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What is the ASIA Scale?
tool used to communicate between providers about the spinal cord injury (American Spinal Injury Association) Impairment Scale
How is the motor level defined in the ASIA scale?
motor level is defined as the lowest key muscle that has a grade of at least 3, provided that the key muscles above are graded as a 5
Category A on the ASIA scale
complete lack of motor and sensory function below the level of injury
Category B on the ASIA scale
Some sensation below the level of injury
Category C on the ASIA scale
some muscle movement is spared below the level of injury but 50% of the muscles below the level of injury cannot move against gravity
Category D on the ASIA scale
most of the muscles that are spared below the level of injury are strong enough to move against gravity
Category E on the ASIA scale
all neurological function has returned
ASIA C
Most common cause of spinal cord injury?
motor vehicle crash
Why is anticipating rehab needs important?
-pt education may prevent secondary complications
-dysfunction in one area can lead to dysfunction in another
-functional needs may change over time
What is DBS surgery?
(deep brain stimulation) very invasive neurosurgical intervention for the treatment of movement disorders (and more)
FDA approved disorders to use DBS on
parkinsons, dystonia, essential tremor and OCD
Do we know exactly how DBS works?
No - thought is that DBS overrides abnormal neuronal activity
Are DBS insertions permanent?
yes, only removed for infection risk
What does MPTP do
kills dopaminergic neurons, induces symptoms similar to parkinsons
_____tremor: High amplitude slower frequency and mostly seen at rest
parkinsons tremor
_____tremor: low amplitude, fast frequency and mostly seen during action
essential tremor
patterned directional and often sustained muscle contractions and causing twisting and repetitive movements or abnormal postures
primary dystonia
Who would be a good candidate for DBS
someone who is responsive to medications, in otherwise good health between ages 7-75
When is DBS appropriate
when other treatments (pharma) are not working, or have stopped working
What is a DBS electrode
platinum wire electrodes connected to a stimulator, the battery is located inside the stimulator
What would be the DBS target in parkinsons disease
-subthalamic nucleus
-globus pallidus interna
Which PD symptoms respond best to DBS
tremors, bradykinesia, cog-wheel rigidity
DBS target for essential tremor
ventral intermediate nucleus of thalamus (unilateral)
What essential tremor symptoms respond best to DBS?
action/postural tremor in upper and lower extremities
What is the DBS target for Dystonia
-subthalamic nucleus
-globus pallidus interna (unilateral or bilateral)
Correct term for the amputated limb
"residual limb"
What is phantom limb phenomena
global feeling that the body part is still present, accompanied by specific sensations or pain
What is Telescoping or Tele-Limb?
the limb is felt in an awkward paralyzed position, can change shape/position, more common in upper limbs
Is amputation is adults or in children more likely to result in phantom limb pain?
adult amputation
Can phantom limb occur in people born without limbs?
yes
In war torn nations, what causes most traumatic amputations?
landmines
Who is more likely to experience pain memory?
people with history of pre amputation limb pain
phantom limb pain memory can be triggered by
depression, stress, anxiety
Which systems are involved in causing phantom limb pain?
CNS and PNS
What occurs in peripheral reorganization?
amputation neuromas (small tumors made of nerve tissue)
highly sensitive and induces actual and phantom pain
up regulated sodium channels in these neuromas
What occurs in spinal reorganization?
Dorsal root ganglion cells show abnormal spontaneous activity and increased sensitivity
when anesthetizing the residual limb does not improve pain, this indicates what?
more central changes have occurred (cortical reorganization)
What is a preventative treatment for phantom limb pain?
pre surgical analgesia (longer pain free period)
2 types of surgical intervention for phantom limb pain
-nerve revision removal of neuromas
-spine stimulator
Name 2 of the main psychological therapies for phantom limb pain
Eye movement desensitization and reprocessing (EMDR)
Mirror therapy
Describe how Virtual Reality works as treatment for phantom limb
computer translates neural impulses into movement of the virtual limb via electrodes placed on muscles, pt repeats movements prompted by the computer
What is meant by cortical reorganization
the areas in the cortex can become "mixed" (example of patient who could feel their amputated fingers when someone touched different areas of their face)
