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Neuro II Exam 2
SCI notes
175
Health Care
Graduate
11/02/2012

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Cards

Term
mm to keep long (5)
Definition
elbow flexors, GH flexors, GH ERs, wrist flexors, hamstrings
Term
mm to keep short (2)
Definition
thoracolumbar fascia, finger flexors
Term
SCI demographics (3)
Definition
M>F, avg age 30, common age 19
Term
SCI avg acute stay
Definition
15 days
Term
SCI avg rehab stay
Definition
44 days
Term
spinal regional anatomy includes: (4)
Definition
spinal cord,
dorsal/ventral nn roots,
spinal nn,
meninges
Term
vertebra levels & numbers (e.g. C-7)
Definition
C-7
T-12
L-5
S-5
Ccx-4
Term
Order of structures leaving spinal cord (4)
Definition
rootlets,
roots,
spinal nn,
primary rami
Term
Spinal nerve (4)
Definition
- formed by joining of dorsal & ventral roots
- very short
- divide to become rami
- carry all sensory/motor axons connecting c single CORD SEGMENT
Term
Naming spinal nerves relative to vertebrae:
C-spine
Other
Definition
Cspin: named for inf vert
Other: named for sup vert
Term
Dorsal rami innervate (3)
Definition
paravertebral mm
post vertebrae
overlying skin
Term
Ventral rami innervate
Definition
skeletal, muscular, cutaneous areas of limbs & lat trunk
Term
Sympathetic nn cell bodies located...
Definition
in lateral horn (thoracolumbar region)
Term
Embryonic germ layers (3)
Definition
ectoderm,
mesoderm,
endoderm
Term
Ectoderm >> (3)
Definition
nervous system,
epidermis,
sensory organs
Term
Mesoderm >> (7)
Definition
mm,
bone,
tendon,
cartilage,
dermis,
excretory system,
circulatory system
Term
Endoderm >> (4)
Definition
gut,
liver,
pancreas,
lungs
Term
Mesodermal columns >> (3)
Definition
dermatome,
myotome,
sclerotome (bone, tendon, cartilage, capsule)
Term
Primary damage in SCI produced by...
Definition
disruption of cell bodies/axons by trauma
Term
Mechanisms of secondary damage in SCI (5)
Definition
ischemia,
inflammation,
disrupted ion concentrations,
accumulation of glutamate,
apoptosis
Term
Mechanisms of primary damage in SCI (3)
Definition
bruising by impingement from bony/soft tissues,
transection (rare),
damage to blood supply
Term
Length of secondary damage in SCI
Definition
days - 4 weeks
Term
Cell damage in spinal cord >>
Definition
release of substances to cause cascade of more damage
Term
necrosis due to 2º damage results in ____ shaped area of damage
Definition
spindle-shaped
Term
2º damage to cord can spread...
Definition
up and down several segments
Term
Causes of ischemia
Definition
interrupted arterial supply & resulting vasospasm (damaged cells release vasoconstrictive substances)
Term
how long until anoxia produces irreversible damage?
Definition
10-30 seconds
Term
Mechanism of damage by inflammation
Definition
damaged cells release WBC-attracting substances >>
phagocytize damaged tissue & release free radicals >>
damage cellular components (nucleic acids, phospholipids) >>
disrupted cell fxn

contribute to ion imbalance in tissue
Term
Mechanism of damage by ion derangement
Definition
membrane damage >> K out, Na in >>
...disruption of nn conduction
...influx of Ca >> Ca-dependent proteases >> cell death
Term
Mechanism of damage by accumulation of glutamate
Definition
glutamate facilitates Ca influx >> cell death
Term
What is glutamic acid's purpose? Where is it usually found?
Definition
major excitatory neurotransmitter in CNS,
present within synaptic cleft
Term
Mechanism of damage by apoptosis
Definition
"programmed cell death" or "intrinsic suicide mechanism";
normal during embryonic development,
unknown cause p CNS damage
Term
Duration of apoptosis p SCI
Definition
24 hr at injury site,
≥3 wk above/below injury site
Term
Diaschisis =
Definition
spinal shock: temporary disruption of the cord below the level of the lesion
Term
Functions lost 2º diaschisis (4)
Definition
all reflexes, sensory, voluntary motor, autonomic control
Term
Duration of diaschisis
Definition
24hr to 2 weeks (≤2mos)
Term
Reflex to determine presence of diaschisis
Definition
bulbocavernous reflex
Term
Spinal cord recovery - reflexes
Definition
return p diaschisis; do NOT require desc info to occur
Term
Spinal cord recovery - motor, sensory, autonomic
Definition
return p diaschisis IF neurons have survived
Term
Neurological return =
Definition
recovery of VOLUNTARY motor function or sensation
Term
Neurological return in incomplete; most (50-70% of 1yr recovery) occurs in...
Definition
1st 2 mos; slows p 3-6 mos.
Continues ≤2 yr.
Term
"Zone of injury" recovery
Definition
focusing on improving mm at <3/5 just below mm at 3/5
Term
Zone of injury recovery - faster recovering population
Definition
incompletes faster than completes
(2wk v 2mos)
Term
Mechanisms of Neurological return (2)
AND
which is more common?
Definition
nerve root return (more common),
cord return
Term
Mechanisms of cord return (6)
Definition
resolution of hemorrhage, ischemia, edema, inflammation, ion derangement;
relief of compression on cord;
neuron regeneration;
axon remyelination;
axon sprouting;
reactivation of "sleeping" neurons
Term
How long to wait before neuro exam for accuracy (2º to diaschisis)?
Definition
1 month post injury
Term
Positive suggestion of greater chance of motor return:
Definition
sacral sparing, motor fxn below lesion
Term
Level of injury defn:
Definition
most caudal level of sp cord that exhibits intact sensory/motor fxn bilat
Term
Determining motor spinal level
Definition
≥3/5, with 5/5 above (<5/5 ok if caused by non-SCI)
Term
C5 key mm
Definition
elbow flex
Term
C6 key mm
Definition
wrist ext
Term
C7 key mm
Definition
elbow ext
Term
C8 key mm
Definition
finger flex
Term
T1 key mm
Definition
finger abd
Term
L2 key mm
Definition
hip flex
Term
L3 key mm
Definition
knee ext
Term
L4 key mm
Definition
ankle DF
Term
L5 key mm
Definition
long toe ext
Term
S1 key mm
Definition
ankle PF
Term
How to test mm motor fxn c no testable myotome
Definition
Assume motor level = sensory level
Term
Oblique lesion designation
Definition
lowest normal level for each side (e.g. C6(R), C7(L))
Term
ASIA sensory scores (2, 1, 0)
Definition
2 = normal
1 = diminished
0 = absent
Term
Complete v. Incomplete
Definition
incomplete = function (motor or sensory) at S4-5 (able to feel finger in anus, and contract around finger)
Term
ASIA Impairment Scale: A
Definition
Complete: No sensory/motor in S4-5
Term
ASIA Impairment Scale: B
Definition
Incomplete: Sensory preserved below neurological level, incl S4-5
Term
ASIA Impairment Scale: C
Definition
Incomplete: Motor fxn preserved; >50% of key mm below level are <3/5
Term
ASIA Impairment Scale: D
Definition
Incomplete: Motor fxn preserved; ≥50% of key mm below level are ≥3/5
Term
ASIA Impairment Scale: E
Definition
Normal
Term
LMNL s/sx (2)
Definition
flaccid paralysis,
hyporeflexia
Term
UMNL s/sx (4)
Definition
spastic paralysis,
clonus,
hyperreflexia,
abnormal superficial reflexes
Term
Mechanism behind UMNL hyperactivity (3)
Definition
loss of inhibition,
loss of facilitation of GTO afferents,
hypersensitivity of neurons below lesion 2º to decr input
Term
SCI = UMNL or LMNL?
Definition
mixed UMNL/LMNL
Term
Problems 2º to loss of sensation (2)
Definition
discoordination,
vulnerability to injury
Term
Paradoxical breathing
Definition
paralysis of intercostals >>
upper ribs not fixated >>
diaphragm contraction pulls ribs down and in >>
chest diameter decr c inspiration
Term
SCI pts breathe more easily in which position?
Definition
supine
Term
Functional coughing: sound
Definition
loud, forceful
Term
Functional coughing: # coughs/exhalation
Definition
2+
Term
Functional coughing: independence
Definition
indep in resp clearance
Term
Weak functional coughing: sound
Definition
soft, less force
Term
Weak functional coughing: # coughs/exhalation
Definition
1
Term
Weak functional coughing: independence
Definition
indep for clearing throat, small amt of secretions
Term
Nonfunctional coughing: sound
Definition
sigh, throat clearing
Term
Nonfunctional coughing: # coughs/exhalation
Definition
no true cough
Term
Nonfunctional coughing: independence
Definition
assist needed for airway clearance
Term
Complications 2º to respiratory problems (3)
Definition
decr ventilation >> atelectasis;
fatigue & ventilatory failure 2º to weakness;
buildup of secretions, pneumonia 2º ineffective coughing
Term
Voluntary control of bowel/bladder supplied by:
Definition
sacral spinal cord
Term
Cardiovascular system controlled by vasomotor centers located in:
Definition
the medulla
Term
Vasomotor centers adjust sympa/parasympa outflow to heart to control (3)
Definition
BP,
HR,
distribution of blood flow
Term
Cell bodies of sympa:
Definition
lateral horns, T1-L2
Term
Cell bodies of parasympa:
Definition
brainstem
Term
parasympa transmitted via ____ nerve
Definition
vagus (CN X)
Term
Results of cord injury blocking medullary control of sympathetic outflow: (5)
Definition
bradycardia, bradyarrhythmias (no sympa left, just parasympa);
hypotension (vasodilation below lesion);
OH (sympa reflexive BP control is lost);
impaired response to exercise (decr cardiovascular reflexes below lesion);
L ventricular hypertrophy & decr endurance (decr venous return >> decr SV)
Term
Problematic level for sympa dysfunctions
Definition
injury above T6 (leaves many sympa segments s descending control)
Term
Timeframe for resolution of autonomic dysfunction
Definition
within a few weeks of injury
Term
Mechanism of resolution of autonomic dysfunction
Definition
compensatory decr in parasympa,
return of sympa reflexes
Term
Timeframe for resolution of cardiovascular response and venous return
Definition
N/A; do not return after injury
Term
Thermoregulation prob soon after injury
Definition
HYPOthermia (loss of sympa)
Term
Thermoregulation prob after return of tone
Definition
HYPERthermia (loss of ability to sweat below lesion)
Term
Genital innervation (regions)
Definition
thoracolumbar, sacral regions
Term
Fertility p SCI (by gender)
Definition
women = fertile,
men = infertile
Term
Brown-Sequard: dermatomal sensation loss
Definition
ipsilat
Term
Brown-Sequard: hyporeflexia, clonus
Definition
ipsilat
Term
Brown-Sequard: loss of kinesthesia, proprio, vibration
Definition
ipsilat
Term
Brown-Sequard: loss of pain/temp
Definition
contralat; begins several segments below level of lesion
Term
Spinothalamic decussation
Definition
ascends 2-4 segments before decussating
Term
Anterior cord syndrome mech of injury
Definition
flexion injury >> compression of ant cord or disruption of ant spinal artery
Term
Brown-Sequard mechanism of injury
Definition
hemisection: head rotated, rear-ended
Term
Anterior cord: loss of motor, pain/temp
Definition
bilat
Term
Brown-Sequard: ipsilat losses
Definition
dermatomal sensation,
hyporeflexia/clonus,
kinesthesia/proprio/vibration
Term
Brown-Sequard: contralat losses
Definition
pain/temp (several segments below lesion)
Term
Anterior cord syndrome: losses
Definition
motor, pain/temp bilat
Term
Anterior cord syndrome: functions maintained
Definition
kinesthesia, proprio, vibration (dorsal column)
Term
Central cord syndrome: mech of injury
Definition
hyperextension
Term
Central cord syndrome: affects which limbs most?
Definition
UEs (cervical tracts more central)
Term
Central cord syndrome: affects motor or sensory?
Definition
motor more than sensory
Term
Posterior cord syndrome: mech of injury
Definition
tabes dorsalis (syphilis; but very rare)
Term
Posterior cord syndrome: losses
Definition
proprio, kinesthesia, vibration;
develop wide-based gait pattern
Term
Cauda Equina syndrome: complete or incomplete?
Definition
incomplete
Term
Cauda Equina syndrome: LMNL or UMNL?
Definition
LMNL
Term
Reasons for lack of full regeneration p cauda equina injury (4)
Definition
large distance between lesion and end organ;
axon regeneration may not occur along original distribution;
glial cell-collagen scarring;
end organ lost fxn before reinnervation occurs
Term
Sacral tracts: central or lateral location?
Definition
lateral
Term
Clinical signs of sacral sparing (4)
Definition
perianal sensation,
rectal sphincter contraction,
cutaneous sensation in saddle region,
active contraction of toe flexors
Term
Most common cause of death in SCI pts
Definition
respiratory complications
Term
3 directions of thoracic expansion during inhalation
Definition
cephalocaudal (diaphragm contraction),
AP ("pump handle" of upper rib elev),
lateral ("bucket handle" of lower rib elev)
Term
Primary mm of forced exhalation
Definition
abdominals
Term
Secondary mm of forced exhalation
Definition
intercostals
Term
Stages of coughing (4)
Definition
maximal inspiration >>
glottis closure >>
contraction of mm of forced expiration against closed glottis >>
glottis opening c continued forceful expiration
Term
Paradoxical breathing usually ______ with time (following injury) secondary to ______ in intercostals
Definition
decreases;
increased tone
Term
Timeframe for rapid gains in ventilation
Definition
5 wks
Term
Reasons for improvement in ventilation post-injury (3)
Definition
decr in diaschisis >> incr tone in resp mm,
motor return,
incr stiffness of rib cage jts
Term
Reasons for deterioration of ventilation in first few days (3)
Definition
ascending lesion,
secretion accumulation,
vent mm fatigue
Term
Warning signs of ventilatory failure (3)
Definition
rapid, shallow breathing;
drop in VC (<15 mL/kg ideal BW),
drop in negative insp pressure (<20 cmH2O)
Term
CAH (respiration)
Definition
chronic alveolar hypoventilation
Term
CAH caused by (4)
Definition
aging,
obesity,
inactivity,
decr compliance of lungs/chest wall
Term
IPPV
Definition
intermittent positive pressure ventilator
Term
IPPV function
Definition
delivers set volume/pressure during inspiration;
exhalation passive
Term
Respiratory interventions (8)
Definition
teach diaphragmatic breathing,
teach upper chest breathing,
incr strength/endurance of resp mm,
incr ecc exhalation control,
glossopharyngeal breathing,
abdominal support in upright posture,
ventilator weaning,
clearing secretions
Term
Method of teaching diaphragmatic breathing
Definition
place object on abdomen; instruct patient to raise object
Term
Method of teaching upper chest breathing
Definition
place hands on upper chest; instruct pt to push against hands
Term
Method of incr strength/endurance of resp mm (2)
Definition
resistance at epigastric level (manual or weights),
inspiratory mm trainers
Term
Eccentric exhalation control exercise (and norm)
Definition
inhale maximally, say "ahh" for as long as possible;
fairly norm = 10-12 sec
Term
Early garments for Rx of OH
Definition
abdominal corset,
thigh-high antiembolism stockings
Term
Factors that complicate ventilator weaning (5)
Definition
resp/med complications,
preexisting resp conditions,
>50yo,
VC<1000,
hx of smoking
Term
Method of weaning (3)
Definition
disconnect vent for progressively longer periods,
teach resp mm program,
secretion management program
Term
Results of accumulation of secretions (3)
Definition
atelectasis,
pneumonia,
resp insufficiency
Term
Early techniques for secretion clearing (3)
Definition
postural drainage (percussion),
IPPB,
suctioning
Term
Other techniques for secretion clearing (6)
Definition
manually-assisted coughing,
mechanical insufflation-exsufflation,
self-cough,
position changes,
strengthening,
pt ed
Term
Pt Ed for clearing secretions (4)
Definition
potential complications (early signs, prevention),
techniques for secretion clearance,
HEP for strength/endurance of resp mm,
operation of home equipment
Term
OH defn (2)
Definition
decr ≥20mmHg systolic BP,
decr 10mmHg systolic & diastolic BP + pulse incr by 15bpm
Term
Causes of OH (6)
Definition
volume depletion,
venous pooling,
meds,
prolonged immobility,
sluggish normal regulatory mechanisms,
damage of nervous system (esp above T6)
Term
Preventing pressure sores: in bed, must be turned every...
Definition
every 2 hrs
Term
"Pressure reduction" v. "Pressure relief" surfaces
Definition
relief = reduces pressure below capillary closing pressure (no turning required)
Term
Specialized beds for pressure relief for stable spines (2)
Definition
low air loss bed,
air-fluidized bed
Term
Specialized beds for pressure relief for unstable spines
Definition
"rotating beds" or "oscillating support surface"
Term
Positioning to prevent pressure sores (3)
Definition
pillows where needed,
tip 30º back in sidelying,
keep HOB ≤30º
Term
W/C cushion - foam
Advantages:
Definition
light & inexpensive
Term
W/C cushion - foam
Disadvantages:
Definition
non-washable,
heat buildup
Term
W/C cushion - gel
Advantages:
Definition
best relief of shear
Term
W/C cushion - gel
Disadvantages:
Definition
heavy,
moisture buildup
Term
W/C cushion - air
Advantages:
Definition
good wt dist
Term
W/C cushion - air
Disadvantages:
Definition
easily punctured,
decr sitting stability
Term
W/C cushion - urethane honeycomb
Advantages:
Definition
light,
washable
Term
W/C cushion - urethane honeycomb
Disadvantages:
Definition
pressure relief ability not known
Term
Techniques for pressure relief (every 15-20 min)
(3)
Definition
sitting pushup,
wt shift,
power tilt/recline
Term
S/Sx of autonomic dysreflexia (excessive reaction of sympa to noxious stim)
(5)
Definition
sudden incr in BP,
bradycardia,
pounding HA,
diaphoresis above lesion,
anxiety

(also goosebumps, blurred vision, nasal congestion)
Term
Causes of autonomic dysreflexia (2)
Definition
loss of descending inhibition from medullary CV centers,
hypersensitivity of sympa neurons
Term
Common stimuli that provoke autonomic dysreflexia (8)
Definition
bladder/rectal distention,
UTI,
bowel impaction,
motion ex,
skin stim,
mm spasm,
pressure ulcer,
fx
Term
Timeframe for development of autonomic dysreflexia
Definition
6 mos p injury
Term
Rx for autonomic dysreflexia
Definition
medical emergency!

sit pt up & loosen clothing,
remove noxious stim (catheter tubing, rectal exam)
Term
S/Sx of PE (7)
Definition
immediate chest pain,
SOB,
tachycardia,
sweating,
apprehension,
fever,
cough
Term
frequent sites of HO (3)
Definition
hips, knees, elbows
Term
S/Sx of HO (5)
Definition
pain,
swelling,
erythema,
warmth,
restricted ROM in affected area
Term
Rx for HO (3)
Definition
ROM ex,
Meds to restrict bone growth,
Surgery to resect bone
Term
Causes for osteoporosis (not in spine)
(2)
Definition
venous stasis,
lack of WB/mm action
Term
Osteoporotic bone not visible on Xray until ____% bone loss
Definition
40%
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