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SCI > 4: Intervention > Flashcards

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

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2
Q

What are key interventions in the ICU?

A
  • Airway clearance
  • Positioning
  • Equipment
  • Early mobility
  • Acclimation to upright
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3
Q

What are key interventions for inpatient rehab?

A
  • Functional mobility, ADLs
  • Discharge planning
  • Prevent secondary complications
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4
Q

What are the four methods of muscle substitution?

A
  1. Agnostic musculature (fascia)
  2. Gravity
  3. Tension in passive structures
  4. Fixation of distal extremity
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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

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6
Q

What is the head-hips relationship?

A

Moving the head in one direction causes the hips to move in the opposite direction

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7
Q

What are potential benefits of tone?

A
  • Independent transfers
  • Stability to maintain postures
  • Compensatory strategies
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8
Q

How often should UE strengthening be done in early rehab?

A

2-3 days per week

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9
Q

What is the intensity of UE strengthening in early rehab?

A

60-80% of 1RM (10 reps to fatigue)

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10
Q

What are acute strengthening contraindications for paraplegia?

A

Trunk and hip musculature

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11
Q

What are acute strengthening contraindications for quadriplegia?

A

Scap and shoulder muscles

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12
Q

Should you focus on unilateral or bilateral exercises and why?

A

Bilateral - avoid rotational stresses

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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

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14
Q

What is the ideal ROM for UEs?

A
  • Greater than normal shoulder extension and ER
  • Supination for locking elbows
  • Tenodesis
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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

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16
Q

What ROM should be avoided in peds and why?

A

Hip adduction for hip integrity

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17
Q

How is HO diagnosed and monitored?

A

DEXA

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18
Q

What medications are indicated for HO?

A

Biphosphonates, NSAIDs

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19
Q

What are interventions for HO?

A

Gentle ROM and exercise, surgery

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20
Q

What are interventions for osteoporosis?

A

Biphosphonates, e-stim, early WB

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21
Q

What are strategies to promote early WB?

A

Tilt table, standing frame, parapodium, mobile standers, body weight support treadmill

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22
Q

Why is proper seating posture important?

A

Skin breakdown, overstretching prevention, scoliosis, kyphosis, forward head, pain reduction, improve respiratory function

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23
Q

What is the benefit of bracing/splinting/casting?

A

Allows for healing and stabilization, reduce contractures, scoliosis, improve alignment

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24
Q

What three pulmonary impairments need to be managed?

A
  1. Hypoventilation
  2. Secretion management
  3. Atelectasis
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25
Q

When is nasotracheal intubation used for ventilation?

A

Short-term in emergency situations

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26
Q

When is a tracheotomy used for ventilation, and what are its benefits?

A

Long-term use - promotes ease in eating, communication, secretion removal

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27
Q

What does IPPV stand for?

A

Intermittent Positive Pressure Ventilators

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28
Q

Describe a pressure controlled IPPV

A

Terminates inspiration when a predetermined pressure is reached

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29
Q

Describe a volume cycle ventilator IPPV?

A

Terminates inspiration when a predetermined amount of gas is delivered to the patient

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30
Q

What are modes for IPPV?

A

Control, assist control, synchronized intermittent mandatory ventilation, pressure control, pressure support, continuous positive airway pressure (CPAP)

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31
Q

What are additional methods for assisted ventilation?

A
  • Intermittent abdominal pressure ventilator
  • Negative pressure body ventilators
  • Phrenic nerve stimulations/pacemakers
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32
Q

What is done if a ventilator fails?

A

Glossopharyngeal breathing or ambu bag with abdominal or lower rib compressions

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33
Q

What is glossopharyngeal breathing?

A

Technique to increase the volume of air being inhaled that uses the tongue and pharyngeal muscles to force air into the lungs with gulps

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34
Q

What are the impacts of respiratory muscle training?

A

Decreased risk of pulmonary infection and mortality

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35
Q

Is changing intensity or volume more effective when dosing respiratory muscle training?

A

Intensity

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36
Q

What are functional activities that require expiratory muscle training?

A

Blowing into instrument, straw, singing

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37
Q

What is the optimal sitting posture for respiration?

A

Erect trunk, scapular adduction, head and neck alignment, anterior pelvic tilt

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38
Q

Why is positional changing and out of bed activity important for respiration?

A

Aids in secretion mobilization

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39
Q

What is the purpose of an abdominal binder?

A

Used to support abdominal contents and position the diaphragm for optimal function

40
Q

What are methods to assist with orientating to vertical?

A
  • Gradual
  • Abdominal binder, compression
  • Vitals
  • Medication
41
Q

What medications can assist with orientation to vertical?

A
  • Ephedrine, NaCL
  • Low dose diuretics for edema
42
Q

What LOI and timeframe is someone at risk for orthostatic hypotension?

A

Above T6 in the acute stages

43
Q

What LOI and timeframe is someone at risk for autonomic dysreflecia?

A

Above T6, sub-acute or chronic

44
Q

How do you respond to signs of orthostatic hypotension?

A
  • Lower head, elevate legs
  • Medical assist if severe and not resolving
45
Q

How do you respond to signs of autonomic dysreflexia?

A
  • Sit up, lower legs
  • Loosen clothing
  • Noxious stimuli
  • Call for medical assistance
46
Q

What are the parameters for endurance training for CV fitness?

A

20-30 minutes 3x/week at moderate intensity

47
Q

How often should a pt perform pressure relief in a chair and in bed?

A

15-20 minutes in a chair
2 hours in bed

48
Q

How often should the skin be inspected, and how long is it okay for redness to last?

A

At least once a day - no more than 30 minutes

49
Q

What interventions are indicated for traumatic pain?

A

Analgesics, immobilization, TENS

50
Q

What interventions are indicated for MSK pain?

A
  • Prevention is key
  • Positioning, ROM, equipment
  • Anti-spasticity meds
51
Q

What medications are used for spasticity?

A

Baclofen, Dantrolene, Diazepam, Tizanidine, anti-inflammatories

52
Q

What interventions are indicated for visceral GI and bowel pain?

A

NG tube, prophylactic meds for GI stress, diet, antibiotics, mobilization, education

53
Q

How do you treat neuropathic pain at the LOI?

A
  • Anticonvulsants
  • Antidepressants
  • Analgesics
  • TENS
  • Surgery
54
Q

How do you treat neuropathic pain below the LOI?

A
  • Education
  • Gentle handling
  • Medications
55
Q

How do you manage a reflexive bladder?

A
  • Intermittent catheterization
  • Train micturation reflex with tactile stimulation
56
Q

How do you manage an areflexive bladder?

A
  • Timed voiding program
  • Manual pressure, valsalva
57
Q

How do you manage a reflexive bowel?

A
  • Suppositories
  • Stimulation of sphincter
58
Q

How do you manage an areflexive bowel?

A
  • Manual pressure or evacuation
  • Valsalva
  • Suppositories
59
Q

What is the PT role in bowel and bladder management?

A

Encourage compliance, education, enhance QOL, max physical skills for independence

60
Q

What should be avoided with psychosocial interventions?

A

Medical model, dependence, negative attitude

61
Q

What should you promote with psychosocial interventions?

A

Education model, independence, autonomy, positive attitude, social support, empowerment

62
Q

What is FES cycling/rowing?

A

Used to minimize bone loss and aerobic conditioning

63
Q

When should you implement FES cycling/rowing, and what should you be mindful of?

A

Early at a high frequency - beware of post-exercise hypotension

64
Q

What are the parameters for FES cycling/rowing?

A
  • 20-60 minutes, 3-5x/week
  • 50-80% HR max
  • 13-17 RPE
65
Q

What is the purpose of epidural stimulators?

A

Neuromodulation therapy that enables lower limb voluntary movement

66
Q

How does an epidural stimulator work?

A

Electrical currents on lower spinal cord stimulates nerves directly by bypassing brain to spinal cord pathways

67
Q

What is needed for locomotor training?

A

Adequate strength, postural alignment, postural control, ROM, CV endurance

68
Q

How can you compensate for hip extension for gait training?

A

Leaning into anterior ligaments of hip with the trunk extended to stabilize the trunk and pelvis

69
Q

How do you compensate for decreased strength with locomotor training?

A

Forearm crutches

70
Q

What gait pattern is most common with forearm crutches?

A

4-point swing through

71
Q

What is the functional/recovery based approach to treatment?

A

Interventions to promote intrinsic ability of the nervous system to control rhythmical movement patterns and modulate sensory input into task specific motor output

72
Q

What are the four components of the functional/recovery based approach?

A
  1. Legs maximally loaded
  2. Sensory cues
  3. Coordination movements
  4. Minimize compensatory strategies
73
Q

What locomotor training techniques have good evidence?

A

Mod-high intensity gait training and VR

74
Q

What locomotor training techniques have strong evidence against them?

A

BWSTT, robotic training, balance without VR

75
Q

Are robotic devices better than walking programs or manually assisted BSWTT?

A

No

76
Q

What is the benefit of robotics training?

A

Reduces assistance required from therapist

77
Q

What % of people with SCI have shoulder pain?

A

30-70%

78
Q

What are risk factors for shoulder pain?

A

Increased time since injury, age, higher LOI

79
Q

What impairment does the STOMPS trial look at?

A

Shoulder pain

80
Q

What are the five interventions in the STOMPS trial?

A
  1. Stretching
  2. Strengthening
  3. Transfers
  4. Wheelchair propulsion
  5. Posture
81
Q

What are the key results of the STOMPS trial?

A
  • Increased strength
  • Decreased pain, maintained at four weeks
  • Improved QOL
82
Q

What are the clinical implications from the STOMPS trail?

A
  • 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
Q

What is transmagnetic stimulation?

A

Stimulation of the cortex to enhance motor evoke potential of neurons

84
Q

What are possible uses of transmagnetic stimulation?

A
  • Evaluate motor evoked potentials
  • Control neuropathic pain
  • Spasticity
  • Restore somatomotor function
  • Reduce corticospinal inhibition
85
Q

What are the two benefits of stem cell therapy?

A
  • Reduce inflammation
  • Promote neural regeneration
86
Q

Where can synapses form with stem cell therapy?

A

With neurons but not muscles

87
Q

What is the function of Schwann cells with regenerative medicine?

A

Provide guidance to the axons for regeneration, challenges with apoptosis

88
Q

What is Olfactory Ensheathing Cell Regneration?

A

Transplantation with peripheral nerve grafts for scaffolding

89
Q

What is the outcome of Olfactory Ensheathing Cell Regeneration?

A

Axon regeneration and neuron preservation, functional recovery

90
Q

Why are zebra fish used for regenerative medicine?

A

They are capable of neuronal proliferation regeneration within 6-8 weeks following SCI

91
Q

What is nanomedicine?

A

Use nanoparticles to deliver medicine to injury area and prevent secondary damage

92
Q

What is Nago Trap?

A

A decoy receptor that binds to growth inhibitors

93
Q

What is Ch’ase?

A

Biological enzyme that can degrade scar tissue and promote growth

94
Q

What is Minocycline?

A

Antibiotic and anti-inflammatory that also has neuroprotective benefits

95
Q

What is Riluzole?

A

ALS drug that blocks sodium channels and decreases excitotoxicity

SCI (6 decks)

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