A client with a C8 spinal cord injury is working on independence with their bowel and bladder routine. Which of the following is the MOST appropriate recommendation?
Likely independent with digital stimulation and intermittent catheterization
A client with an incomplete SCI has intact sensation at S4-5 but no motor function below the injury. What ASIA classification is this?
B
Which spinal cord syndrome is characterized by loss of motor function, pain, and temperature sensation below the level of injury while preserving proprioception?
Anterior cord syndrome
What is the most common cause of death in individuals with a spinal cord injury?
Pneumonia
Which of the following describes a compensatory strategy for a client with reduced sensation in their hands?
Visual scanning and use of unaffected hand for temperature checks
A therapist is using silicone sheets and massage to manage a client’s scar formation after surgery. Which phase of healing is this most appropriate for?
Maturation
A client with a hand injury is unable to feel light touch but can detect deep pressure. How should this be documented?
Loss of protective sensation
Which phase of wound healing involves fibroplasia and new blood vessel growth?
Proliferative
What is the best way to document a client’s sensory function after
testing with
Semmes-Weinstein Monofilaments?
The smallest monofilament size detected
A client who describes pain as "a burning sensation that spreads down the arm" is most likely experiencing:
Neuropathic pain
Which of the following is NOT a typical sensory
assessment used in occupational
therapy?
Berg Balance Scale
At what level is bowel and bladder function affected?
Below S2 - S4
Hypotension: _/_ mmHG
90/60 mmHG
Normal: _/_ mmHG
120/80 mmHG
Hypertension: _/_ mmHG
130/80 mmHG
Semmes Weinstein Monofilaments
Green (1.65-2.83):
Normal; recognition of touch and deep pressure
Semmes Weinstein Monofilaments
Purple (3.84-4.31):
Diminished light touch; fair use of hand, intact temp/stereognosis
Semmes Weinstein Monofilaments
Red (4.56 & up):
Diminished protective sensation; difficult manipulating
objects, drops
objects, has temp and pain awareness
Semmes Weinstein Monofilaments
Red (no response to 6.65):
Loss of protective sensation; little hand use, reduced
temperature
appreciation, intact pressure, high risk of injury
Semmes Weinstein Monofilaments
Loss of all sensation
Moberg Pick-Up Test (Stereognosis)
Assesses hand dexterity and functional sensibility
Tested with
vision and with vision occluded
Vibration
Inability to sense may indicate nerve compression or
inadequate
sensory re-innervation
Desensitization
Start early- so long as no open wounds and there are
complaints of
hypersensitivity
- ◦Grade stimulus materials: fine ⇒ coarse
- Grade type
of contact, gentle to strong:
- passive touch -> moving rub ->tap
- Gradually increase force, duration, frequency of stimulus
- Immersive exploration in graded background
Specific Reeducation Protocols: Wynn-Parry & Dellon
- Mostly for PNI
- Stroke fingertips with static/moving
deep touch (pencil eraser)
- Alternating with/without vision
- When 256 cps vibration perceived
- Stimulate with varying textures/manipulate objects of
differing
sizes/textures
- Stimulate with varying textures/manipulate objects of
differing
Hyperalgesia
- Increased pain in response to a stimulus because of sensitized peripheral afferents
- bumping your shin on a coffee table at thelocation of a bruise (likely from the sametable)
Allodynia
- Perceiving innocuous stimuli as painful
- Putting on a shirt over a sunburn
Spontaneous pain
- Temporally distinct from an external stimulus; often appears to be unprovoked
- Often described as burning pain, shootingsensations, or electrical sensations
Temporal summation
- Perception of increased pain in response to a repeated or continued presence of a stimulus
- Increasing pain with each repetition of a therapeutic exercise
Secondary hyperalgesia
- “spread” of pain to adjacent, uninjured areas
- Entire finger is painful even though the paper cut is localized
CHRONIC PRIMARY PAIN
- Pain matrix dysfunction (central sensitization)
- Fibromyalgia
- Pain syndromes
- Complex regional pain syndrome
(CRPS) - Chronic non-specific low back pain
- Complex regional pain syndrome
CHRONIC SECONDARY PAIN
- Nociceptive
- Osteoarthritis
- Cancer pain
- Neuropathic
- Phantom pain
Chronic Secondary Pain Syndromes
- Arthritis
- Cancer
- Myofascial
- Traumatic injury
Neuropathic Pain Examples
PNI
Small fiber neuropathy
Amputation
Phantom pain
Mechanisms of Wound Healing
- Tissue regeneration
◦Regeneration of identical cells without loss of function - Tissue repair
◦Damaged tissue is replaced, but new tissue lacks the structure and function of the original tissue - Primary closure (skin)
◦Wound edges are in close proximity with little or not tissue loss
◦Think sutures - Secondary closure
◦Wounds heal through contraction & re-epithelialization