3A: Examination Flashcards
What are four things to look for during a chart review?
- AIS score and LOI
- Primary and secondary complications
- Other injuries
- Previous rehab record
What are the three types of orthopedic precautions to be aware of?
- Spinal
- Osteoporosis
- Overuse shoulder injuries
What timeframe will you normally see orthopedic precautions?
Acute and early rehab - 6-12 weeks
What are the precautions for cervical LOI?
- Shoulder < 90 until spine stabilized
- Avoid strong shoulder muscle contractions
What are the precautions for lumbar LOI?
- Hip flexion < 90
- SLR < 60
- Avoid strong hip muscle contractions
What blood pressure precautions should you be cautious of?
Orthostatic hypotension and autonomic dysreflexia
What is the WISCI II?
Walking Index for SCI
What does the WISCI II assess?
AD, orthoses, and assistance pt requires to walk 10 m
How is the WISCI II scored?
0 = unable to stand/participate
20 = ambulates with no assistance
What is the SCIM-III?
Observation based comprehensive functional assessment tool designed specifically for individuals with SC lesions
What are examples of items included on the SCIM-III?
Self-care, breathing, coughing, bowel and bladder management, bed mobility, pressure relief, transfers, mobility, stair negotiation
How does the SCIM-III compare to the FIM?
SCIM-III is more sensitive than FIM to functional changes
What are four considerations for neuromuscular testing?
- Substitutions
- Inability to stabilize
- Increased tone
- Document alternate test positions
What are the key ASIA UE muscle groups?
- Elbow flexors
- Wrist extensors
- Elbow extensors
- Finger flexors
- Finger abductors
What are the key ASIA LE muscle groups?
- Hip flexors
- Knee extensors
- Ankle DF
- Great toe extensors
- Ankle PF
What are the functionally relevant UE muscles?
- Deltoids
- Serratus anterior
- Lat
What are the functionally relevant LE muscles?
- Hip extensors
- Abductors
- Adductors
- Hamstrings
What tool should you use to assess tone?
Modified Ashworth Scale
Why should you screen for cognitive deficits?
60% of people with traumatic SCI have TBI
What ROMs are important to maintain?
- Need increased shoulder ROM
- Hamstring length for full hip extension
- Hip extension
- Dorsiflexion
What ranges should you work to preserve tightness of?
Tenodesis grip and lumbar fascia
What muscle groups are most common sites of contractures?
Hip IR, hip adductors, shoulder flexors and extensors, IR, ADD, elbow flexion
What are the seven exam components to assess respiration?
- Ventilatory muscle strength
- Chest mobility and breathing pattern
- RR
- Coughing ability
- Posture
- Breath support for speech
- Pulmonary function testing
What is the most significant determinant of breathing and coughing ability after SCI?
Innervation of muscles of ventilation
How do you assess muscles of ventilation if the spine is stable?
Assess both accessory muscles and abdominals
How do you assess diaphragmatic function?
Observe abdomen motion during breathing
Why is it important to assess trunk and UE muscles when considering respiratory function?
- Postural support
- Self-cough
- Trunk and shoulder motions can improve ventilation
What is the pt position to assess breathing patterns?
Need to observe and palpate in both supine and sitting
How do you assess a pt’s breathing pattern?
Motions of the abdomen and chest as well as contractions of neck accessory muscles
How do you assess for chest excursion and mobility during respiration?
Measure expansion during inhalation in supine
What is normal chest excursion with respiration?
2.5 - 3”
What is the normal RR?
12-20 bpm
What is a functional cough and its functional significance?
- Loud and forceful (2+)
- Independent secretion clearance
What is a weak functional cough and its functional significance?
- Soft, less forceful
- Independent of clearing throat and small amount of secretions, assistance needed for larger amounts
What is a nonfunctional cough and its functional significance?
- Sigh, throat clearing - no true cough
- Assistance needed for airway clearance
What positions make breathing more difficult?
- Posterior pelvic tilt
- Thoracic kyphosis
- Forward shoulders
- Forward head
How do you assess breath support for speech?
Pt inhales maximally and then says ah for as long as possible
What is indicated with better inspiratory capacity and eccentric control of inspiratory muscles?
Increased phonation for longer time with single breath
How do you assess pulmonary function?
- Vital capacity with spirometer
- Max negative inspiratory pressure
- FEV1
How do you assess for aerobic capacity and endurance?
Physiologic response to position change and activity, monitor vitals
What are six things to consider when assessing the skin?
- Edema
- Pliability
- Scar formation
- Skin color
- Temperature
- Wound assessment
How do you observe pliability?
Redness, discoloration, blisters, cracks, rashes, scabs, areas that are dry, raised, or shiny
How do you palpate for pliability?
Skin temperature changes can be indicative of hyperemic reaction
What are risk factors for pressure injuries?
CV disease, DM, UTI, pulmonary disease, renal disease, nutrition, psychosocial
What are two tools to measure skin integrity and risk factors?
- Braden Scale
- SCIPUS (SCI pressure ulcer scale)
What are the 7 key areas of the skin to assess when in supine?
- Occiput
- Scap
- Vertebrae
- Elbows
- Sacrum
- Coccyx
- Heels
What are the 6 key areas of the skin to assess when prone?
- Ears
- Anterior shoulders
- Iliac crest
- Male genitals
- Patella
- Dorsum of feet
What are the 7 keys areas of the skin to assess when sidelying?
- Ears
- Shoulders
- Greater trochanter
- Fib head
- Knees
- Lateral malleolus
- Medial malleolus from contact with other foot
What is included in a wheelchair assessment?
- Footrest height
- Backrest height and angle
- Armrest height
- Axle position
- Wheel alignment
- Tire pressure
What is included in an orthotics assessment?
- Adjustability
- Weight
- Skin
- Durability
- Ease of donning and doffing
-Cosmesis, cost, funding
What should be considered when a child with SCI is transitioning to adulthood?
- Require ongoing examination
- Update expected outcomes
- Seen 2-3x year
- Consider changes in ROM, strength, sensation, spasticity
What determines expected functional outcomes?
Level and completeness of injury
What is the the prognosis of recovering 1 level of motor function with a complete injury?
67%
What is the prognosis of recovering 2 levels of motor function with a complete injury?
16%
What is the prognosis of recovering 3 or more levels of motor function with a complete injury?
3%
What is the prognosis for an incomplete SCI?
Incomplete status is a good prognostic indicator of motor recovery
When does motor function generally plateau?
12-18 months after injury
