5 - SCI Rehab Flashcards
SCI C1-C4: Functional Outcome & Equipment/Assistive Devices Respiratory Bowel, Bladder Bed Mobility & Transfer Ambulation Wheelchair Transportation Eating, Dressing, Bathing
Respiratory
- Breathing: Ventilator or diaphragm / phrenic pacer dependent (C1โ3)
- Cough & Clearance: Inability to clear secretions, Suction equipment (C1โ3), Nebulizer
Bowel
- Total assist for digital stimulation, insertion of minienema or suppository
- Padded reclining commode chair with head support
Bladder
- Total assist for inserting indwelling or suprapubic catheter
- Foley catheter or external catheters + Urine drainage bags
Bed Mobility & Transfer
- Total assist
- Fully electric hospital bed + Trendelenburg position + side rails + Pressure relieving mattress
- Power or mechanical lift with sling + Transfer board
Ambulation
- Not indicated
Wheelchair
- Total assist in powered or manual
- Power WC with recline and tilt
Transportation
- Total assist
- Attendant operated van
Eating, Dressing, Bathing
- Total assist
- Handheld shower + Padded reclining commode chair
Braddom 6th Edition Chapter 49 SCI pg1066 Table 49.5
SCI C5 vs C6-C7: Functional Outcome & Equipment/Assistive Devices ๐๐ MOCK Respiratory Bowel, Bladder Bed Mobility & Transfer Ambulation Wheelchair Transportation Eating, Dressing, Bathing
Respiratory C5 & C6-C7
- Intact diaphragm, weak intercostal, weak cough and clearance
- Low endurance and vital capacity secondary to paralysis of intercostals
- Assist to clear secretions
Bowel
- C5: can flex elbow only, canโt extend and poor wrist function
- Total assist for digital stimulation, insertion of minienema or suppository
- Padded reclining commode chair
- C6-7: can flex and extend arm, fair wrist function
- Independent suppository insertion and digital rectal stimulation
- Suppository inserter, Digital bowel stimulator, Mirror
Bladder
- C5: can flex elbow only, canโt extend and poor wrist function
- Total assist for inserting indwelling catheter
- Foley or external catheters, Urine drainage bags โfor caregiverโ
- C6-C7: can flex and extend arm, fair wrist function
- Independent self-catheterization
- Foley or external catheters + Bimanual catheter inserter + Urine drainage bags
Bed Mobility
- Some assist, both have poor grip function (C7-C8)
- Fully electric hospital bed with side rails + Pressure relieving mattress
Transfer
- C5
- Total assist, canโt use triceps top push nor his hand to grip
- Transfer board, Power or mechanical lift with sling โcaregiverโ
- C6-C7
- Independent with extension and locking of elbow joint
- Transfer board only
Standing & Ambulation
- C5 & C6-C7 both have no trunk control
- Standing: Total assist
- Hydraulic standing frame
- Ambulation: Not indicated
Wheelchair
- C5
- Power: Independent
- Manual: assist outdoors and pressure relief
- C6
- Power: Independent
- Manual: assist outdoors, but independent pressure relief
- Power: Power recline and tilt wheelchair with arm drive control
- Manual: Ultralightweight + Postural support + Pressure relieving wheelchair cushion
Transportation
- C5: Independent with highly specialized modified van with lift or total assist for attendant operated vehicle
- C6-C7: Independent driving from wheelchair with modified van with lift
Eating, dressing, and bathing
- C5 can flex elbow only, canโt extend and poor wrist function
- Eating: Total assist for setup including cutting food, independent eating
- Dressing and bathing: Total assist
- C6-C7 can flex and extend arm, fair wrist function
- Eating: Total assist for setup including cutting food, independent eating
- Dressing and bathing: Independent upper body; some to total assist for lower body
Braddom 6th Edition Chapter 49 SCI pg1066 Table 49.5
Best level of driving in SCI? ๐๐
C5 Highly specialized modified van with lift
C6-7 Modified van with lift, sensitized hand controls, and tie-downs for wheelchair
Braddom 6th Edition Chapter 49 SCI Table 49.5 pg1066
28 years old female patient who had RTA 6 months back. She has C6-7 ASIA A. Expect the level of function for bowel, bed mobility and positioning and transfers? (3 marks) Mention equipment she will need for transfer and bowel management? (2 marks).๐๐
Functional Outcome
- Bowel
Some to total assist for setup and perineal hygiene
Independent suppository insertion with suppository insert
Independent rectal stimulation with digital bowel stimulator
- Bed Mobility: Some assist
- Transfers: Some assist to independent
Equipment
- Transfer board
- Padded commode chair, suppository Insertor, Digital bowel stimulator, Mirror
Braddom, 5th edition,P 1108-1109
Why are pts with a C5 ASIA A spinal cord injury in a supinated position?
Supinator muscles (biceps) is C5, but pronator muscles (PT, PQ) are C6,7 and C8.
Mention 4 eating / feeding adaptive devices.๐๐
- Wrist splint with utensil holder or universal cuff
- Bent fork or spoon
- Nonslip mat
- Plate guard
- Arm rest extension
Braddom 6th Edition Chapter 49 SCI Table 49.5 pg1066
Mention 4 dressing adaptive devices. ๐๐ MOCK
- Button hooks
- Long shoehorn
- Loops on zippers
- Sock doning aid
- Velcro on shoes
- Elastic shoe laces
- Dressing stick
Mention 4 dressing adaptive devices. ๐๐ MOCK
- Button hooks
- Long shoehorn
- Loops on zippers
- Sock doning aid
- Velcro on shoes
- Elastic shoe laces
- Dressing stick
Mention 4 bathing adaptive devices.
- Padded tub transfer bench
- Commode chair
- Handheld shower
- Grab bars
- Wash mitt
Mention the equipments to perform CIC . ๐๐ OSCE
- Disinfectant gel or soap
- Catheters (single use catheters are preferred)
- Bimanual catheter inserter
- Alcohol wipes, sterilizer
- Urinary bags
- Sterile compresses
- Gloves
Dr. Salem Lecture
Mention 4 bowel equipment devices. ๐๐ MOCK
- Commodes, raised or padded toilet seat, or automated toilet seat
- Suppository inserter or digital stimulator
- Mirrors
- Anal plugs
- Footstools
- Bowel irrigation systems
https://community.scireproject.com/topic/bowel/#other-treatments-and-techniques
List 2 Transfers & mobility equipments.
- Transfer board
- Power/mechanical lift
- Grab bars
- Power wheelchair
Mention 2 bed mobility equipment devices. ๐๐ EXAM 2020
- Bed rails
- Bed rope leader
- Electric Hospital Bed with remote
Dr. Maitham
Patient asking โWill I regain use of my hands?โ
Muscle with 1-2/5 at 1 month
90% chance of reaching grade 3 by 1 year.
Muscle with 0/5 at 1 month
25% chance for reaching grade 1 by 1 year.
Highest complete SCI level that can live independently without the aid of an attendant ๐
C6 complete tetraplegia
ู ุณุชุงูุณ .. ูุงูู ููุฑูุญ ุงูุญู ุงู
- Extremely motivated
- Feeding is accomplished with a universal cuff for utensils
- Bowel care is performed using a suppository inserter and digital stimulation
- Transfers require stabilization of elbow extension with forces transmitted from shoulder musculature through a closed kinetic chain.
Cuccurollo 4th Edition Chapter 7 pg560
Write down 4 goals for PT & OT for SCI patient.
Newly admitted SCI patient, what would be the goal of admission? ๐ (Ward Call)
Four ways to improve general hand function in C6 ASIA A. ๐
- Tenodesis splint
- Using universal cuff
- Neuromuscular Electrical Stimulation (NMES)
- Brachioradialis to FPL tendon transfer โ active key grip.
Ref: SCI medicine principles and practice (textbook), pg 559-561.
Family doctor calls you regarding a C6 ASIA A patient. Asks questions regarding possible function. ๐
a. Is this patient able to grip or hold objects? Explain your answer (2 points).
b. List 2 muscle substitutions that allow elbow extension.
a. Yes โ hand can grip with wrist extension (tenodesis). Can use tenodesis WHO.
Alternatively, pt can โholdโ an object using universal cuff.
Ref: SCI Medicine
b. anterior deltoid and upper pectorals in closed-chain activity
Push up: Hand planted on surface
Ref: Marciello (Archives PMR 1994; 5: 426-432), Gefen (Spinal Cord 1997; 35: 308-313)
Orthopedic surgeries for C5 SCI patient to restore elbow extension & wrist extension ๐๐ MOCK
๐ก Deltoid for triceps, for hand and wrist we use radialis family BR and ECR
Elbow extension: Deltoid to triceps
Wrist extension: Brachioradialis to extensor carpi radialis brevis
Braddom 5th Edition Chapter 49 SCI pg1077 Table 49.6
Orthopedic surgeries for C6 SCI patient to restore hand function / finger flexions and grasp
๐ก Deltoid for triceps, for hand and wrist we use radialis family BR and ECR
Thumb flexion: Brachioradialis (BR) to Flexor pollicis longus (FPL)
Finger flexion: Extensor carpi radialis brevis (ECR) to the flexor digitorum profundus (FDP)
Moberg โkey gripโ procedure: Restore lateral or โkeyโ grip
Braddom 5th Edition Chapter 49 SCI pg1077 Table 49.6
Patient asking โWill I walk again?โ ๐๐
Patient asking โWill I get better in 1 year?โ
What percent of ASIA A patients remain complete (ASIA A)?
Dr. Abdulrazaq
ASIA A
70% to 80% will remain the same
20% to 30% convert to AISA B or better
8% convert to AISA C
7% convert to AISA D
AISA B
30% become AISA C
37% convert to AISA D.
AISA C
Over 80% convert to AIS D or E
Braddom 6th Edition Chapter 49 SCI pg1064
Write plan for gait rehabilitation for SCI
Gait Training
- Balance Training (Static and Dynamic Balance)
- Parallel bars
- Body weight support (BWS)
- Treadmill
Exercise
- Cycling (ergometer) for Cardiovascular/Aerobic training
- Strength/Resistance Training
Orthosis
- High Paraplegia โ Standing frame to Reciprocating Gait Orthoses
- Lower Paraplegia โ Walking frame
- Swedish cage in case of genu recurvatum
- AFO in case of drop foot
What are the three strongest predictors of functional outcomes / ambulation in SCI ?
ASIA Class & Motor Function
- Level of injury.
- Completeness of injury
- Lower extremity motor score (LEMS) greater or equal to 15
Other predictors:
- Age
- Comorbidity
- Motivation
- Training
What are the Significant predictors of mortality post- spinal cord injuries? 5 marks
SCI
- Neurologically complete
- Injured by acts of violence
- Having a high neurologic level
- Ventilator dependent, and
Patient
- Old age
- Male
Braddom 6th edition p1051
What factors increase the likelihood of RTW (return to work) post-SCI?
๐ก Pre injury status (education, employed, married, young male)
Post injury status (level, severity, ambulation and transport)
ENVIRONMENTAL BARRIERS:
- able to drive.
- job accommodation
NON-MODIFIABLE:
- Younger age (declines after 50yo)
- Male
PSYCHOSOCIAL FACTORS:
- depression (lack of).
- Greater formal pre-injury education
INJURY RELATED FACTORS:
- less severe injury.
- paraplegia (versus tetraplegia).
- AIS D injury
- Nonviolent SCI etiology
MODIFIABLE FACTORS:
- Married
- Employed at time of injury
- Greater motivation to return to work
Ref: Delisa p666; http://www.scireproject.com/case-studies/case-7-mrs-f-l/return-to-work.
Name 6 predictors of independent living for pts with an SCI
๐ก Family, car, job, low injury
- Marital status.
- Transportation barriers.
- Education level.
- economic disincentives.
- disability severity (berthed index).
Ref: Arch Phys Med Rehabil. 1984 Feb;65(2):66-73.
Name 4 predictors of discharge to nursing home.
- ventilator-dependent.
- tetraplegic with non-useful motor recovery.
- older age.
- unmarried.
- unemployed.
- medicaid or health maintenance organization (HMO) insurance.
Ref: Delisa pg 666.
What are 5 Predictors of mortality after SCI injury? ๐
- Male
- Advanced age
- Ventilator dependence
- Injured by at of violence
- High injury level (particularly C4 or above)
- Complete injury
- Poor self-rated adjustment to disability
- Poor community integration
- Poor economic status indicators
- Having either Medicare or Medicaid third-party sponsorship of care
Ref: Delisa p666
