Procedures 3

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Procedures 3
2013-01-23 22:17:29

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  1. SCI def
    trauma SCI occurs when an external force, causes stretching, bruising, laceration, or compression to the spinal cord
  2. Complete Injury
    • no motor or sensory function below the level o lesion and in S4, S5
    • caused by transection, compression, or vascular impairment
  3. Incomplete Injury
    partial preservation of sensory or motor function below the level of the lesion with S4, S5 intact
  4. Neurologic Level of Injury
    • may be different on L&R side of body
    • most caudal segment intact motor and sensory function (different from vertebral level)
  5. Motor Level Level of Injury
    • lowest key mms which grades at least F+
    • given all mm above are N
  6. Sensory Level of Injury
    the last nerve root at which sensation is normal
  7. Zone of Partial Preservation
    • some sensory or motor function(although deminished) below the neurological level since many mm have intervation from more than 1 spinal level
    • most caudal segment w some sensory or motor function
  8. Tetraplegia
    • cervical lesions to T1
    • spasticity, hypertonia, pathologic reflexes after spinal shock
  9. Paraplegia
    • thoracic and lumbar lesions
    • spasticity, hypertonia, pathologic reflexes after spinal shock
  10. Cauda Equnia Injuries
    • no longer the spinal cord, just peripheral nerves decending from it (PNI)
    • see flacciid paralysis, mm atrophy, absent reflexes
  11. Secondary Cascade of Destruction
    • edema of the cord compresses spinal tracts
    • myelin sheaths disintergrate
    • axons shrink
    • any bleeding damages cord and peripheral nerves: tissue necrosis
  12. Immediately after Injury 2nd damage to ANS
    • flaccidity
    • areflexia
    • loss of bowl/bladder function
    • decreased blood pressure
    • poor temp regulation
  13. Resolution of Shock
    • 24-48 hours after injury, possibly weeks
    • earlies return in sacral segments
    • flexor withdrawl
    • spasticity develops
    • difficult accurate neurological assessment during this time
  14. If posterior Aspect is damaged
    lose discrimative touch and prioprioception
  15. Brown Sequard Syndrome
    • ilpsilateral loss of motor function, prioprioception, and vibration
    • contralateral loss of pain and temperature few levels below injury
    • light togh-may or may not be preserved
  16. Brown Sequard Syndrome Prognosis
    many can perform ADLs and have bladder/bowl control
  17. Central Cord Syndrome
    • compression injury-involves bleeding into central part of spinal cord
    • UE's more than LE's
    • spinothalamic, dorsal columns, and corticospinal tracts tend to be damaged
    • happens most frequently in elderly
  18. Anterior Cord Syndrome
    • Damage to all except dorsal columns
    • often occurs secondary to fracture/dislocation
    • disruption of ant spinal artery
    • retention of propriorecption
  19. ACS Prognosis
    if complete injury motor function will be lost
  20. Cauda Equina Syndrome
    • results from direct trauma with fx dislocation
    • injury at lumbosacral nerve roots within neuro canal
    • possible nerve regeneration if the damag is in the PNR
  21. PNR injury
    • may regenerate bc not CNS
    • flaccid paralyss to mm that it was supplying
  22. SCI Body Systm Impairments
    • paralysis or paresis of skeletal mm
    • sensory loss
    • respiratory impairments
    • impaired temp regulation
    • autonomic dysreflexia/hyperreflexia
    • spasticity
    • bowl and bladder dysfunction
    • sexual dysfunction
    • pain
  23. Impairments depend on
    • complete or incomplete
    • level
    • side
    • CNS, LMN, UMN
    • any change in inflammation
    • and time since injury
  24. Respiratory Impairments from SCI
    • Phrenic nerve C3-C5
    • external and internal intercostals assist respiration
    • T10 to have 100% vital capacity
    • upper and lower abdominals assist breathing
    • susceptible to pneumonia
  25. Autonomic Dysreflexia
    • inability to convey impulses to regulate vasomotor responses to stimuli
    • occurs in lesions above T6
    • considered a medical emergency
  26. Onset of Autonomic Dysreflexia
    acute onset secondary to noxious stimuli below level of injury
  27. Causes of Autonomic Dysreflexia
    • bladder and rectal distention
    • pressure sores
    • urinary stones
    • urethral irritation
    • passive stretching of hamstrings
  28. Symptoms of Autonomic Dysreflexia
    • hypertension
    • heacache
    • brachycardia, tachycardia
    • blurred vision
    • restlessness
    • flushed or patchy redness
    • diaphoresis
  29. Autonomic Dysreflexia may lead to
    • CVA
    • renal failure
    • retinal hemorrage
    • death!
  30. Spacitiy
    • can sometimes aid pt: improve bowl control, prevent venous pooling, and transfers
    • may use medications-baclofen
    • usually cervical and incomplete injuries
  31. Bladder Dysfunction
    bladder innervated by S2-S4
  32. Neurogenic bladder
    • injury above S2(cord)
    • reflex are  intact- bladder empties w certain amount of pressure
    • pt can assist
  33. Non-reflexive bladder
    • injury are conus medullaris or cauda equina
    • bladder is flaccid
  34. Traumatic Pain
    • maybe d/t fx, ligamentous or soft tissue damage, mm spasm, or sugery
    • subsides in1-3 months
    • immobilization, analgesics or TENS
  35. Musculoskeletal Pain
    • frequently involves shoulders and wrist
    • d/t bad positioning, poor ROM, or overuse
    • describes as dull, achy, movement related
    • stress prevention
    • achieve full ROM
    • use pillow to position
  36. Neuropathic Pain
    • damaged nerves near site of injury
    • described as sharp, stabbing, burning, shooting
    • compression or tearing of nerve roots, spinal instability, scar tissue, and adheasions
  37. Compensitory Pain
    pain caused by movements for function that hurt another aread d/t dysfunctional movement
  38. Spinal Cord Dysesthesia
    • painful sensations below level of injury
    • burning, numbness, pins/needles, tingling
    • abnormal proprioreceptors
    • usually subsides, may persist in cauda equina
    • hangle limbs gently, position properly
  39. 2nd SCI Impairments
    • pressure ulcers
    • postural hypotension
    • contractures
    • heterotopic ossification
    • osteoprosis
    • DVT