I Got A Stiffy
What are the three types of hypertonia
Rigidity, Spasticity, Dystonia
What are the types of SCIs?
Traumatic and Non-Traumatic
What is the pathology of GBS?
Demyelination of the peripheral nerves from an infection
Name 3 Causes of TBI
Falls, MVA, Assault, Struck by/against, unknown, other
What the three pain categories according to the IASP
Nociceptive, Neuropathic, Nociplastic
Name 3 Diagnoses that can lead to spasticity.
SCI, CP, MS, TBI, CVA
Name a spinal cord presentation/syndrome and give its presentation
Central Cord Syndrome, Anterior Cord Syndrome, Posterior Cord Syndrome, Brown Sequard Syndrome
Name 3 characteristics of GBS
Severe fatigue, symmetrical ascending weakness from distal LE to UE, numbness and tingling, tachycardia, postural hypotension, HTN, urinary retention, sensory loss, muscle ache with activity, severe burning, proximal muscle weakness
Name the 3 types of TBI
Direct Impact, acceleration-deceleration (coup-contra coup), shock wave
What is the molecule that mediates inflammation?
Substance P
Define Spasticity and determine what kind of lesion does it occur with (general)
Velocity dependent increase in tonic stretch reflex (increase muscle tone). UMN
Why are SCI survivors unable to receive/send signals at the level of injury?
A syrinx (fluid filled cavity in spinal cord), forms a barrier preventing reconnection of the damaged sides of the spinal cord.
What are the three phases of GBS and their duration
Initial: 1-3 weeks
Plateau: Several days-2 weeks
Recovery 4 mos-2 years
Name 3 secondary damage that occurs from TBIs.
Cell death, increased glutamate, mitochondrial dysfunction, excitotoxicity, brain blood barrier damage, cerebral edema, cerebral hypoxia, ROS generation, increased intracerebral pressure
What are 3 symptoms of Nociplastic pain and define them.
Allodynia- pain due to non-painful stimuli
Sensitivity- Increase response of pain receptor to low threshold of tactile stimuli
Hyperalgesia- Abnormal/increased pain from stimuli that provoke pain
What is the pathophysiology of spasticity?
The UMN cannot innervate the inhibitory interneuron leading to hyperexcitability of spinal reflexes.
Give 3 non-traumatic diagnoses that can cause a SCI
Transverse myelitis, acute intervertebral disc herniation, dural infections, aortic dissection, spinal epidural hematomas, spinal tumors, syphilis
What is the difference between chronic inflammatory demyelinating polyneuropathy
CIDP progresses slower (8 weeks), persist for years, doesn't involve the respiratory, and has relapses
What is the indicator for possible increasing brain damage after initially injury?
Increased microglial activity (specifically M1-type microglia)
What do you test for in central sensitization?
Name 3 treatments to reduce spasticity
Warm water/compresses, stretching, whole body vibration, constant pressure (air splint/ace wrap), aerobic exercise, TENS
Name the 5 areas of critical concern for the SCI team.
Cardiovascular hypotension, autonomic changes, bladder/bowel function, respiratory, skin integrity
What are 3 negative prognostic indicators for GBS
Older than 40, rapid rate of progression from onset (<7 days), severe muscle weakness, CN involvement (loss of eye movement and swallowing), Need a vent, Preceding diarrheal illness or cytomegalovirus, avg distal motor response amplitude reduction to less than 20% of normal.
You are seeing a patient in the hospital s/p MVA. While chart reviewing it reports the pt had a loss of consciousness for approximately 1.5 days but is now awake. When you walk into the room the patient is non-responsive to your voice but awakens to pain, curling up from it. As you converse with the pt, you have a hard time understanding what they are talking about as it feels erratic and random. Score and classify the TBI severity based off of the Glasgow Coma Scale.
9; Moderate TBI
What is the pathophysiology of central sensitization?
The dorsal horn has increased excitability, losing its gatekeeping function. Increased C-fiber and alpha-delta fiber input coupled w increased excitability leads to plastic change of dorsal horn.