3.7 Goal Setting, Spinal Shock

Question 1

goal categories for ALL SCI patients

Answer 1

• ROM
• strength
• function/ADLs
• community reintegration/work
• education (paramount)
• cardiopulmonary
• adaptive equipment

Question 2

important aspects of educational goals

Answer 2

• complications that could arise
• ROM/strengthening (HEP)
• skincare

Question 3

major issues: acute care

Answer 3

• orthopedic injuries
• status after SCI
• work on upright sitting tolerance
• education

Question 4

education for an acute SCI pt

Answer 4

• neck/back brace
• breathing and heart (hugely important at beginning)
• can they educate other people (i.e. teach someone to transfer them)

Question 5

major issues: inpatient rehab

Answer 5

• How much can be done in the short time they have there
• Equipment
• What services will they be able to get in their home?
• Vehicle: ≥ 40,000 for a special van
• Tons of education for the family who will be taking care of them

Question 6

What may impact length of stay in an inpatient rehab setting?

Answer 6

usually stay longer at bigger centers

Question 7

inpatient rehab: equipment and home

Answer 7

• Home is a nightmare

- Many pts struggle because their house won’t work with their chair

Question 8

What would qualify a pt to go to one of the bigger SCI pts

Answer 8

need to be trying to get to move back home to get to go to one of the bigger centers like Shepherd

Question 9

major issues: in home rehab

Answer 9

• working on things in the home, more easily transferrable to their daily activities
• one on one, no team
• won’t be at the highest level of independence when they go home

Question 10

spinal shock

Answer 10

occurs after an SCI and the patient presents worse than what the neurological injury actually was

• happens with every spinal injury
• may have a C7 but present like a C5

Question 11

How long does spinal shock last?

Answer 11

• can take a while for it to go away

- weeks or a month or two

Question 12

Why does spinal shock happen?-

Answer 12

• body is trying to “wake up” from the injury

- don’t know if it’s a protective mechanism

Question 13

spinal shock and ASIA score

Answer 13

ASIA score will look a lot different until spasticity plateaus

Question 14

When should an ASIA score be done for a pt with spinal shock?

Answer 14

• wait for primitive reflexes to show up again before doing ASIA scoring (esp bulbocavernous and cremasteric)
• females: clitoral or catheter tug