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

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

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