3A: Examination Flashcards by Abbey Kowalski

What are four things to look for during a chart review?

AIS score and LOI
Primary and secondary complications
Other injuries
Previous rehab record

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What are the three types of orthopedic precautions to be aware of?

Spinal
Osteoporosis
Overuse shoulder injuries

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What timeframe will you normally see orthopedic precautions?

Acute and early rehab - 6-12 weeks

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What are the precautions for cervical LOI?

Shoulder < 90 until spine stabilized
Avoid strong shoulder muscle contractions

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What are the precautions for lumbar LOI?

Hip flexion < 90
SLR < 60
Avoid strong hip muscle contractions

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What blood pressure precautions should you be cautious of?

Orthostatic hypotension and autonomic dysreflexia

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What is the WISCI II?

Walking Index for SCI

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What does the WISCI II assess?

AD, orthoses, and assistance pt requires to walk 10 m

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How is the WISCI II scored?

0 = unable to stand/participate
20 = ambulates with no assistance

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What is the SCIM-III?

Observation based comprehensive functional assessment tool designed specifically for individuals with SC lesions

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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

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How does the SCIM-III compare to the FIM?

SCIM-III is more sensitive than FIM to functional changes

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What are four considerations for neuromuscular testing?

Substitutions
Inability to stabilize
Increased tone
Document alternate test positions

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What are the key ASIA UE muscle groups?

Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors
Finger abductors

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What are the key ASIA LE muscle groups?

Hip flexors
Knee extensors
Ankle DF
Great toe extensors
Ankle PF

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What are the functionally relevant UE muscles?

Deltoids
Serratus anterior
Lat

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What are the functionally relevant LE muscles?

Hip extensors
Abductors
Adductors
Hamstrings

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What tool should you use to assess tone?

Modified Ashworth Scale

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Why should you screen for cognitive deficits?

60% of people with traumatic SCI have TBI

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What ROMs are important to maintain?

Need increased shoulder ROM
Hamstring length for full hip extension
Hip extension
Dorsiflexion

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What ranges should you work to preserve tightness of?

Tenodesis grip and lumbar fascia

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What muscle groups are most common sites of contractures?

Hip IR, hip adductors, shoulder flexors and extensors, IR, ADD, elbow flexion

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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?

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