Neuro 2 Final: SCI Rehab Questions with 100% correct answers + detailed rationales

Prognosis for patients with complete injury

they won't be ale to recover lost motor function, they need to learn to compensate

Symptoms of autonomic dyreflexia

Severe headache

Anxiety

Profuse sweating above LOI

Flushing and piloerection above LOI

Dry and pale skin below LOI

Blurred vision

Nasal congestion

Bradycardia, arrhythmias, atrial fibrillation

Autonomic dysreflexia can be asymptomatic. T or F?

TRUE

Autonomic dsrelfexia is an acute elevation of _____ BP by ____ mmHg or more, triggered by _______ ________ stimulation below level of injury.

SBP; 20; noxious or nonnoxious; visceral or somatic

Face is red....

raise the head

Face is pale...

raise the tail

Causes of pain in SCI patients

pain at injury site, nerve root, other injuries not yet found, neurogenic pain below injury

How can we manage pay in SCI?

pain modalities (CAUTION USING HOT/COLD), alternative exercise, acupuncture

How do shoulder injuries/carpal tunnel present?

caused by overuse of wheelchair, transfers, and vocations

pain/weakness in shoulders or wrists

Mgmt of shoulder injuries/carpal tunnel

•Proper wheelchair

position and work station

set up

•Use of power chair vs.

manual when stress is

too much on

shoulders/wrists.

•Surgical repair is an

option but can be very

limiting in in the

recovery phase

Documentation options for ROM

WFL or flaccid

ROM limitation may be caused by...

HO

Other injury

Premorbid contractures

Arthritis

Contracture from spasticity and insufficient PROM (in a

patient with a longer history of SCI)

early detection of HO is important so that....

medication can be started

Can you do ROM with HO?

Phylicia orders, not aggressively

Considerations for spasticity and contractures

proper positioning, surgical releases, tendon transfers, baclofen pump

spinal shock

applies to all phenomena surrounding physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflex activity below the level of the injury.

a progression of weakness proximal to the level of injury

syringomyelia

Why is syringomyelia especially problematic for cervical injuries?

level can make a big difference in function

Mgmt of syringomyelia

requires surgery

Myotomes

C5 - elbow flexors

C6 - wrist extensors (can use

tenodesis grip)

C7 - triceps (yay!)

C8 - finger flexors (may have

weak grip and trouble with fine

motor control in hand)

T1 - 12 - expect full UE motion,

varying levels of abdominal

function / trunk control based on

level of injury

L2 - hip flexors

L3 - knee extensors

L4 - ankle dorsiflexors

L5 - toe extensors

S1 - ankle plantar flexors

Tenodesis grip

Should SCI balance on a therapy ball?

unrealistic expectation, instead do short sitting with and without UE support, progress to dynamic reading over stable base

Long sitting is necessary for ___________

independent dressing

Why is long sitting easier than short sitting?

larger BOS

What ight you consider in long sitting if the pt is having difficulty with anterior tilt of pelvis?

hamstring length, flexing knees can help

Bladder function in SCI

21-36% of patient have issues

neurogenic bladder

bladder won't empty with voluntary control

hypo-reflexive bladder

does not empty

hyper-reflexive bladder

empties too often

Frequent bladder distention can promote....

UTIs

neurogenic bowel

bowel will not empty with volitional control

Bowel care for Sci

Position

Equipment

Digital stimulation

Abdominal massage

Vasalva maneuver

Why might diarrhea mean an obstruction?

loose stool passes around obstruction

Redness that does not fade within ____ minutes may progress to an open wound.

20

To what degree do you need to tilt a chair for the pt to actually feel pressure relief?

65 degrees

What is the mean duration of pressure relief required to re-oxygenate tissues?

1 minute and 51 seconds at 3.1x per hour

Weight shifting is defined as _______% off loading of at least one buttock for _____ seconds.

30-90; 15

Spinal deformities with SCI

scoliosis, pelvic obliquities, kyphosis

Spinal deformities are often caused by... resulting in...

poor wheelchair positioning and support; deformity develops over time, increasing pressure sores, overuse syndromes, respiratory compromise

Deformities cannot be corrected at any stage. T or F?

false, can be fixed if caught early

C6 tetraplegia and above need a POWER or MANUAL wheelchair?

power

Can C7-T1 tetraplegia propel manual?

maybe, weigh cost benefit of energy expenditure vs other benefits

New paraplegic WC users should use a RIGID or FOLDING frame?

rigid

The shoulder should be over the ______.

axel

Pros and Cons of a rigid back

pros- better posture and shoulder positioning

cons- hassle to load in car

How much of a difference does cushion type make?

cushion is better than no cushion, regardless of type

Combine a cushion with a ______ if possible.

back

3 skill levels of wheelchair

indoor, community, advance

a HIGHER or LOWER level of injury will have more difficulty maintaining blood pressure?

higher

What can we use to help maintain vascular support?

ace bandages and abdominal binder, but need to progress past these

C6-7 respiratory musculature

diaphragm intact, limited intercostals, potentially hard to wean from ventilator, difficulty handing secretions, pneumonia risk

The HIGHER or LOWER the level, the better the respiratory function?

lower

Why might a pt have difficulty weaning from the ventilator?

smoking history, pneumothorax, infection

****might need tracheostomy

What levels of injury are candidates for ambulation?

incomplete and lower lesions

begin gait training _____ after SCI

ASAP!!!!!

evidence for bodyweight support walking?

no significant difference over ground walking

Higher intensities re more effective when ambulating. T or F?

true

Pros of Exoskeleton

The ability to WALK while wearing the suit

Decreased pain

Decreased spasm

Improved bowel and bladder function

Decreased incidence of UTI

Cardiovascular Function

Psychosocial

Increase steps during therapy time

Decreased therapist workload

SCI patients are at a risk for hypo or hyperthermia. Why?

body is unable to regulate temperature and is susceptible to external conditions

Some men and women with SCI are able to achieve psychogenic or reflex ______

erections (orgasms)

-psychogenic T10-L2

-Reflexic S2-S4

Why is infertility common in men with SCI?

difficulty with

temperature regulation and prolonged sitting

resulting in increased scrotal temperature

Can a woman with SCI get pregnant?

yes, but would have complications from pressure sores and respiratory compromise

Acute Care Treatment Goals of SCI

tolerate upright, positioning, prevent secondary complications

Types of Acute care SCI treatment

strengthening, PROM, education on pressure relief and skincare, balance in short and long sit, transfer training

Progressive aerobic exercise in chronic

incomplete Spinal Cord Injury using ________ has been shown to increase fitness and walking related outcomes.

the Nustep

Home adaptation suggestions

Ramps: one foot of run for one inch of rise

Replace carpet with hardwood or other

surface with less friction

Remove throw rugs

Pedestal sink or cut out cabinet in bathroom

Flat surfaces for bathroom sink for easier access

Put frequently used items on lower shelves in

kitchen (plates, cups, etc)

Saety Suggestions at home

emphasize smoke detectors, call fire dept and alert them to disabled person in home, adjust hot water heater to lower temp