Discharge Planning Part 2 Flashcards
Which is more common, an Incomplete SCI or a Complete SCI?
Incomplete!
Syringomyelia
Central cavitation (syrinx) of the SC
Most commonly in cervical region
Idiopathic / associated with tumor, hemorrhage, brain malformation / late complication of SC trauma
Segmental weakness / atrophy of hands and arms / loss of DTRs
May require surgical drainage of cyst
What should you consider when DC planning for someone with a neurodegenerative condition?
Think prognosis (speed of progression) in addition to current state
When teaching Self-PROM to pts with Paraplegia/Low Tetraplegia, what equipment/position can be used?
Pts can engage in this activity by leaning on the wall / headboard of bed
Pts can use footloops / leg lifters
Self-PROM for Pts w/ Paraplegia or Low Tetraplegia: Hip and Knee Flexion
Self-PROM for Pts w/ Paraplegia or Low Tetraplegia: Hip ER and Abduction
Self-PROM for Pts w/ Paraplegia or Low Tetraplegia: Dorsiflexion
Step #2 = Abd / ER position
Self-PROM for Pts w/ Paraplegia or Low Tetraplegia: SLR
Initial Prone Progression for Patients w/ SCI
Quad Push-Ups
Hands near shoulders / elbows next to trunk
Dig elbows into mat in an attempt to lift upper trunk
PT may need to assist initially
Strengthens Anterior Deltoid / Serratus Anterior / Pec (Clavicular)
Prone Exercise for Patients With SCI: Balancing on Elbows / WS on Elbows / Lifts on Elbows
Balancing: PT positions patient in this position / rhythmic stabilization could be done to increase strength and improve stability
WS: Lateral initially to be followed by forward and back / Slow Reversal Hold can be done to strengthen and reinforce movement
Lifts: Protraction or abduction of scapula to lift chest higher / stress extra arch at end of movement
Prone Exercise for Patients With SCI: Balance on Hands and Knees / POE to SOE / “Walking” POE
Balance on Hands and Knees: Pt can assume this position if they have triceps OR very strong shoulders
POE to SOE: WS to one arm - side-lying position - SOE
“Walking” POE: Pt should be able to move sideways, forward, and backward on elbows
Long Sitting for Patients With SCI (Initial Progression): Initial Balancing - Backward / Balancing Forward / Balancing Erect
Initial Balancing - Backward: Pt in long sitting w/ hips and knees slightly flexed + hands behind hips (leaning back on hands) / elbows close to sides / PT may provide partial support if patient does not have triceps / shoulder ER, forearm supination, wrist extension and PIP flexion
Balancing Forward: Teach patient to lean forward on hands and to rely on back tightness for stability / patient can pull themselves forward by “hooking” hands under knees
Balancing Erect: Most difficult / hands positioned near GTs / upper trunk and head slightly flexed / difficult to maintain initially (find where to position hands)
Long Sitting for Patients With SCI (Middle Progression): Catching Balance / Lifting / Moving Legs in Long Sitting
Catching Balance: Moving arms fast enough to prevent themselves from falling when balance is disturbed (both quickly and slowly)
Lifting: Lifting hips / PT may have to help with balance / bending upper trunk forward, flexing hips and knees may make movement easier / patient should do a long, sustained lift
Moving Legs in Long Sitting: For the purposes of dressing and bed mobility / patient can move leg with opposite arm / hooking wrist under leg with wrist extensor will provide the most power
Long Sitting for Patients With SCI (Advanced Progression): Moving Hips / Moving Legs / Sitting Unsupported
Moving Hips: All directions / forward and sideways will be easiest - backward the hardest / patient can rock hips forward + S2S in lifted position / facilitate via resistance and stabilization / push-up blocks - stools - parallel bars
Moving Legs: Crossing one leg over the other / hook wrist under opposite leg and move leg by bending elbow + twisting upper trunk - other arm is being used to stabilize trunk and help maintain balance
Sitting Unsupported: Support on one arm + placing that arm in different positions - balancing without arm control and using arms to control trunk movement (batting ball / catch and throw different size and weight balls)
(Pressure Relief) Weight Shifts for Patients with SCI
C4 and Higher: Dependent unless in power tilt-in-space WC
C5: Hook (with forearm or elbow due to inactivation of wrist) around WC push handle and lean forward or to side
C6: Hook and lean forward or to side (can now use partial innervation of wrist extensors, therefore easier than C5)
C7: (Like C6) or WC push-up if strong enough - partial innervation of Triceps
2 minutes every 30 minutes (at least)
How will patients with SCI / impaired sensation in their buttocks be aware if they are unweighting properly during pressure relief?
Can have markers that cue them to know that they are in the proper position (fingers reaching the floor / wrist reaching hubcap of WC)
The Americans with Disabilities Act (ADA) expanded to include what conditions related to building accessibility?
Tenants with disabilities have right to modify rental properties at their own expense (could lose deposit / be required to return property to previous state)
Physical barriers in older buildings must be removed if reasonably possible
All features of complex need to be accessible to and usable by people with disabilities (e.g., mail rooms)
Minimum standards outlined and details can vary by state
T or F: ADA standards do NOT apply to privately owned homes.
T
At discretion of homeowner / can be a good starting point for planning
When recommending an alteration to a doorway, what details should you include?
Current width
New (ideal) width - go beyond width of WC to allow room for knuckles, elbows, etc.
What width is sufficient enough for many people to enter when utilizing a WC?
30 inches
Wider may be necessary if person has to turn and enter at angle
What details about a door in a patient’s home should the PT also consider?
Which direction door opens
If door itself is partially blocking the doorway opening
People with limited hand function can benefit from ___ door handles.
lever-style
Indoor vs. Outdoor Thresholds
May need to remove indoor thresholds - keep flooring type consistent throughout home to avoid tripping
Exterior thresholds more challenging because they cannot be removed due to possibility of damage to the home
What features within a bathroom / kitchen does a PT have to consider when discussing accessibility?
Sink / stove / counter access
Exposed pipes
Refrigerator / freezer access
Oven / stove set-up (handle location in relation to burners)
Standard vs. Handicapped Toilets
Standard toilets lower than handicapped (usually 2” taller)
Handicapped toilets can be purchased at HD/Lowe’s (generally more expensive than standard)
What is the ideal toilet set-up for patients with SCI that have to insert suppository for bowel program?
Open access / raised height
Elevated toilet seat on top of standard toilet height
What style of tub is this?
Garden-Style
Very difficult for people with mobility issues
Are built-in shower seats compatible with patients who have mobility issues?
Generally no
Narrow seat depth / set back from door / slick
Which shower set-up is usually the easiest to access?
Traditional bathtub/shower combos
What is required when installing Grab Bars? What can we educate patients on regarding the usage of Grab Bars?
Grab Bars require installation via a secure mount into wall studs, CANNOT drill into fiberglass walls
Educate patients on distinguishing between bars that can tolerate BW vs. common bathroom features
Research states that patients who have had a stroke that are provided with better information about the pathology / prognosis had ___.
less depression, better functional recovery
Options for Levels of Supervision Post-D/C
Independent living
Living independently with someone checking on them a certain amount of times a day / week / month
Patient being left alone at home for certain number of hours/day (set up)
24 hour supervision
