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
|
|
