Module 8. A: spinal cord injury fully solved questions with 100% accurate solutions(Latest Update)

risk factors for spinal cord injury

age

sex

alcohol

drug use

major problems from spinal cord injuries

disruption of individual growth and development

high cost of rehab and long term health care

most common region of spinal cord injury

cervical spine

primary spinal cord injury

the result of the initial trauma- the mechanical disruption of axons because of stretch or laceration

secondary injury

ongoing, progressive damage that occurs after initial injury- usually the result of ischemia, hypoxia, and hemmorhage, edema, which destroys the nerve tissues

are secondary injuries reversible

thought to be reversible or preventable during first 4-6 hours after injury

treatment needed to prevent partial injruy from developing into more extensive, permanent damage

flexion injury

cervical spine ruptures the posterior ligaments

hyperextension injury

cervical spine rupture anterior ligaments

compression fractures

crush the vertebrae and force bony fragments into the spinal canal

flexion rotation injury

injury of the cervical spine often results in tearing of ligamentous structures that normally stabilize the spine

what does a concious person usually report with a spinal cord injury

usually reports acute pain in back or neck

complete spinal cord lesion

involves total loss of sensation and voluntary muscle control below the lesion

incomplete spinal cord lesion

there is preservation of the sensory or motor fibres or both below the lesion

paraplegia

paralysis of the lower extremities with dysfunction of the bowel and bladder from a lesion in the thoracic, lumbar or sacral region of the spinal cord

tetraplegia

paralysis of both arms and legs, with dysfunction of bowel and bladder from a lesion of the cervical segments of the spinal cord

ASIA impairment scale

commonly used for classifying sever of impairment resulting from SCI

assessment of motor and sensory function

determines neurological level and completeness of injury

what is the ASIA impairment scale useful for

recording changes in neurological staus

identifying appropriate function goals for rehabilitation

SICRE project

covers topics related to SCI rehab and community reintegration

complecations of spinal injury

DVT

Spacticity

pneumonia

resp failure

autonomic dysreflexia

pressure ulcer

infections

depression

rehabilitation and home

organized around individual goals and needs

involved in therapies

learn self care

can be very stressful

needs frequent encouragement

goals of care for spinal injury

enable or modify self care

assist in mobility

intervention for physical needs

focus on gross motor movement first then finer movement

assist and assess ADLs

most important piece of assistive technology

wheelchair

enables activity and participation for person with SCI

what must be provided for the wheelchair

proper postural support

back supports

wheelchair cushions

footrests

preventing complications intervention

prevent them from the beginning

maintain skin integrity

bowel and bladder management and training

early mobilization

autonomic dysreflexia occurs when

after spinal shock has resolved and may occur years after the injury

who can autonomic dysreflexia occur in

persons with SC lesion above T6

treatment of autonomic dysreflexia

removing triggering stimuli

if still having symptoms do a head to toe to find the stimuli

what syste responses are exageratted in autonomic dysreflexia

autonomic nervous system responses

what can increased BP in autonomic dysreflexia lead to

seizure

stroke

MI

blood pressure in autonomic dysreflexia

90-100 systolic

120 systolic would be high in SCI

symptoms of autonomic dysreflexia

severe pounding headache

increase in BP

bradycardia

profuse sweating

nausea

nasal congestion

where is sweating with autonomic dysreflexia

above injury

what part of the body is cold in autonomic dysreflexia

cold and goosebumps below injury

triggering stimuli for autonomic dysreflexia

distended bladder (most common)

distension or contraction of visceral organs (constipation)

stimulation of skin

interventions for autonomic dysreflexia

seated position to lower BP

rapid assessment to identify and eliminate cause

hydralazine hydrochloride IV

nifedipine

mechanical ventilation

C2 and above are ventilator dependent

C3 or C4 injury have variable diaphragmic function and may have potential for ventilator weaning and enudurance training

phrenic nerve stimulators

or electronic diaphragmatic pacemakers increase mobility

attach to pregnic nerve and diaphragm to tigger a breath

tracheostomy placement

if anticipated they will need ventilation support for more than 3 weeks

girdle or abdominal binder

position diaphragm and used in those with lesions above T6

can improve respiratory function, and longer term use can continue to be effective

vibration

chest wall vibration may improve pulmonary function while the vibration is applied

remove secretions and improve airway

what level of cervical spine injury have intact diaphragmic function

C5

when is post SCI pain common and severe

early post SCI injury

Neuropathic and musculoskeletal

what combination improves chronic pain in SCI individuals

cognitive behavioural therapy with pharmacological treatment

what medications improve neuropathic pain post SCI

gabapentin and pregabalin

lamotrigine or tramadol

cannabinoids

what medications improve neuropathic pain in an incomplete SCI

lamotrigine

reasons for neuropathic pain

heterotopic ossification of bones an issue for hips, knees, shoulders, elbows causing decreased ROM and contractures

spasicity

increased muscle tone in muscle that is weak

flexor or extensor spasms that occur below the level of the spinal cord lesion

short term reductions in spasticity

passive movement

muscle stretching

electric passive pedaling systems

active exercie interventions for spasticity

hydrotherapy

FES assisted cycling

walking

electrical stimulation for spasicity

applied to individual muscles may produce short term decrease in spascity

concern in long term use because may cause increase in spasicity

baclofen and spasicity

reduces muscle spascity in people with SCI

antispazmatic meds for spascity and side effects

effective in controlling spasm

antispasmodic meds may cause drowsiness, weakness, vertigo

acute undernutrition post SCI intervention

boost caloric intake of healthy foods

promote healing to avoid osteoporosis

over nutrition post SCI intervention

obesity and abdominal obesity prevalent among those with SCIs

what is adequate dietary consumption important for in SCI and what to screen for

bone health

screen for vitamin B deficiency and dysphagia

what can help a person with a SCI increase lean tissue, work efficiency and resting oxygen uptake

nutrition

exercise

behaviour modification

neurogenic bladder

urgency, frequency, incontinence, inability to void, high bladder pressures resulting in reflux of urine into kidneys

*risk for UTI

depending on the lesion, a neurogenic bladder may have what

no reflux detrusor contractions

hyperactive reflex detrusor contractions

lack or coordination between detrusor contracttion and urethral relaxation

what should be encouraged for neurogenic bladder

fluid intake

empty bladder frequently

good perineal care

cotton underwear

condom catheter

bladder care for males with SCI

remove sheath nightly

cleanse penis and dry carefully

meds for bladder management: anticholinergic therapy

for detrusor over activity

medications for bladder function improvement

clonidine

tadalafil

vardenafil

intrathecal baclofen

tamusolin for SCI

imrpove urine flow in SCI individuals with bladder neck dysfunction

UTI and SCI meds

ciprofloxacin for 14 days

surgery for bladder management

urinary diversion

is neurogenic bowel dysfunction common in SCIs

yes

bowel management

bowel training program

high fibre diet and adequate fluid intake

oral laxatives, suppository

record bowel movements

electrical stimulation and bowel management

stimulation of abdominal wall muscles can improve bowel management for individuals with tetraplegia

bisacodyl suppositories

effective in stimulating reflex evacuation as part of bowel management

how often should an SCI patient be repositioned

Q2h

what can pressure injuries lead to

sepsis

osteomyelitis

fistulas

how often should the skin be examined

twice daily

what does continent urinary diversion improve

self image

quality of life

sexual satisfaction

drugs for reproductive health SCI

viagra

should be cautioned for tetraplegia or high level paraplegia because of possibility of experiencing postural hypotension for several hours after use)

when is reflex sexual function possible

if the client has an upper motor neuron lesion

what does the absense of external rectal sphincter tone, bulbocavernosus reflex or both indicate

the client has lower motot neuron involvement and may be capable of psychogenic erection but not reflex erection

if ejaculation occurs it may retrograde into bladder

does a person of child bearing age with an SCI remain fertile

yes

they hve ability to become pregnant or deliver normalluy through birth canal

upper motor neuron injuries and sexual reproduction

may retain capacity for reflex lubrication whereas psychogenic lubrication depends on completeness of injury

clitorial stimulation and SCI

may increase genital responsiveness

SCI and pregnancy

tend to have more complications during pregnancy, labour and delivery

close monitoring throughout pregnancy and post partum

SCI and breastfeeding

may have difficulties with breast feeding because of autonomic dysreflexia and inhibition of milk ejection reflexes

psychological need with SCI interventions

monitor frustration and toleration need

help to accept new image of body

depression and SCI

common psychological problem in people with SCI

what is depression with SCI associated with

lower functional dependence, more secondary complications, less community and social integration and a reduced quality of life

vocational needs interventions

returning the SCI person to earn their livelihood or go to school

jobs are great with less physical movement and more brain work

gradually start

social needs intervention

help enter previous life with new capabilities and adjustments

ask for help and conserve energy

why is discharge from hospital delayed in many cases

lack of accessiible housing