Clin med 22

AD

100

Increased systolic BP by 40 mmHg or more above baseline (>150 mmHg) 

Autonomic dysreflexia 

200

In autonomic dysreflexia, ________ response occurs above the NLI

Parasympathetic (bradycardia and vasodilation) 

300

In autonomic dysreflexia, ________ response continues below the NLI 

Sympathetic 

400

Autonomic dysreflexia happens at which spinal level

T6 and above

500

The two major players in autonomic dysreflexia 

1. T6 and above 

2. Noxious stimulus below the NLI 

AD

100

Main s/s of autonomic dysreflexia 

Severe headache 

200

Can begin anytime within the first year; always after spinal shock clears; triggers sympathetic reflex to the intermediolateral grey columns; lack of compensatory descending medullary parasympathetic response (vagal N); generalized vasoconstriction occurs 

Autonomic dysreflexia 

300

What to do first during autonomic dysreflexia 

SIT THE PATIENT UP

400

After sitting the patient up during AD, what are the next steps 

1. sit the patient up

2. remove restrictive clothing 

3. find the trigger

4. if it doesn't clear, call 911 

500

What can happen if autonomic dysreflexia does not clear 

Can lead to stroke, death 

Myelomeningocele: functional mobility SB

100

What will the patient look like once they have been relieved of AD

Patient will relax, stop sweating, HA will disappear and patient will be exhausted 

200

Critical motor function: No LE movement 

bracing: standing brace or equipment 

Function: supported sitting 

< T10

300

motor: quadriceps, medial hamstrings, anterior tibialis 

bracing: KAFOs, crutches, floor reaction, AFOs twister cables

function: household and short community ambulation, wheelchair long distances 

L3-L4

400

motor: lateral hamstring, peroneals 

bracing: usually no AFOs or upper limb support 

function: community ambulation 

S1

500

motor: mild intrinsic foot weakness

bracing: possible crutch or cane with increased age 

function: community ambulation 

S2-3

Types of SB

100

Neural tube did not close entirely, meninges and nervous tissue protrude through defect 

SB with myeloschisis 

200

Least severe; typically L5-S1; meninges do not protrude through the defect; tuft of hair or dimple in the back 

SB occulta 

300

Meninges and SC protrude through the defect 

SB with myelomeningocele 

400

Meninges protrude through the defect, typically lumbar (dont necessarily have neurological tissue coming out) 

SB cystica/meningocele 

500

Common comorbidity with spina bifida 

Hip dislocation 

Myelomeningocele: functional mobility SB

100

motor: strong trunk, no LE movement 

bracing: HKAFO's, sometimes with thoracic corset 

function: sliding board transfers, good sitting balance, therapeutic ambulation, independent wheelchair mobility 

T12 

200

Neural tube disorder; vitamin deficiency, genetics, teratogens; failure of the vertebral arches to fuse in midline 

Spina bifida 

300

motor: unopposed hip flexion, some adduction

bracing: standing brace or equipment; HKAFOs, KAFOs or RGOs; crutches once ambulating with walker 

function: household ambulation; may community ambulate if motivated 

L1-L2

400

motor: weak toe activity 

bracing: KAFOs, crutches, floor reaction, AFOs

function: household and short community ambulation, wheelchair for long distances 

L5

500

Other systems involved with spina bifida

Respiratory, integumentary, musculoskeletal