Term
|
Definition
elbow flexors, GH flexors, GH ERs, wrist flexors, hamstrings |
|
|
Term
|
Definition
thoracolumbar fascia, finger flexors |
|
|
Term
|
Definition
M>F, avg age 30, common age 19 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
Term
Order of structures leaving spinal cord (4) |
|
Definition
rootlets, roots, spinal nn, primary rami |
|
|
Term
|
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
|
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
|
Definition
nervous system, epidermis, sensory organs |
|
|
Term
|
Definition
mm, bone, tendon, cartilage, dermis, excretory system, circulatory system |
|
|
Term
|
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
|
|
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
|
|
Term
2º damage to cord can spread... |
|
Definition
up and down several segments |
|
|
Term
|
Definition
interrupted arterial supply & resulting vasospasm (damaged cells release vasoconstrictive substances) |
|
|
Term
how long until anoxia produces irreversible damage? |
|
Definition
|
|
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
|
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
|
Definition
|
|
Term
Reflex to determine presence of diaschisis |
|
Definition
|
|
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
|
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
|
|
Term
Positive suggestion of greater chance of motor return: |
|
Definition
sacral sparing, motor fxn below lesion |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
Definition
incomplete = function (motor or sensory) at S4-5 (able to feel finger in anus, and contract around finger) |
|
|
Term
|
Definition
Complete: No sensory/motor in S4-5 |
|
|
Term
|
Definition
Incomplete: Sensory preserved below neurological level, incl S4-5 |
|
|
Term
|
Definition
Incomplete: Motor fxn preserved; >50% of key mm below level are <3/5 |
|
|
Term
|
Definition
Incomplete: Motor fxn preserved; ≥50% of key mm below level are ≥3/5 |
|
|
Term
|
Definition
|
|
Term
|
Definition
flaccid paralysis, hyporeflexia |
|
|
Term
|
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
|
Definition
|
|
Term
Problems 2º to loss of sensation (2) |
|
Definition
discoordination, vulnerability to injury |
|
|
Term
|
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
|
|
Term
Functional coughing: sound |
|
Definition
|
|
Term
Functional coughing: # coughs/exhalation |
|
Definition
|
|
Term
Functional coughing: independence |
|
Definition
|
|
Term
Weak functional coughing: sound |
|
Definition
|
|
Term
Weak functional coughing: # coughs/exhalation |
|
Definition
|
|
Term
Weak functional coughing: independence |
|
Definition
indep for clearing throat, small amt of secretions |
|
|
Term
Nonfunctional coughing: sound |
|
Definition
|
|
Term
Nonfunctional coughing: # coughs/exhalation |
|
Definition
|
|
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
|
|
Term
Cardiovascular system controlled by vasomotor centers located in: |
|
Definition
|
|
Term
Vasomotor centers adjust sympa/parasympa outflow to heart to control (3) |
|
Definition
BP, HR, distribution of blood flow |
|
|
Term
|
Definition
|
|
Term
Cell bodies of parasympa: |
|
Definition
|
|
Term
parasympa transmitted via ____ nerve |
|
Definition
|
|
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
|
|
Term
Brown-Sequard: hyporeflexia, clonus |
|
Definition
|
|
Term
Brown-Sequard: loss of kinesthesia, proprio, vibration |
|
Definition
|
|
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
|
|
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
|
|
Term
Anterior cord syndrome: functions maintained |
|
Definition
kinesthesia, proprio, vibration (dorsal column) |
|
|
Term
Central cord syndrome: mech of injury |
|
Definition
|
|
Term
Central cord syndrome: affects which limbs most? |
|
Definition
UEs (cervical tracts more central) |
|
|
Term
Central cord syndrome: affects motor or sensory? |
|
Definition
|
|
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
|
|
Term
Cauda Equina syndrome: LMNL or UMNL? |
|
Definition
|
|
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
|
|
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
|
|
Term
Secondary mm of forced exhalation |
|
Definition
|
|
Term
|
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
|
|
Term
Timeframe for rapid gains in ventilation |
|
Definition
|
|
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
|
Definition
chronic alveolar hypoventilation |
|
|
Term
|
Definition
aging, obesity, inactivity, decr compliance of lungs/chest wall |
|
|
Term
|
Definition
intermittent positive pressure ventilator |
|
|
Term
|
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
|
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
|
Definition
decr ≥20mmHg systolic BP, decr 10mmHg systolic & diastolic BP + pulse incr by 15bpm |
|
|
Term
|
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
|
|
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
|
|
Term
W/C cushion - foam Disadvantages: |
|
Definition
non-washable, heat buildup |
|
|
Term
W/C cushion - gel Advantages: |
|
Definition
|
|
Term
W/C cushion - gel Disadvantages: |
|
Definition
|
|
Term
W/C cushion - air Advantages: |
|
Definition
|
|
Term
W/C cushion - air Disadvantages: |
|
Definition
easily punctured, decr sitting stability |
|
|
Term
W/C cushion - urethane honeycomb Advantages: |
|
Definition
|
|
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
|
|
Term
Rx for autonomic dysreflexia |
|
Definition
medical emergency!
sit pt up & loosen clothing, remove noxious stim (catheter tubing, rectal exam) |
|
|
Term
|
Definition
immediate chest pain, SOB, tachycardia, sweating, apprehension, fever, cough |
|
|
Term
|
Definition
|
|
Term
|
Definition
pain, swelling, erythema, warmth, restricted ROM in affected area |
|
|
Term
|
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
|
|