spinal cord injury 10

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Author:
shmvii
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205927
Filename:
spinal cord injury 10
Updated:
2013-03-08 21:27:25
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spinal cord injury
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spring 2013 rosen & karpatkin
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  1. pt w C1-3 injury - how's the respiration?
    • respirator dependent secondary to phrenic nerve involvement
    • can be respiratory free for short times w training of accessory muscles
  2. pt w C1-3 injury - how's the facial muscles?
    intact
  3. pt w C1-3 injury - if tracheostomy (surgical construction of a respiratory opening in airway) is required, what's a major goal?
    secretion management
  4. pt w C1-3 injury - how's the voice - limited by what?
    intact but limited by poor respiratory revserve (there'll be a limited number of words/syllables per expiration)
  5. pt w C1-3 injury - how're the adls, transfers, mobility? -- in one word - but also, how can this pt power a WC?
    • dependant
    • sip & puff (possible even when trach'd), or head control
  6. pt w C4 injury - how's the breathing
    not vent dependant (or may just use it at night), but still significantly at risk for espiratory compormise bc resp reserve is still very restricted
  7. pt w C4 injury - how's the head/neck mobility, and why?
    • can use head/neck for balance and mobility
    • trapezius & SCM are invervated
  8. apical breathing pattern
    using only the upper chest
  9. pt w C4 injury - how's pt w transfers & adls -- in one word
    dependant
  10. at what level injury does the shoulder shrug appear?
    C4
  11. highest level with limted self feeding, grooming, hygeine?
    C5
  12. pt w C5 injury - transfers?
    max A w sliding board (this is an improvement from the dependant status of higher injuries)
  13. pt w C5 injury - how's the shoulder?
    • reasonably functional -
    • can lift & manipulate light things,
    • has use of arms for balance & stability (can lock arms and put a hand out)
    • can be in a manual WC if wrists are splinted, but it's exhausting, so only for short distances
    • long dist - can use a toggle/joy-stick to control a powered WC
  14. the jist of what's innervated in C5
    partial innervation of most of the rotator cuff, shoulder muscles, arm flexors
  15. at what level does tenodesis kick in? why?
    • C6
    • be you now hoave ext carp radialis long & brev, putting the wrist in ext, so the stretched flexors handily curl the fingers into a grasping pos
  16. first level where you get indep transfers?
    C6 .. well, somewhat indep, and has "improved" function in ADLs
  17. level where you get full scap muscles, RC, sternal pec, lat dorsi
    C6
  18. what level gives you protraction?
    C6 - bc now you have serratus ant and pec major -- this lets pt position the arm in a way that makes up for loss of triceps - kinda mimics extension?
  19. what level gives you triceps?
    C7
  20. C7 gives what muscular additions, in basic terms?
    • triceps
    • finger extensors
    • wrist flexors
  21. first level where pt can def live indep, w HHA just a few hours a few times a week?
    C7 - good for indep transfers, bed mob, WC mob, and most ADLs if in an adapted env w good ADs
  22. C8-T1 SCi - describe UEs, amb, WC
    • full UE innervation, including hand intrinsics
    • amb feasible w KAFOs
    • advanced WC skills, including wheelies
  23. classification of C8-T1
    • still a tetra
    • but w significant flexion in hands
  24. limitations still seen at C8-T1
    • LE
    • balance
    • respiration
  25. T1-T8 pts have segmental innervation of _ _ _
    • abs
    • intercostals
    • erector spinae

    these pts have improved respiration, trunk control, and balance as the levels go down, and moreso when you get to T9-T12
  26. T12 - name one important muscle that kicks in here, and what it does
    quadratus lumborum - hip hiker
  27. T9-T12 - how are these pts w using abs as hip flexors?
    can do it,but very high energy expenditure -- these pts may opt not to walk bc a WC is more efficient, leaves them w energy for rest of life
  28. L2 adds partial innervation of _ _
    adductors (gracilis) & rectus femoris
  29. what AD does an L2-3 pt need for amb?
    KAFO w walker or lofstrand (not axillary) crutches
  30. L3's big addition
    • quads - now pt can get into standing and the quads can be strengthened
    • stair climbing will remain a challenge til gluts come in at L5-S1
  31. L4 bring in partial innervation of _ _ _ _ _
    • hip abductors
    • hamstrings
    • peroneals/fibulars
    • hip ER
    • tib ant
  32. L5 bring in what? _ _
    partial innervation of glut max & EHL
  33. S1-2 give what?  _ _
    • foot intrinsics
    • gastroc/soleus
  34. S3-5 brings what?
    bowel & bladder motor
  35. gracilis nerve, root, action
    • (ant div of obturator)
    • L2-3
    • add hip, flex knee, IR
  36. tibialis posterior actions, nerve, root
    • stabilize, invert, help with PF
    • tibial n.
    • L5-S1
  37. tibialis anterior action, nerve, root
    • DF & inversion
    • deep fibular/peroneal nerve
    • L4-5
  38. fibularis/peroneus longus and brevis - act, n, root
    • eversion & PF
    • sup fibular/peroneal n
    • L5-S1

    the longus attaches higher and more medially
  39. C5 key action & muscles
    elbow flexion

    • biceps (musculocutaneous C5-6)
    • brachialis (musculocutaneous C5-6)
    • brachioradialis (radial C5-6)
  40. C6 key action & muscles
    wrist extension

    • extensor carpi radialis longus (radial C6-7)
    • and brevis too, though it comes in at 6.5 on the chart
  41. C7 key action & muscles
    elbow extension

    triceps (radial C7-8)
  42. C8 key action & muscles
    finger flexion

    flexor dig profundus (median C8, T1)

    • and?
    • flexor dig superficialis (median C7, C8, T1)
  43. T1 key action & muscles
    finger abd - use the pinky

    abductor digiti minimi (deep branch of ulnar n. C8-T1)

    dorsal interossei doesn't act on the pinky, only the 3 middle fingers
  44. L2 key action & muscles
    hip flexion

    iliopsoas (psoas major is innervated by L1-3 branches of lumbar plexus -- iliacus by femoral n L2-4
  45. L3 key action & muscles
    knee extension

    quads (femoral n. L2-4)
  46. L4 key action & muscles
    dorsiflexion

    tibialis anterior (deep fibular/peroneal nerve L4-5 -- maybe S1 too?)
  47. L5 key action & muscles
    extend big toe

    extensor hallucis longus (deep fibular nerve (L5-S1 -- maybe L4 too?)
  48. S1 key action & muscles
    PF

    • gastroc (tibial S1-2)
    • soleus (tibial S1-2)

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