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SCI > 3A: Examination > Flashcards

3A: Examination Flashcards

1
Q

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

A
  1. AIS score and LOI
  2. Primary and secondary complications
  3. Other injuries
  4. Previous rehab record
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2
Q

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

A
  1. Spinal
  2. Osteoporosis
  3. Overuse shoulder injuries
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3
Q

What timeframe will you normally see orthopedic precautions?

A

Acute and early rehab - 6-12 weeks

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4
Q

What are the precautions for cervical LOI?

A
  • Shoulder < 90 until spine stabilized
  • Avoid strong shoulder muscle contractions
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5
Q

What are the precautions for lumbar LOI?

A
  • Hip flexion < 90
  • SLR < 60
  • Avoid strong hip muscle contractions
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6
Q

What blood pressure precautions should you be cautious of?

A

Orthostatic hypotension and autonomic dysreflexia

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7
Q

What is the WISCI II?

A

Walking Index for SCI

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8
Q

What does the WISCI II assess?

A

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

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9
Q

How is the WISCI II scored?

A

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

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10
Q

What is the SCIM-III?

A

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

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11
Q

What are examples of items included on the SCIM-III?

A

Self-care, breathing, coughing, bowel and bladder management, bed mobility, pressure relief, transfers, mobility, stair negotiation

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12
Q

How does the SCIM-III compare to the FIM?

A

SCIM-III is more sensitive than FIM to functional changes

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13
Q

What are four considerations for neuromuscular testing?

A
  • Substitutions
  • Inability to stabilize
  • Increased tone
  • Document alternate test positions
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14
Q

What are the key ASIA UE muscle groups?

A
  • Elbow flexors
  • Wrist extensors
  • Elbow extensors
  • Finger flexors
  • Finger abductors
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15
Q

What are the key ASIA LE muscle groups?

A
  • Hip flexors
  • Knee extensors
  • Ankle DF
  • Great toe extensors
  • Ankle PF
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16
Q

What are the functionally relevant UE muscles?

A
  • Deltoids
  • Serratus anterior
  • Lat
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17
Q

What are the functionally relevant LE muscles?

A
  • Hip extensors
  • Abductors
  • Adductors
  • Hamstrings
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18
Q

What tool should you use to assess tone?

A

Modified Ashworth Scale

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19
Q

Why should you screen for cognitive deficits?

A

60% of people with traumatic SCI have TBI

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20
Q

What ROMs are important to maintain?

A
  • Need increased shoulder ROM
  • Hamstring length for full hip extension
  • Hip extension
  • Dorsiflexion
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21
Q

What ranges should you work to preserve tightness of?

A

Tenodesis grip and lumbar fascia

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22
Q

What muscle groups are most common sites of contractures?

A

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

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23
Q

What are the seven exam components to assess respiration?

A
  • Ventilatory muscle strength
  • Chest mobility and breathing pattern
  • RR
  • Coughing ability
  • Posture
  • Breath support for speech
  • Pulmonary function testing
24
Q

What is the most significant determinant of breathing and coughing ability after SCI?

A

Innervation of muscles of ventilation

25
Q

How do you assess muscles of ventilation if the spine is stable?

A

Assess both accessory muscles and abdominals

26
Q

How do you assess diaphragmatic function?

A

Observe abdomen motion during breathing

27
Q

Why is it important to assess trunk and UE muscles when considering respiratory function?

A
  • Postural support
  • Self-cough
  • Trunk and shoulder motions can improve ventilation
28
Q

What is the pt position to assess breathing patterns?

A

Need to observe and palpate in both supine and sitting

29
Q

How do you assess a pt’s breathing pattern?

A

Motions of the abdomen and chest as well as contractions of neck accessory muscles

30
Q

How do you assess for chest excursion and mobility during respiration?

A

Measure expansion during inhalation in supine

31
Q

What is normal chest excursion with respiration?

A

2.5 - 3”

32
Q

What is the normal RR?

A

12-20 bpm

33
Q

What is a functional cough and its functional significance?

A
  • Loud and forceful (2+)
  • Independent secretion clearance
34
Q

What is a weak functional cough and its functional significance?

A
  • Soft, less forceful
  • Independent of clearing throat and small amount of secretions, assistance needed for larger amounts
35
Q

What is a nonfunctional cough and its functional significance?

A
  • Sigh, throat clearing - no true cough
  • Assistance needed for airway clearance
36
Q

What positions make breathing more difficult?

A
  • Posterior pelvic tilt
  • Thoracic kyphosis
  • Forward shoulders
  • Forward head
37
Q

How do you assess breath support for speech?

A

Pt inhales maximally and then says ah for as long as possible

38
Q

What is indicated with better inspiratory capacity and eccentric control of inspiratory muscles?

A

Increased phonation for longer time with single breath

39
Q

How do you assess pulmonary function?

A
  • Vital capacity with spirometer
  • Max negative inspiratory pressure
  • FEV1
40
Q

How do you assess for aerobic capacity and endurance?

A

Physiologic response to position change and activity, monitor vitals

41
Q

What are six things to consider when assessing the skin?

A
  • Edema
  • Pliability
  • Scar formation
  • Skin color
  • Temperature
  • Wound assessment
42
Q

How do you observe pliability?

A

Redness, discoloration, blisters, cracks, rashes, scabs, areas that are dry, raised, or shiny

43
Q

How do you palpate for pliability?

A

Skin temperature changes can be indicative of hyperemic reaction

44
Q

What are risk factors for pressure injuries?

A

CV disease, DM, UTI, pulmonary disease, renal disease, nutrition, psychosocial

45
Q

What are two tools to measure skin integrity and risk factors?

A
  • Braden Scale
  • SCIPUS (SCI pressure ulcer scale)
46
Q

What are the 7 key areas of the skin to assess when in supine?

A
  • Occiput
  • Scap
  • Vertebrae
  • Elbows
  • Sacrum
  • Coccyx
  • Heels
47
Q

What are the 6 key areas of the skin to assess when prone?

A
  • Ears
  • Anterior shoulders
  • Iliac crest
  • Male genitals
  • Patella
  • Dorsum of feet
48
Q

What are the 7 keys areas of the skin to assess when sidelying?

A
  • Ears
  • Shoulders
  • Greater trochanter
  • Fib head
  • Knees
  • Lateral malleolus
  • Medial malleolus from contact with other foot
49
Q

What is included in a wheelchair assessment?

A
  • Footrest height
  • Backrest height and angle
  • Armrest height
  • Axle position
  • Wheel alignment
  • Tire pressure
50
Q

What is included in an orthotics assessment?

A
  • Adjustability
  • Weight
  • Skin
  • Durability
  • Ease of donning and doffing
    -Cosmesis, cost, funding
51
Q

What should be considered when a child with SCI is transitioning to adulthood?

A
  • Require ongoing examination
  • Update expected outcomes
  • Seen 2-3x year
  • Consider changes in ROM, strength, sensation, spasticity
52
Q

What determines expected functional outcomes?

A

Level and completeness of injury

53
Q

What is the the prognosis of recovering 1 level of motor function with a complete injury?

A

67%

54
Q

What is the prognosis of recovering 2 levels of motor function with a complete injury?

A

16%

55
Q

What is the prognosis of recovering 3 or more levels of motor function with a complete injury?

A

3%

56
Q

What is the prognosis for an incomplete SCI?

A

Incomplete status is a good prognostic indicator of motor recovery

57
Q

When does motor function generally plateau?

A

12-18 months after injury

SCI (6 decks)

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