losses are confined to ___ to ___ spinal segments about the lesion.

A

1-1.5

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29
Q

________ scaring can permanently connect the cord to the overlying dura and tether it.

A

dural

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30
Q

Neural function below the lesion are subject to accelerated _______ and loss of _______.

A

aging; function

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31
Q

Areas of the brain under go atrophic changes from loss of signals, = ________.

A

diaschesis

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32
Q

Acutely after an injury the pt will go into ______ ______.

A

spinal shock

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33
Q

______ ___ of spinal shock = complete loss of all reflexes below the injury. This phase lasts for a day. Neurons have lost input, become hyperpolarized and less responsive to stimuli.

A

phase 1

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34
Q

______ _____ of spinal shock = return of some, but not all, reflexes below the SCI.

A

phase 2

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35
Q

______ ____ = mononsynaptic reflexes such as the deep tendon reflexes are restored.

A

phase 3

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36
Q

The first synapses to form in phase 3 of spinal shock are form ________ axons, usually from _______.

A

shorter; interneurons

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37
Q

_______ ___ = hyperreflexia occurs. Interneurons and lower motor neurons below the SCI begin sprouting, attempting to re-establish synapses.

A

phase 4

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38
Q

Clinical manifestations: C5?

A

elbow flexors

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39
Q

Clinical manifestations: C6?

A

wrist extensors

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40
Q

Clinical manifestations: C7?

A

elbow extensors

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41
Q

Clinical manifestations: C8?

A

finger flexors

42
Q

Clinical manifestations: T1?

A

finger abductors

43
Q

Clinical manifestations: L2?

A

hip flexors

44
Q

Clinical manifestations: L3?

A

knee extensors

45
Q

Clinical manifestations: L4?

A

ankle dorsiflexors

46
Q

Clinical manifestations: L5?

A

long toe extensors

47
Q

Clinical manifestations: S1?

A

ankle plantar flexors

48
Q

What are the two scores taken in the sensory test of clinical manifestations of SCI?

A
  1. Pin prick score

2. Light touch score

49
Q

What is ASIA scale A?

A

Complete: No motor or sensory function is preserved in the sacral segment S4-S5

50
Q

What is ASIA scale B?

A

Incomplete: Sensory but nor motor function is preserved below the neurological level and includes the sacral segments S4-S5

51
Q

What is ASIA scale C?

A

Incomplete: Motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade less than 3

52
Q

What is ASIA scale D?

A

Incomplete: Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more

53
Q

What is ASIA scale E?

A

Normal: Motor and sensory function are normal

54
Q

________ injury = absence fo sensory and motor function in segments below the injury

A

complete

55
Q

__________ injury = partial preservation of sensory and/or motor functions below the neurological level

A

incomplete

56
Q

______ ________ = voluntary anal sphincter contraction or sensory function (light touch, pinprick at the S4-S5 dermatome, or anal sensation on rectal examination)

A

sacral sparing

57
Q

Preservation of the _______ of the SC is key

A

periphery

58
Q

Incomplete injury = indicates incomplete injury and the possibility of some recovery including ______ and ______ function.

A

bowel; bladder

59
Q

Sacral sparing in incomplete SCI is important because it represents at least partial structural continuity of the _______ _______ long tracts.

A

white matter

60
Q

In the _____, axonal regeneration is slow.

A

CNS

61
Q

In the CNS, myelin sheaths are produced by ________. In the PNS, myelin sheaths are produced by ______ _____.

A

oligodendrocytes; schwann cells

62
Q

Myelin debris is more slowly removed in the CNS, taking ___-__ weeks post injury for the macrophages to remove debris.

A

2-4

63
Q

CNS myelin debris contains _______ factors which slow the regeneration process.

A

inhibitory

64
Q

CNS ________ proliferate into the transected area and form _______ scars which block the pathways for axonal growth,

A

astrocytes; astrocytic

65
Q

Oligodendrocytes are limited in their ability to regenerate themselves (T/F).

A

TRUE

66
Q

How long can the period of cortical remodelling post SCI take?

A

6-12 months

67
Q

Brown-Sequard syndrome = ______-_____ of the cord.

A

hemi-section

68
Q

Hemi-section SC; ________ side = muscle weakness, abnormal reflexes, clonus/spasticity from corticospinal and reticulospinal tract damage.

A

ipsilesional

69
Q

Hemi-section of the SC; _______ side = proprioception, kinesthesia and vibratory sense lost from dorsal column tract damage

A

ipsilesional

70
Q

Hemi-section SC; __________ side = pain and temp loss starting a few levels below the lesion (lateral spinothalamic tact ascends for a few segments before crossing)

A

contralateral

71
Q

_________ ______ _____ lesion = loss of pain, temp, and light touch below a specific dermatome level; sacral sensation may be spared

A

contralateral spinothalamic tract

72
Q

______ _______ syndrome = loss of all modalities at one of several dermatome levels, loss of pain and temp below a specific dermatome love, loss of proprioception and discriminatory touch up to similar level and limb weakness.

A

brown sequard

73
Q

_______ ______ lesion = bilateral loss of all modalities, bilateral leg weakness.

A

complete cord

74
Q

________ ______ lesion = bilateral loss of pain and temp, preservation of proprioception and discriminatory sensation

A

central cord

75
Q

central cord lesion = ______ ______ loss

A

suspended sensory

76
Q

__________ = cysts in cord

A

syringomyelia

77
Q

Syringomyelia can be __________ or can develop after an ________.

A

spontaneous; injury

78
Q

Syringomyelia account for ___% of SCI

A

2

79
Q

Cysts do not occupy the entire spinal cord area (T/F).

A

FALSE (they can)

80
Q

As the cysts develops it causes what 6 things?

A
  1. Significant pain
  2. Spasms
  3. Phantom sensations
  4. Reflex changes
  5. Autonomic changes
  6. Blocks CSF flow
81
Q

What is the most common site for cervical spine injury?

A

C5-C6

82
Q

Autonomic Dysreflexia = lesions above T__.

A

5

83
Q

________ _______ = irritating stimulus is introduced blow the level of SCI, and stimulus is blocked by the lesion at the level of injury.

A

Autonomic dysreflexia

84
Q

In autonomic dysreflexia, the reflex is activated that increases activity of the ______ portion of the ANS

A

sympathetic

85
Q

Autonomic dysreflexia results in _______, which causes a sharp rise in blood pressure.,

A

vasospasms

86
Q

One of the skeletal changes associated with SCI = ______ _______.

A

heterotopic ossification

87
Q

Respiratory complications of SCI will occur above a C___ paralysis.

A

4

88
Q

In regards to a DVT, if the clot breaks free, what 3 areas can it go and what could it cause at these locations?

A

1) Go to brain and cause stroke
2) Go to heart and cause heart attack
3) Go to lung and cause pulmonary embolus

89
Q

Muscle and nervous causes of spaspticity = increases sensory ________ and ________ .

A

responsiveness; relfexia

90
Q

In regards to spasticity, where is the increased sensory responsiveness and reflexia coming from?

A
  1. distended bladder
  2. constipation
  3. infection
  4. fracture
  5. smoking
  6. pressure sores
  7. physical and emotional stressors
91
Q

What are 3 treatment for spasticity?

A
  1. medication
  2. positioning
  3. stretching
92
Q

Thermal regulation is effected in SCI due to the loss of tract from _______.

A

hypothalamus

93
Q

Higher the lesion = worse thermoregulation (T/F).

A

TRUE

94
Q

______ ______ = unable to get proper venous return to heart and is a rate limiter for exercise.

A

orthostatic hypotension

95
Q

Heterotrophic ossification is an issue in ______ joints.

A

large

96
Q

What is the most common cause of death in SCI?

A

pneumonia

97
Q

What are areas of concern for skin ulcers before getting out of bed?

A
  1. Heel
  2. Sacrum
  3. Scapula
98
Q

What are areas of concern for skin ulcers once in a chair?

A
  1. Trochanter

2. Ischium

99
Q

Bowel and bladder are controlled by what sacral segments?

A

S2,S3, S4

100
Q

A lesion at conus medullaris = _____ bladder.

A

flaccid

101
Q

A lesion above S2 = ______ bladder (after spinal shock)

A

reflex

102
Q

UTI’s are almost constant due to catheterization (T/F).

A

TRUE

PHTH 521 (9 decks)

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