Evaluation and Rehabilitation

Question 1

Components of initial evaluation

Answer 1

• medical chart and hx
• social and vocational hx, prior and expected living situations, occ hx, goals of ct.
• determine baseline neurologic, clinical, functional status
• psychosocial status
• physical status
• cognitive perceptual status
• observation for clinical and functional status

Question 2

Components of evaluation: physical status

Answer 2

• obtain medical precautions
• PROM (determine available pain free mvmt before MMT)
• presence/potential for contractures
• presence of shoulder pain (especially cts with c4-c7)
• MMT: establish neurologic level baseline for physical recovery
• sensation: light touch, superficial pain, kinesthesia
• assess spasticity after spinal shock
• assess hand/wrist function for suggesting equipment
• gross grasp and pinch measurement (for those with active hand musculature)

Question 3

Components of evaluation: observation

Answer 3

• clinical observation: assess endurance, oral motor control, head and neck control, LE functional muscle strength, total body function
• observe ADL performance for present and potential ability.
• if cleared of bed rest, observe light activity such as feeding, light hygiene at sink

Question 4

SCI rehab goals

Answer 4

• maintain/increase joint ROM
• prevent problems with body structures and functions (skin breakdown)
• increase strength of all innervated/partially innervated muscles
• address problems with sensation, cognition, emotions
• increase activity tolerance/endurance
• maximize independence in all areas of occupation
• psychosocial adjustment
• eval/recommend/educate in DME, AE
• ensure safe and independent home and environmental accessibility
• communication skills for training caregivers
• ct. education for maintaining health lifestyle

Question 5

SCI intervention: acute phase

• characteristics
• contraindications
• evaluation

Answer 5

• immobilized, may be in traction or wearing stabilization device (halo, body jacket)
• contraindications: flexion, extension, rotary mvmts of spine and neck
• eval: total body positioning, hand splinting

Question 6

SCI intervention: acute phase

UE positioning

Answer 6

intermittently positioned

to alleviate shoulder pain/ROM limitations for quad/tetra:

• 80* shoulder abduction
• external rotation with scapular depression
• full elbow extension
• forearm in pronation (at risk for supination contracture such as at C5 level)

Question 7

SCI intervention: acute phase

Splinting

Answer 7

• splints should be dorsal to allow for max sensory feedback from hand on surfaces
• for inadequate musculature supporting wrist/hand (MMT below 3+ (F+) for ECRL and ECRB), make dorsal long opponens splint to support wrist in extension & thumb in opposition use for C5 SCI
• With at least 3+ (F+) wrist extension, maybe short opponens splint to maintain web space, support thumb in opposition; can be used functionally use for C6 SCI

Question 8

SCI intervention: acute phase

List intervention strategies

Answer 8

• positioning
• splinting
• active, active-assisted ROM
• muscle re-ed for wrists and elbows when indicated
• progressive resistive exercises for wrists
• self-care activities (feeding, hygiene, keyboard/writing) **using devices like U-cuff, custom writing splint
• discuss DME
• environmental adaptation (tech)

Question 9

SCI intervention: active phase

List intervention strategies

Answer 9

• mobilization
• WC
• develop upright tolerance
• high priority: methods for relieving sitting pressure (prevent ulcers)
• active/passive ROM and splinting-prevent undesirable contractures
• progressive resistive exercise for innervated/partially innervated musculature
• eval for AE and devices
• program should be graded
• ADLs and IADLs
• psychological support

Question 10

SCI intervention: active phase

Pressure relief techniques

Answer 10

• every 20-30 mins
• with 3+(F+) strength in B shoulders and elbows, can perform forward weight shift with loops on WC frame (**C6)
• F+ or better triceps, can perform full depression weight shift off arms or wheels of WC (**C7 or paraplegia)
• full depression weight shift off arms with elbows in extension, shoulders externally rotated (**C6)
• lateral weight shifting (**C6)
• tilt in space: C5 and above, dependent on tech

Question 11

SCI intervention: active phase

Contractures and splinting

Answer 11

• never allow elbow contractors to develop-use casts or splints, AROM, PROM
• for cts with active wrist extension, some tightness desirable for tenodesis grasp
• for cts using tenodesis grasp, range finger flexion with wrist extension, & finger extension with wrist flexion

Question 12

SCI intervention: active phase

progressive resistive activities

Answer 12

• promote proximal stability in shoulders: lats, deltoids, shoulder girdle and scapular muscles
• transfers and shifting weight: triceps, pectoralis, lats,
• maximize tenodesis function: wrist extensors

Question 13

SCI intervention: active phase

ADLs

Answer 13

• independent feeding with AE/devices
• oral and facial hygiene
• UE bathing
• bowel and bladder mgmt (digital stimulation, intermittent catheterization
• UE dressing
• transfers (mechanical lift, sliding board)
• communication skills and writing, with AE and tech
• mobile arm supports (C5), overhead sling training, wrist-hand orthosis training, other assistive devices (u-cuff, mouthstick, environmental controls, etc.)