4: Intervention Flashcards
1
Q
What is required for a pt to begin PT in the ICU?
A
Must be alert and stable, possibly surgical precautions
2
Q
What are key interventions in the ICU?
A
- Airway clearance
- Positioning
- Equipment
- Early mobility
- Acclimation to upright
3
Q
What are key interventions for inpatient rehab?
A
- Functional mobility, ADLs
- Discharge planning
- Prevent secondary complications
4
Q
What are the four methods of muscle substitution?
A
- Agnostic musculature (fascia)
- Gravity
- Tension in passive structures
- Fixation of distal extremity
5
Q
What is angular momentum?
A
Body segments with available motor function can be used to generate momentum to facilitate movement of denervated body segments
6
Q
What is the head-hips relationship?
A
Moving the head in one direction causes the hips to move in the opposite direction
7
Q
What are potential benefits of tone?
A
- Independent transfers
- Stability to maintain postures
- Compensatory strategies
8
Q
How often should UE strengthening be done in early rehab?
A
2-3 days per week
9
Q
What is the intensity of UE strengthening in early rehab?
A
60-80% of 1RM (10 reps to fatigue)
10
Q
What are acute strengthening contraindications for paraplegia?
A
Trunk and hip musculature
11
Q
What are acute strengthening contraindications for quadriplegia?
A
Scap and shoulder muscles
12
Q
Should you focus on unilateral or bilateral exercises and why?
A
Bilateral - avoid rotational stresses
13
Q
What is the ideal ROM in the low back and LE?
A
Low back = mild tightness
SLR = 110-120
Hip and knee extension = full
DF = 10 for ambulation
14
Q
What is the ideal ROM for UEs?
A
- Greater than normal shoulder extension and ER
- Supination for locking elbows
- Tenodesis
15
Q
Specific to pediatrics, what muscle groups should be stretched and why?
A
Hip adductors and flexors to reduce risk of dislocation and subluxation
16
Q
What ROM should be avoided in peds and why?
A
Hip adduction for hip integrity
17
Q
How is HO diagnosed and monitored?
A
DEXA
18
Q
What medications are indicated for HO?
A
Biphosphonates, NSAIDs
19
Q
What are interventions for HO?
A
Gentle ROM and exercise, surgery
20
Q
What are interventions for osteoporosis?
A
Biphosphonates, e-stim, early WB
21
Q
What are strategies to promote early WB?
A
Tilt table, standing frame, parapodium, mobile standers, body weight support treadmill
22
Q
Why is proper seating posture important?
A
Skin breakdown, overstretching prevention, scoliosis, kyphosis, forward head, pain reduction, improve respiratory function
23
Q
What is the benefit of bracing/splinting/casting?
A
Allows for healing and stabilization, reduce contractures, scoliosis, improve alignment
24
Q
What three pulmonary impairments need to be managed?
A
- Hypoventilation
- Secretion management
- Atelectasis
25
When is nasotracheal intubation used for ventilation?
Short-term in emergency situations
26
When is a tracheotomy used for ventilation, and what are its benefits?
Long-term use - promotes ease in eating, communication, secretion removal
27
What does IPPV stand for?
Intermittent Positive Pressure Ventilators
28
Describe a pressure controlled IPPV
Terminates inspiration when a predetermined pressure is reached
29
Describe a volume cycle ventilator IPPV?
Terminates inspiration when a predetermined amount of gas is delivered to the patient
30
What are modes for IPPV?
Control, assist control, synchronized intermittent mandatory ventilation, pressure control, pressure support, continuous positive airway pressure (CPAP)
31
What are additional methods for assisted ventilation?
- Intermittent abdominal pressure ventilator
- Negative pressure body ventilators
- Phrenic nerve stimulations/pacemakers
32
What is done if a ventilator fails?
Glossopharyngeal breathing or ambu bag with abdominal or lower rib compressions
33
What is glossopharyngeal breathing?
Technique to increase the volume of air being inhaled that uses the tongue and pharyngeal muscles to force air into the lungs with gulps
34
What are the impacts of respiratory muscle training?
Decreased risk of pulmonary infection and mortality
35
Is changing intensity or volume more effective when dosing respiratory muscle training?
Intensity
36
What are functional activities that require expiratory muscle training?
Blowing into instrument, straw, singing
37
What is the optimal sitting posture for respiration?
Erect trunk, scapular adduction, head and neck alignment, anterior pelvic tilt
38
Why is positional changing and out of bed activity important for respiration?
Aids in secretion mobilization
39
What is the purpose of an abdominal binder?
Used to support abdominal contents and position the diaphragm for optimal function
40
What are methods to assist with orientating to vertical?
- Gradual
- Abdominal binder, compression
- Vitals
- Medication
41
What medications can assist with orientation to vertical?
- Ephedrine, NaCL
- Low dose diuretics for edema
42
What LOI and timeframe is someone at risk for orthostatic hypotension?
Above T6 in the acute stages
43
What LOI and timeframe is someone at risk for autonomic dysreflecia?
Above T6, sub-acute or chronic
44
How do you respond to signs of orthostatic hypotension?
- Lower head, elevate legs
- Medical assist if severe and not resolving
45
How do you respond to signs of autonomic dysreflexia?
- Sit up, lower legs
- Loosen clothing
- Noxious stimuli
- Call for medical assistance
46
What are the parameters for endurance training for CV fitness?
20-30 minutes 3x/week at moderate intensity
47
How often should a pt perform pressure relief in a chair and in bed?
15-20 minutes in a chair
2 hours in bed
48
How often should the skin be inspected, and how long is it okay for redness to last?
At least once a day - no more than 30 minutes
49
What interventions are indicated for traumatic pain?
Analgesics, immobilization, TENS
50
What interventions are indicated for MSK pain?
- Prevention is key
- Positioning, ROM, equipment
- Anti-spasticity meds
51
What medications are used for spasticity?
Baclofen, Dantrolene, Diazepam, Tizanidine, anti-inflammatories
52
What interventions are indicated for visceral GI and bowel pain?
NG tube, prophylactic meds for GI stress, diet, antibiotics, mobilization, education
53
How do you treat neuropathic pain at the LOI?
- Anticonvulsants
- Antidepressants
- Analgesics
- TENS
- Surgery
54
How do you treat neuropathic pain below the LOI?
- Education
- Gentle handling
- Medications
55
How do you manage a reflexive bladder?
- Intermittent catheterization
- Train micturation reflex with tactile stimulation
56
How do you manage an areflexive bladder?
- Timed voiding program
- Manual pressure, valsalva
57
How do you manage a reflexive bowel?
- Suppositories
- Stimulation of sphincter
58
How do you manage an areflexive bowel?
- Manual pressure or evacuation
- Valsalva
- Suppositories
59
What is the PT role in bowel and bladder management?
Encourage compliance, education, enhance QOL, max physical skills for independence
60
What should be avoided with psychosocial interventions?
Medical model, dependence, negative attitude
61
What should you promote with psychosocial interventions?
Education model, independence, autonomy, positive attitude, social support, empowerment
62
What is FES cycling/rowing?
Used to minimize bone loss and aerobic conditioning
63
When should you implement FES cycling/rowing, and what should you be mindful of?
Early at a high frequency - beware of post-exercise hypotension
64
What are the parameters for FES cycling/rowing?
- 20-60 minutes, 3-5x/week
- 50-80% HR max
- 13-17 RPE
65
What is the purpose of epidural stimulators?
Neuromodulation therapy that enables lower limb voluntary movement
66
How does an epidural stimulator work?
Electrical currents on lower spinal cord stimulates nerves directly by bypassing brain to spinal cord pathways
67
What is needed for locomotor training?
Adequate strength, postural alignment, postural control, ROM, CV endurance
68
How can you compensate for hip extension for gait training?
Leaning into anterior ligaments of hip with the trunk extended to stabilize the trunk and pelvis
69
How do you compensate for decreased strength with locomotor training?
Forearm crutches
70
What gait pattern is most common with forearm crutches?
4-point swing through
71
What is the functional/recovery based approach to treatment?
Interventions to promote intrinsic ability of the nervous system to control rhythmical movement patterns and modulate sensory input into task specific motor output
72
What are the four components of the functional/recovery based approach?
1. Legs maximally loaded
2. Sensory cues
3. Coordination movements
4. Minimize compensatory strategies
73
What locomotor training techniques have good evidence?
Mod-high intensity gait training and VR
74
What locomotor training techniques have strong evidence against them?
BWSTT, robotic training, balance without VR
75
Are robotic devices better than walking programs or manually assisted BSWTT?
No
76
What is the benefit of robotics training?
Reduces assistance required from therapist
77
What % of people with SCI have shoulder pain?
30-70%
78
What are risk factors for shoulder pain?
Increased time since injury, age, higher LOI
79
What impairment does the STOMPS trial look at?
Shoulder pain
80
What are the five interventions in the STOMPS trial?
1. Stretching
2. Strengthening
3. Transfers
4. Wheelchair propulsion
5. Posture
81
What are the key results of the STOMPS trial?
- Increased strength
- Decreased pain, maintained at four weeks
- Improved QOL
82
What are the clinical implications from the STOMPS trail?
- Teaching transfer and wheelchair techniques
- Stretching and strengthening for scap and GH kinematics
- Modify if scap is not fully innervated
- Power mobility if pain persists
83
What is transmagnetic stimulation?
Stimulation of the cortex to enhance motor evoke potential of neurons
84
What are possible uses of transmagnetic stimulation?
- Evaluate motor evoked potentials
- Control neuropathic pain
- Spasticity
- Restore somatomotor function
- Reduce corticospinal inhibition
85
What are the two benefits of stem cell therapy?
- Reduce inflammation
- Promote neural regeneration
86
Where can synapses form with stem cell therapy?
With neurons but not muscles
87
What is the function of Schwann cells with regenerative medicine?
Provide guidance to the axons for regeneration, challenges with apoptosis
88
What is Olfactory Ensheathing Cell Regneration?
Transplantation with peripheral nerve grafts for scaffolding
89
What is the outcome of Olfactory Ensheathing Cell Regeneration?
Axon regeneration and neuron preservation, functional recovery
90
Why are zebra fish used for regenerative medicine?
They are capable of neuronal proliferation regeneration within 6-8 weeks following SCI
91
What is nanomedicine?
Use nanoparticles to deliver medicine to injury area and prevent secondary damage
92
What is Nago Trap?
A decoy receptor that binds to growth inhibitors
93
What is Ch'ase?
Biological enzyme that can degrade scar tissue and promote growth
94
What is Minocycline?
Antibiotic and anti-inflammatory that also has neuroprotective benefits
95
What is Riluzole?
ALS drug that blocks sodium channels and decreases excitotoxicity
