Acute Ax and Rx Flashcards

Question

What are the benefits of standing?

Answer 1

1. High COG/ small BoS – improve balance and strengthen trunk musculature, development of postural control, maintenance of functional ranges of movement and skill acquisition in components of gait 2. Increased WB increasing proprioception awareness in turn leads to increase extensor activity 3. Increased strength/motor recruitment 4. Psychological benefits – boost in self confidence, motivation. Improved sense of well-being and quality of life related to standing and a general sense of improved fitness 5. Visual stimulation 6. Increased BMD 7. Decreased risk of secondary MSK complications 8. Cardiovascular benefits 9. Respiratory benefits 10. Relieves pressure 11. Bladder/bowel sensation and movement

Answer 2

**If level of deficit post stroke/TBI allows can attempt standing with****:** * Check observations before and during getting patient into standing * Have plinth behind and sturdy support on unaffected side * Block affected knee * Support affected arm * Weight transference, tapping, approximation **SCI may present with overall trunk instability and loss of LL motor control:** * SCI may need to commence upright stance position with use of mechanical aids (tilt table/electric standing frame/OSF) in order to splint lower limbs and trunk and to accommodate for BP changes/ regulation – gradual increase to vertical especially for Cx injury due to risk of AD * Also need abdominal binder to maintain abdominal pressure for BP

Answer 3

**Pros:** 1. Conform to manual handling guidelines 2. Allow early rehab of heavy patients 3. Allow rehab of very disabled patients 4. Allows for grading of movement 5. Require fewer staff **Cons:** 1. Activity level is restricted by equipment 2. Not “normal” sensation of standing 3. Reduced feedback to therapist re activity etc

Answer 4

* BP/HR * Autonomic dysreflexia (SCI) * Bowel/bladder * Respiratory dysfunction * Colour/sweating

Answer 5

1. Direction of glenoid fossa: up / fward / lat (when arm is dependent) 2. Glenoid labrum 3. Capsule - superior part 4. Rotator cuff

Answer 6

**Superior (least common)** Due to tight supraspinatus and/or deltoid Low tone + high tone **Inferior subluxation (most common)** Seen in low tone 1. Scapula loses stability on thorax causing shoulder depression and medial rotation 2. Humerus in relative abduction 3. Joint unprotected by stability of capsule & supraspinatus leading to inferior subluxation (postural asymmetry may contribute) **Anterior subluxation:** Due to tight pecs and lat dorsi May get anteroinferior sublux

Answer 7

1. Care of shoulder: education, positioning, supportive device 2. Strengthening 3. Sensory retraining 4. Mirror box therapy 5. Mental Practice 6. FES

Answer 8

1. Education – educating family and carers about care of shoulder 2. Positioning for support 3. Potential use of supportive devices (subcuff’s/sling) during therapy sessions focused on lower limb 4. Ensure safe and supportive handling of UL 5. Pain management

Answer 9

1. Holding 2. Following 3. Placing (isometric) 4. Combine with taping 5. Combine with approximation **Adjuncts:** 1. Mirror box therapy 2. Sensory retraining 3. Mental practice 4. Compensatory techniques 5. Spasticity management – botox, FES

Answer 10

**Procedure:** 1. Patient sits with the affected arm behind the mirror 2. Focuses on the reflection and imagines it is the affected limb. May cause emotional response, dizziness or nausea 3. Recommended to exercise for 10 min every day 4. May explain that being able to visually see unaffected mirrored hand ‘tricks’ brain into thinking this is the unaffected hand and this makes it easier to move **Activities without object:** 1. Unilateral movement of the ‘good’ arm only 2. Bilateral movements 3. Guiding of the affected arm by the therapist 4. Guiding of both arms by the therapist **Activities with object:** 1. Unilateral movements of the ‘good’ arm with an object 2. Bilateral movements with an object in the non-affected hand 3. Bilateral movements with guidance of the affected arm by the therapist 4. Bilateral movements while imagining objects in hands

Answer 11

1. Oxford scale – strength testing 2. ROM (goniometer) 3. 9 hole peg test/SARA - Co-ordination and UL function 4. ADL measures – timed or videoed ADLs – PADLs, DADLs 5. Modified Ashworth Scale (MAS) - tone 6. Fugl-meyer or Nottingham Sensory Assessment - sensation 7. Action Research Arm test 8. Wolf Motor Function Test

Answer 12

A serious, acute medical event whereby noxious stimuli causes an increase in blood pressure which the anatomic nervous system is unable to control or regulate leading to cardiovascular response of further increase of blood pressure and increased heart rate. Usually seen in spinal cord injury patients who have had damage to T6 and above, can have life threatening implications unless treated immediately

Answer 13

The ability to passively utilise the natural propensity to create a finger flexion through wrist extension due to tension in long finger flexors in the absence of motor activity in fingers/ wrist flexion

Answer 14

sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing, usually accompanied by symptoms of dizziness/ loss of balance/ pale complexion/ sweating / lack of verbal communication/ vacant episode

Answer 15

1. Doctors (Consultant, Registrar, Core Trainee Specialty Training, Trust Grade, Foundation Year 1 &2) 2. Pharmacists 3. Occupational Therapists (OTs) 4. Therapy assistants 5. Nursing staff 6. Health care assistants 7. Speech and Language Therapists (SALTs) 8. Dieticians 9. Psychologists 10. Social workers 11. Orthotists

Answer 16

To diagnose, treat and manage patients medical plan including decision making with regards to active care, palliative or end of life care

Answer 17

Managing medication doses and interactions, prescribing and assisting medical team with subscribing medication, communication with patients surrounding management of medication

Answer 18

**OTs:** Assessment of physical, sensory, cognitive problems in functional activities in order to assist rehabilitation / address barriers affecting emotional/ social/ physical needs/ May be specialists in: Equipment/ adaptation assessment, splinting, seating/ postural management equipment, cognitive assessment **Therapy assistants:** Assisting therapy staff with assessment and treatment

Answer 19

**Nursing staff:** Medication administration, management of plan for continence, skin/ pressure management, caring for physical needs of patient, taking regular observations of patient, depending on speciality: ITU/ clinic nurse/ ward nurse/ community nursing/ school nurse – will include wide variety of roles and responsibilities **Health care assistants:** Assisting nursing staff with practical care of patients

Answer 20

Assessment and management of people experiencing communication, swallowing, eating and drinking difficulties or support/ treatment for people experiencing cognitive/ psychological problems with speaking and communicating

Answer 21

Assessment and treatment around assisting individuals with dietary advise, planning, nutrition advise and treatment

Answer 22

Assessment and treatment for behavioural, emotional and psychological problems, counselling, CBT, lifestyle advise and assistance with social integration/ management, liaison with medical team r.e appropriate medications.

Answer 23

Provide advice/ support, assists services in local community to provide appropriate care for patients, assist in decisions surrounding housing/ accommodation, level of care provided outside of hospital, discharge destination – in liaison with MDT/ patient/ family members

Answer 24

Assessment and provision of orthotics and adaptive aids – splints, AFOs, braces, specialist footwear