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PassPMR - 03 Spinal Cord Injury > 5 - SCI Rehab > Flashcards

5 - SCI Rehab Flashcards

1
Q

SCI C1-C4: Functional Outcome & Equipment/Assistive Devices Respiratory Bowel, Bladder Bed Mobility & Transfer Ambulation Wheelchair Transportation Eating, Dressing, Bathing

A

Respiratory

  • Breathing: Ventilator or diaphragm / phrenic pacer dependent (C1–3)
  • Cough & Clearance: Inability to clear secretions, Suction equipment (C1–3), 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

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2
Q

SCI C5 vs C6-C7: Functional Outcome & Equipment/Assistive Devices πŸ”‘πŸ”‘ MOCK Respiratory Bowel, Bladder Bed Mobility & Transfer Ambulation Wheelchair Transportation Eating, Dressing, Bathing

A

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, can’t 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, can’t extend and poor wrist function
    • Total assist for inserting indwelling catheter
    • Foley or external catheters, Urine drainage bags β€œfor caregiver”
  • 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, can’t use triceps top push nor his hand to grip
    • Transfer board, Power or mechanical lift with sling β€œcaregiver”
  • 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, can’t 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

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3
Q

Best level of driving in SCI? πŸ”‘πŸ”‘

A

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

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4
Q

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).πŸ”‘πŸ”‘

A

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

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5
Q

Why are pts with a C5 ASIA A spinal cord injury in a supinated position?

A

Supinator muscles (biceps) is C5, but pronator muscles (PT, PQ) are C6,7 and C8.

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6
Q

Mention 4 eating / feeding adaptive devices.πŸ”‘πŸ”‘

A
  1. Wrist splint with utensil holder or universal cuff
  2. Bent fork or spoon
  3. Nonslip mat
  4. Plate guard
  5. Arm rest extension

Braddom 6th Edition Chapter 49 SCI Table 49.5 pg1066

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7
Q

Mention 4 dressing adaptive devices. πŸ”‘πŸ”‘ MOCK

A
  1. Button hooks
  2. Long shoehorn
  3. Loops on zippers
  4. Sock doning aid
  5. Velcro on shoes
  6. Elastic shoe laces
  7. Dressing stick
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8
Q

Mention 4 dressing adaptive devices. πŸ”‘πŸ”‘ MOCK

A
  1. Button hooks
  2. Long shoehorn
  3. Loops on zippers
  4. Sock doning aid
  5. Velcro on shoes
  6. Elastic shoe laces
  7. Dressing stick
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9
Q

Mention 4 bathing adaptive devices.

A
  1. Padded tub transfer bench
  2. Commode chair
  3. Handheld shower
  4. Grab bars
  5. Wash mitt
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10
Q

Mention the equipments to perform CIC . πŸ”‘πŸ”‘ OSCE

A
  1. Disinfectant gel or soap
  2. Catheters (single use catheters are preferred)
  3. Bimanual catheter inserter
  4. Alcohol wipes, sterilizer
  5. Urinary bags
  6. Sterile compresses
  7. Gloves

Dr. Salem Lecture

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11
Q

Mention 4 bowel equipment devices. πŸ”‘πŸ”‘ MOCK

A
  1. Commodes, raised or padded toilet seat, or automated toilet seat
  2. Suppository inserter or digital stimulator
  3. Mirrors
  4. Anal plugs
  5. Footstools
  6. Bowel irrigation systems

https://community.scireproject.com/topic/bowel/#other-treatments-and-techniques

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12
Q

List 2 Transfers & mobility equipments.

A
  1. Transfer board
  2. Power/mechanical lift
  3. Grab bars
  4. Power wheelchair
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13
Q

Mention 2 bed mobility equipment devices. πŸ”‘πŸ”‘ EXAM 2020

A
  1. Bed rails
  2. Bed rope leader
  3. Electric Hospital Bed with remote

Dr. Maitham

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14
Q

Patient asking β€œWill I regain use of my hands?”

A

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.

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15
Q

Highest complete SCI level that can live independently without the aid of an attendant πŸ”‘

A

C6 complete tetraplegia

Ω…Ψ³ΨͺΨ§Ω†Ψ³ .. ΩŠΨ§ΩƒΩ„ ويروح Ψ§Ω„Ψ­Ω…Ψ§Ω…

  1. Extremely motivated
  2. Feeding is accomplished with a universal cuff for utensils
  3. Bowel care is performed using a suppository inserter and digital stimulation
  4. Transfers require stabilization of elbow extension with forces transmitted from shoulder musculature through a closed kinetic chain.

Cuccurollo 4th Edition Chapter 7 pg560

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16
Q

Write down 4 goals for PT & OT for SCI patient.

Newly admitted SCI patient, what would be the goal of admission? πŸ”‘ (Ward Call)

A
17
Q

Four ways to improve general hand function in C6 ASIA A. πŸ”‘

A
  1. Tenodesis splint
  2. Using universal cuff
  3. Neuromuscular Electrical Stimulation (NMES)
  4. Brachioradialis to FPL tendon transfer – active key grip.

Ref: SCI medicine principles and practice (textbook), pg 559-561.

18
Q

Family doctor calls you regarding a C6 ASIA A patient. Asks questions regarding possible function. πŸ”‘

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

a. Yes – hand can grip with wrist extension (tenodesis). Can use tenodesis WHO.

Alternatively, pt can β€˜hold’ 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)

19
Q

Orthopedic surgeries for C5 SCI patient to restore elbow extension & wrist extension πŸ”‘πŸ”‘ MOCK

A

πŸ’‘ 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

20
Q

Orthopedic surgeries for C6 SCI patient to restore hand function / finger flexions and grasp

A

πŸ’‘ 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 β€œkey grip” procedure: Restore lateral or β€œkey” grip

Braddom 5th Edition Chapter 49 SCI pg1077 Table 49.6

21
Q

Patient asking β€œWill I walk again?” πŸ”‘πŸ”‘

Patient asking β€œWill I get better in 1 year?”

What percent of ASIA A patients remain complete (ASIA A)?

Dr. Abdulrazaq

A

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

22
Q

Write plan for gait rehabilitation for SCI

A

Gait Training

  1. Balance Training (Static and Dynamic Balance)
  2. Parallel bars
  3. Body weight support (BWS)
  4. Treadmill

Exercise

  1. Cycling (ergometer) for Cardiovascular/Aerobic training
  2. Strength/Resistance Training

Orthosis

  1. High Paraplegia β†’ Standing frame to Reciprocating Gait Orthoses
  2. Lower Paraplegia β†’ Walking frame
  3. Swedish cage in case of genu recurvatum
  4. AFO in case of drop foot
23
Q

What are the three strongest predictors of functional outcomes / ambulation in SCI ?

A

ASIA Class & Motor Function

  1. Level of injury.
  2. Completeness of injury
  3. Lower extremity motor score (LEMS) greater or equal to 15

Other predictors:

  • Age
  • Comorbidity
  • Motivation
  • Training
24
Q

What are the Significant predictors of mortality post- spinal cord injuries? 5 marks

A

SCI

  1. Neurologically complete
  2. Injured by acts of violence
  3. Having a high neurologic level
  4. Ventilator dependent, and

Patient

  1. Old age
  2. Male

Braddom 6th edition p1051

25
Q

What factors increase the likelihood of RTW (return to work) post-SCI?

A

πŸ’‘ Pre injury status (education, employed, married, young male)
Post injury status (level, severity, ambulation and transport)

ENVIRONMENTAL BARRIERS:

  1. able to drive.
  2. job accommodation

NON-MODIFIABLE:

  1. Younger age (declines after 50yo)
  2. Male

PSYCHOSOCIAL FACTORS:

  1. depression (lack of).
  2. Greater formal pre-injury education

INJURY RELATED FACTORS:

  1. less severe injury.
  2. paraplegia (versus tetraplegia).
  3. AIS D injury
  4. Nonviolent SCI etiology

MODIFIABLE FACTORS:

  1. Married
  2. Employed at time of injury
  3. Greater motivation to return to work

Ref: Delisa p666; http://www.scireproject.com/case-studies/case-7-mrs-f-l/return-to-work.

26
Q

Name 6 predictors of independent living for pts with an SCI

A

πŸ’‘ Family, car, job, low injury

  1. Marital status.
  2. Transportation barriers.
  3. Education level.
  4. economic disincentives.
  5. disability severity (berthed index).

Ref: Arch Phys Med Rehabil. 1984 Feb;65(2):66-73.

27
Q

Name 4 predictors of discharge to nursing home.

A
  1. ventilator-dependent.
  2. tetraplegic with non-useful motor recovery.
  3. older age.
  4. unmarried.
  5. unemployed.
  6. medicaid or health maintenance organization (HMO) insurance.

Ref: Delisa pg 666.

28
Q

What are 5 Predictors of mortality after SCI injury? πŸ”‘

A
  1. Male
  2. Advanced age
  3. Ventilator dependence
  4. Injured by at of violence
  5. High injury level (particularly C4 or above)
  6. Complete injury
  7. Poor self-rated adjustment to disability
  8. Poor community integration
  9. Poor economic status indicators
  10. Having either Medicare or Medicaid third-party sponsorship of care

Ref: Delisa p666

PassPMR - 03 Spinal Cord Injury (9 decks)

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