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140 Cards in this Set
- Front
- Back
What is the most common cause of SCI?
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-Traumatic
-MVA |
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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 ____________?
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-Tetraplegia (Quadriplegia)
-C-Spine |
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T or F:
Nearly all patients are released to a home setting? |
TRUE: 88%
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In general: the most common site for injuries is where?
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-Junctions between Levels:
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Secondary SCI include? (4)
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-Crush
-Hemorrhage -Edema -Infarction |
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T or F:
Glutamate and Glycine are good and assist with healing following initial SCI? |
FALSE:
***Sets off cascade of biochemical and cellular events -Nerve cell death -Demeylination of axons -Triggers inflammation response |
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What accounts for improvement in function in Humans since regeneration does not occur?
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-Neuroplasticity
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What is one of the first and most important signs to determine if spinal shock is resolving?
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Sacral reflexes:
-Bulbocavernosus Relfex -Anal "wink" reflex |
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Initial clinical symptoms of SCI include? (3-4)
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-Loss of movement or sensation
-chest wall weakness -Spinous process deformity -Inadequate ventilation |
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This is the standard drug given following SCI to improve outcome.
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-Methylprednisolone (MP)
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T or F:
Initial/Immediate surgery can be controversial? |
TRUE:
- Some believe the injury needs to run its course before initial surgery |
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Although they are not commonly used anymore, how long is a HALO device worn?
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-approx 12 wks
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KEGEL QUESTION:
-What challenges with mobility will patients with orthoses have? |
-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 |
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What are some of the common Autonomic dysfunction symptoms?
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-Cardiovascular System
-Temperature control -Respiratory System -Bowel and Bladder -Sexual |
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Signs of Hypothermia?
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-Irritability
-Mental confusion -hallucinations -lethargy -clumsiness -slow respiration -slowing of heartbeat |
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About what level do we begin to think about problems with thermoregulation?
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-Level T6
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People with complete spinal cord lesions above what level cannot breathe independently?
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C4
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What is the little rhyme to remember level of assistance?
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C3-4-5, Keep the guy alive
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What nerve innervates the diaphragm?
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Phrenic Nerve; C3-5
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Excessive sympathetic nervous system activity, elicited by noxious stimuli below the lesion is known as?
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-Excessive sympathetic nervous system activity, elicited by noxious stimuli below the lesion
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Autonomic Dysreflexia is seen in patients with a level of _______ and above?
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-T6
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What will the patient with Autonomic Dysreflexia report?
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-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!! |
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What vital changes are seen with Autonomic Dysreflexia?
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-Abrupt increase in BP
-Decrease in HR -APPEARS FLUSH |
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T or F:
Autonomic Dysreflexia is not a medical emergency? |
FALSE
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What do you do if a patient has Autonomic Dysreflexia?
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-SIT THEM UP!!!
-Remove noxious stimuli -Keep checking vitals |
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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. |
-Orthostatic Hypotension
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How do you treat Orthostatic Hypotension?
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-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 |
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___________ ______________ occurs in a large number of SCI due to LE paralysis and blood vessel damage.
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-Pulmonary Embolism
DVT |
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UMN signs are more severe with _____________ SCI?
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-Incomplete
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KEGEL QUESTION:
-What critical interventions should be implemented in the acute phase of rehabilitation to prevent development of pressure sores? |
-Positioning, turning schedule and nutrition are critical.
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What are the benefits to Boots and special air mattresses?
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-May help to prevent pressure sores, more specifically in the acute stages.
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Sudden loss of ROM, swelling, local heat, erythema and nonseptic fever are common signs of what?
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-Heterotopic Ossification
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What can be done to help decrease the likelihood of Renal Calculi
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-Vigorous hydration, early mobility, especially dynamic WB activities.
-TILT TABLE |
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This type of pain is commonly seen below the level of the lesion and involves electric burning pain in dermatomes?
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-Neutopathic Pain
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______________: pain evoked by a non-noxious stimulus, such as light touch, that does not normally evoke pain.
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-Allodynia
-ALLodynia, ALL touch hurts |
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What is one technique to help control or overcome allodynia?
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-desensitization techniques
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Anticonvulsants and Tricyclic Antidepressants are commonly used to treat what type of pain?
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-Neuropathic Pain
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What are some common psychosocial problems that individuals with SCI may face?
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-Depression, suicidal thoughts
-Financial issues -Relationship changes |
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_______________: sulcal arteries arising from ASA supply central portion of SC.
a) Centrifugal system b) Centripetal system |
A)
Centripetal supplies dorsal horns and columns and peripheral WM |
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What is the main blood supply to the inferior spinal cord and has variable origins from the level of T9 to L3?
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-Artery of Adamkiewicz
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Which type of tract lesion/injury results in sensory loss in a dermatomal distribution?
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-Segmental Signs
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Vertical tract signs result in what types of deficits?
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-Sensation loss below lesion level
-Muscle paresis with hyperreflexia -autonomic losses: of BP, pelvic viscera, thermoregulation. |
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Brown-Sequard results from what?
Describe injury |
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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). |
-IPSILATERAL
-IPSILATERAL -CONTRALATERAL |
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What is a common MOI for an anterior cord syndrome?
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-HYPER FLEXION INJURY
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KEGEL: FILL IN THE BLANKS
Caused by trauma to:__________ and/or___________ Decreased_______________________ sensation below the lesion. Paralysis Intact____________________________ |
-to anterior cord or anterior spinal artery
-pain and temp sensation below lesion level -light touch and proprioception |
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Central Cord Syndrome occur with _______________ injury in a person with _______________ ______________
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-Hyperextension
-Spinal Stenosis |
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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). |
-Central
-Cervical -Upper than in the Lower -Bilateral -Cape Distribution |
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Posterior Cord Suyndrome results from what types of conditions?
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-Posterior Artery occlusion
-Tumor -Disc compression |
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KEGEL FILL IN THE BLANKS:
Damage to ____________ Sensory Loss:_________________ Preservation of:________________________________________ Wide-based step gait |
-DORSAL COLUMN
- Descriminative touch and proprioception -Pain and Temp sensory function and motor function |
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Cauda Equina Syndrome experience motor and sensory loss where?
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-BUTT HOLE
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KEGEL FILL IN THE BLANKS
Injury________damaging lumbar and/or sacral ___________ (LMNs). Sensory impairment and flaccid paralysis of________________________________________ |
-L1 or below
-Nerve roots (LMNs) -leg muscles, bladder, bowels and sexual function. |
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What are two differences between the signs present with Cauda Equina and Conus Medullaris?
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-Conus Medullaris may have spasticity of distal LE
-May have Babinski Sign |
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What is often the first sign that a lesion is incomplete?
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-SACRAL SPARING
butt hole wink ;) |
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T or F:
Designation of a spinal lesion is determined by Neurological level alone? |
FALSE:
-2 criteria: The neurological level of injury Whether injury is complete or incomplete |
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What is needed to classify a muscle as "normal"?
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-“Normal” refers to muscle grade of 3/5 or above
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T or F:
Neurological level of injury is the most caudal segment with normal SENSORY and MOTOR function bilaterally? |
-FALSE
normal sensory AND / OR motor function on both sides of the body. |
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To be a complete lesion, at what level must there be no motor or sensory function?
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S4 & S5
BUTT WINKER TEST |
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What is the term for a patient who has a C7 lesion, but has some sensation in the thoracic spine?
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-Zone of Partial Preservation
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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? |
Motor Level = C6
Sensory Level = C5 Neurological Level of Injury (NLOI) = C5 Zone of Partial Preservation = C6-C7 ASIA classification = A |
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What are some common conditions a patient with ASIA A might experience?
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-Autonomic Dysreflexia
-Decreased sweating -Orthostatic Hypotension |
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If a patient has normal light touch, but deminished/absent pin prick below the level of a lesion. What syndrome might you expect?
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-ANTERIOR CORD
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What are some factors that could increase or decrease the Prognosis of SCI?
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-Age
-Level of lesion -Ventilator use |
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T or F:
Central cord and Brown-Sequard have a better prognosis that Anterior cord? |
TRUE
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What are two factors that increase likelihood of ambulation?
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-touch and pinprick intact below lesion level
->3/5 quad strength 2 months post injury |
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After a SCI, Explain how sensory input is INTACT below the level?
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-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 |
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T or F:
A person with a C6 complete injury can send a signal from the brain telling the leg to move? |
TRUE:
They can send the signal, but it will not work because the SC lesion will block transmission. |
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T or F:
A person with a SCI cannot trigger reflexes below the level of the lesion? |
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) |
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List the muscle with the lesion level:
Biceps: Wrist Extensors: Diaphragm: Finger Flexors: Triceps: Abdominals: Gastroc: Anterior Tib: Quad: |
Biceps: C5
Wrist Extensors: C6 Diaphragm: C345 Finger Flexors: C8 Triceps: C7 Abdominals: T5-12 Gastroc: S1 Anterior Tib: L4 Quad: L23 |
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What would the Neuro level be for a patient with Sensory T3 and lowest motor tested is C8?
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T3 would be the Neuro level because you can not test the motor of the thoracic levels.
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What areas of the body would you use to test proprioception?
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-Index finger
-Big Toe |
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What ashworth grade would be given for No increased tone?
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Zero
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Give 3 S/S of a suspected DVT?
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-Swelling
-Pitting edema -Redness -Pain |
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What clinical test can be performed for a suspected DVT?
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-Girth Measurement
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What should be discussed from the beginning and included with notes/goals?
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-discharge plans and destination
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What is one part of treatment that is very important for discharge from acute care to any setting?
THEY MUST HAVE WHAT? |
-Upright Tolerance
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What are two areas in which you want to decrease ROM with a SCI?
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-Low back extensors
-Finger flexors |
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What is the name for a grip in which the finger flexors are tight, and useful for patients?
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-Tenodysis grip?? spelling?
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Name three areas in which you would want to increase ROM?
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-Hamstring
-Shld Ext -Shld ER |
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In order to transfer on an uneven surface, What movements/strength is needed?
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-Shoulder ABD and FLEX
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Uneven transfers require shoulder _________ and must have ___________
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-Extension
-Triceps |
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How often should position changes occur?
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-15-20 min
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Symptoms of Autonomic dysreflexia include?
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in order:
-increased BP -Decreased HR -Anxious -Headache -Sweating |
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What is the key different symptoms for Orthostatic hypotension when compared to autonomic dysreflexia?
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-DECREASED BP
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symptoms of Orthostatic Hypotension include
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-feel dizzy
-faint -blurry vision -dec. hearing |
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Treatment for orthostatic hypotension and autonomic dysreflexia?
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-ORTHO: lay down and elevate feet
AUTO:sit up and remove irritant |
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How does spasticity differ in patients with SCI?
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-It tends to radiate or travel up and down the cord causing a full body reaction to a stimulus applied to the feet.
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Who has worse spasticity, complete or incomplete injuries?
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Incomplete
-Those with cervical and upper thoracic lesions have worse spasticity |
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What type of orthosis would most likely be needed for a T10-11 injury?
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-Knee-Ankle-Foot Orthosis
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What would the Neuro injury level be to require a Hip-Knee-Ankle-Foot Orthosis?
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T1-T9
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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?
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-Recovery-Based Therapy
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What are the four principles that guide locomotor training? (4)
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-Maximize Load
-Optimize sensory input -Optimize kinematics -Maximize recovery/Minimize compensation |
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T or F:
assistive devices are very beneficial when maximizing load for locomotion? |
FALSE:
-AD can be detrimental to recovery. -AD’s do not allow trunk rotation and unweight the limbs |
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How can you optimize sensory input?
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-use appropriate hand contact and sequencing.
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How would you Optimize appropriate kinematics?
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-ensure hip extension
-use arm swing -trunk rotation |
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T or F:
Gait deviations are compensatory? |
TRUE:
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During which phase of gait would the therapist assist by triggering medial HS and anterior tib?
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-At toe off and through swing phase
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What would you trigger during initial contact and stance? (2)
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-Quadriceps tendon
-achilies? |
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A patient who has no motor or sensory below the level of lesion would be ASIA ___?
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-A
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What is the Key difference between ASIA C & ASIA D?
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-ASIA C has less than 1/2 of major muscles while ASIA D has greater than 1/2
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Does the change from ASIA levels indicate an improved potential for recovery?
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-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. |
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Distance gains were greatest with _______________ training?
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-OVERGROUND
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What type of innervation is used to URINATE, DEFICATE, & SEX?
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-Parasympathetics
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What are the two phases of normal bladder function?
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-filling
-voiding |
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Lesions of the CONUS MEDULLARIS cause ___________ bladder.
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FLACCID
-non reflex LMN -due to flaccidity, trouble with voiding urine is noted |
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Frequent and rapid voiding is caused by an UMN lesion is known as a ___________ _______________.
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Spastic bladder / REFLEXIVE
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What are the symptoms of HYPOreflexia/areflexia of the detrusor?
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-Stess incontinence with laughing and coughing.
-dribbling -high residual volume |
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How does a Detrusor-Sphincter dyssynergia present?
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-Both the detrusor and external sphincter are spastic. Both contract simultaneously and little urine can come out.
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Cystography is ??
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radiograph with the bladder filled with a contract medium
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What causes hydronephrosis?
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-Obstruction of any part of the urinary tract causing kidneys to swell
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Describe Vesicoureteral reflux?
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Backflow of urine back into the ureters and into the kidneys
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How does SCI affect giving birth in women?
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-Increase risk of UTI
-High risk of Autonomic Dysreflexia -Pressure Sores -C-Section frequently required |
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T or F:
The ability for men to be fertile and produce children is affected after SCI? |
TRUE:
-Higher % of dead sperm or less mobile (why??) -Increased difficulty with ejaculation |
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___________ ________________ _______________ uses vibration to induce ejaculation in men with a SCI
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Penile Vibratory Stimulation (PVS)
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What is one common risk with both Penile vibration and rectal probes to induce ejaculation?
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-The risk of inducing autonomic Dysreflexia
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T or F:
Both men and women experience the same type of orgasm both pre and post SCI? |
FALSE:
-While women typically experience the same type of orgasm, men do not. -The is due to sensory loss |
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What are two sexual aids for men?
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-Viagra
-Pumps |
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Which of the two types of erection is a result of direct stimulation to the genital area?
a) Reflexogenic erection b) Psychogenic erection |
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 |
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Penile/Clitoral erection is a result of which nervous system?
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-Parasympathetic
-Pelvic Nerve |
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The sympathetic nervous system is never good because ?
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it causes you to lose an erection.
"whiskey dick" |
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Upon arousal, Both men and women experience a __________ in HR, BP and RR?
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-INCREASE
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Which muscle pulls the rectum superior and forward, in essence, closing it off?
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-Puborectalis muscle
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What is the purpose of the Intrinsic nervous system in relationship to bowel mobility?
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-Coordinates colonic wall movement and advancement of stool through the colon.
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The sympathetic nervous system is "fight or flight", therefore it is responsible for ________________ the colon.
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-RELAXING
-you cant poop when you are fighting DUH |
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A diagram
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pic
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What three things work together to keep you from pooping?
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-Internal Anal Sphincter
-External Anal Sphincter -Puborectalis muscle |
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Which sphincter can we control to prevent pooping with coughing?
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-External anal sphincter
striated muscle continuous with pelvic floor; proximal to anus. |
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If in doubt with Pee, Poop or Sex, which spinal cord segments do you guess?
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-S2-S4
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Internal Anal sphincter is activated but what?
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Stretch receptors in the Anal canal
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Damage to an UMN can result in what type of bowel?
|
-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 |
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A lesion directly do the ___________________ ________________ will result in a flaccid/areflexic bowel?
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-Conus Medullaris
-may cause fecal incontinence and slowed bowel motility |
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What type of pharmacological treatment may be used to increase motility? (basic)
|
-Colonic Stimulants
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What type of pharmacological treatment may be used for a patient with spastic bowel syndrome? (basic)
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-Stool softners
-Assistive techniques: Valsalva maneuvers, push-ups, abdominal massage, leaning forward |
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A patient with a flaccid bowel syndrome may require what?
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-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. |
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A successful bowel program follows the S.E.L.F. model?
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S: Schedule
E: Exercise L: Liquids F: Food |
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How much liquid intake is given for a successful SELF program?
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-8-9 (8oz) glasses to prevent constipation.
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What type of food is recommended for a patient with SCI?
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-Foods high in fiber
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Chart
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Chart 2
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Chart 3
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