FES cycling

Question 1

how does FES work

Answer 1

uses electrical pulses to stimulate motor neurons or denervated muscle fibres directly to elicit a contraction during a functional activity
LL cycling activiates- ham, qaud, glutes and calf
UL- biceps and triceps

Question 2

FES cycling

Answer 2

the FES cycling will detect changes in the muscle’s power output will activate a motor when the muscles begin to fatigue to assist in the cycling.
it can maximise function that is recovered through activity dependent neuroplasticity as a result of the repeated exposure and stimulation of the nerves and muscles during the activity

Question 3

FES frequency

Answer 3

FES cycling 2-3 times per week for 10 weeks in individuals with a SCI showed increased total cycling power, endurance, lean muscle and improvements in LL ASIA impairment

Question 4

physical beenfits

Answer 4

increased CV fitness, increase in number of capillary number and increase in glucose metabolism, muscle increase in size and strength, increase in bone density, improves and maintains AROM, increased power output, recover sensation

Question 5

risks

Answer 5

increased risk of autonomic dysflexia, some individuals can experience spasm after use, injuries to the skin or joints, cycling provides a after alternative to FES waling= less risk of falling

Question 6

indications

Answer 6

muscle atrophy, cardiovascular reconditioning, LL sensory and/or motor loss, bone degeneration, spasticity

Question 7

contraindications

Answer 7

active deep vein thrombosis, haemorrhage conditions, pregnancy, damage or at risk skin, cardiac failure, infection, malignancy, recently radiated tissue, tuberculosis, electronic device, impaired circulation

Question 8

precautions

Answer 8

active epiphysis, impaired sensation, impaired cognition, impaired communication, skin disease, regenerating nerves, fatigue

Question 9

how to use FES cycling- frequency

Answer 9

set frequency around 30hz, for higher outputs 50-60hz

Question 10

how to use FES cycling- cadence

Answer 10

training plateaus may be occur due to FES causes rapid muscle fatigue compared to voluntary muscle stimulation
with faster cadences (50RPM), the maximum force produced by the individual decreases quickly, compared to slower cadence. where cadence is slower (20RPM), higher force is generated by the working muscles but the power production is decreased. therefore choosing the right cadence 20RPM-50RPM, should depend on patient goal

Question 11

how to use FES cycling- pulse duration

Answer 11

higher= more energy expenditure, it is important with higher pulse durations for individuals with a SCI above T6- autonomic dyflexia

Question 12

how to use FES cycling- treatment intensity

Answer 12

the intensity may vary depending on whether the motor neuron is intact or whether the muscle needs direct stimulations to elecit a contraction. denervated muscles require up to 100x more electrical energy to elicit contraction. currents range from 120-300MA (150 most common)

Question 13

Compression fractures

Answer 13

common in pt with osteoporosis, if the bone absorbs to much pressure it leads to fractures
wedge fracture- similar to compression fracture, but with a wedge fracture a part of the vertebra, usually anterior, collapses under pressure and becomes wedge shaped

Question 14

burst fracture

Answer 14

caused by severe trauma. This happen when the vertebra is essentially crushed by extreme forces. The vertebra fractured in multiple places. Because vertebra is crushed completely bony fragments can spread out and cause SCI.

Question 15

flexion-distraction fracture

Answer 15

where body is pushed forward, your spine is flexed forward with a sudden forward movement that places incredible stress on spine leading to vertebra breaking. A flexion-distraction usually has fractures in posterior and middle column

Question 16

fracture-dislocation

Answer 16

where the vertebra is dislocated and fractured

Question 17

stable fracture

Answer 17

don’t cause spinal deformity or neurologic problems. Spine can still carry and distribute weight

Question 18

unstable fracture

Answer 18

makes it difficult to distribute weight. They have a chance of changing and progressing and causing further damage, may cause spinal deformity

Question 19

Minor fracture

Answer 19

means part of the posterior elements of vertebra has broken- not important for spinal stability, e.g. facet joints, SP

Question 20

Major fracturee

Answer 20

means part of the vertebral body, the pedicles, or the lamina has fractured. Major because it helps to carry so much weight and distribute force. Increased possibility of nerve damage

Question 21

anterior column

Answer 21

anterior column is the front half of the vertebral body and intervertebral disc. Supported by ALL

Question 22

posterior column

Answer 22

all parts of the vertebra that are on the back side, including pedicles, lamina, facet joints and SP

Question 23

middle column

Answer 23

key part of spinal stability. Its the back half of the vertebral body and intervertebral disc. Much more likely to have nerve damage if fracture to middle column as well as other part (more likely to have unstable fracture)

Question 24

spinothalamic tract

Answer 24

lateral- carries pain and temp, anterior- itch, tickle, pressure, vibrations

Question 25

Route of spinothalamic

Answer 25

FON bring signal from a receptor and synapses with SON at the level of entry into the spinal cord. SON crosses to the opposite side of the spinal cord and then ascends to the thalamus. The SON synapses with a TON at the thalamus and this then travels to the primary somatosensory cortex

Question 26

autoimmune hepatitis

Answer 26

Occurs when your body’s immune system attacks your liver cells causes swelling, inflammation and liver damage
can lead to liver failure or liver cancer

Question 27

how does CBD oil work

Answer 27

interacts with endocannobinoid system. The ECS consists of a series of receptors and eiocosanoids (inflammatory mediators) that regulate homeostasis throughout body. There are endocannabinoid receptors found on virtually every organ in human body, with the highest concentration in CNS. The endocannabinoid system functions like read receipts used in text messages. When the nerve sends a message, the receiving nerve cell uses the ECS to tell the sending nerve that message was received- keeps entire NS in constant feedback with each other and prevents sending the same message more than once- which is essentially what happens when we experience neuropathic pain

Question 28

benefirs of CBD

Answer 28

protects the nerve cell and brain, supports nerve cell regeneration, blocks pain transmission, regulates electrical activity in brain, alleviates anxiety and depression

Question 29

what is CBD

Answer 29

CBD is a chemical found in marijuana. CBD doesn’t contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that produces a high.

Question 30

side effects of CBD

Answer 30

drowsiness, dry mouth, lower head rate sedation

Question 31

benefits of CBD oil for SCI pts

Answer 31

managing chronic pain, relieving symptoms of mild-moderate depression, promotes nerve regen, possibly reducing nerve damage from incident

Question 32

SCI atrophy

Answer 32

Castro et al, SCI and the ensuing muscular disuse lead to muscle atrophy for muscles innervated by motor pools below the lesion and conversion of these muscle fibres type to fast fatigable type 11b. Atrophy occurs quickly with a 33-45% decline in muscle cross sectional area following injury. The rapid atorphy is accompanied by a slower conversation of type 1 muscle fibers to type IIb in humans. These 2 things combined produce a loss in muscle output.

Question 33

how can electrical stimulation effect muscle atrophy

Answer 33

electrical stimulation can reverse the muscle mass loss and prevent conversation conversation of muscle fibres to different types, although the amount of conversation and gain in muscle force varies depending on stimulation protocol and the loading presented to muscles being stimulated.

Question 34

Dorsal columns

Answer 34

this is found in the dorsal white matter, this carries information from skin receptrs, joint and muscle receptors, 2 sections gracils and cuneatus. Fine touch, 2-point discrimination, conscious proprioception, and vibration sensations from the body

Question 35

Doral column order neurones

Answer 35

FON brings signal from a receptor, UL= cuneatus and LL uses gracilits. FON synapses with SON at the gracile nucleus or cuneate nucleus and crosses contralaterally @medulla and travels to thalamus. SON synapse with TON at thalamus and TON travels to the primary somatosensory cortex

Question 36

how does Azathioprine work

Answer 36

Azathioprine is a type of medicine called an immunosuppressant. These medicines work by suppressing or “calming” your immune system. This means your immune system becomes weaker. If you take azathioprine for an inflammatory or autoimmune condition, it slows down the production of new cells in your body’s immune system.

Question 37

GAS- JC

Answer 37

1st goal- +1 as able to achieve more than 12 reps
2- 0 as likely to achieve this
3- on track to achieve before set end date- as pt stepping improved significantly with reps

Question 38

GAS JS

Answer 38

-1- On track to achieve goal as pt posture is already improving- pt more aware
goal 2- -1 on track to achieve- but limited abdominal work in last couple of sessions
goal 3- 0
goal 4- +1
goal 5- 0 pt feels much more confident doing split level transfers after one session

Question 39

what causes neuropathic pain

Answer 39

Neuropathic pain (“neurogenic pain”) is caused by abnormal communication between the nerves that were damaged by your spinal cord injury and the brain, where nerve signals that inform your brain how your body feels are interpreted. In neuropathic pain, it is thought that the brain “misunderstands” the signals it is getting from around the area of your injury and causes you to experience pain coming from below where you have little or no feeling. This is why a person can feel neuropathic pain in an area that otherwise has no feeling.

Question 40

Exoskeleton

Answer 40

The battery-powered system features a light, wearable exoskeleton with motors at the hip and knee joints. The ReWalker controls movement using subtle changes in his/her center of gravity. A forward tilt of the upper body is sensed by the system, which initiates the first step. Repeated body shifting generates a sequence of steps which mimics a functional natural gait of the legs.

Question 41

Proprioception

Answer 41

visual feedback from mirror

visual target

Question 42

Spinocerebellar tract

Answer 42

This tract runs from the spinal cord to the cerebellum. Made up of 2 sections
Posterior spino-cerebellar tract- this is an uncrossed tract (i.e. the fibres rises ipsilaterally) and enter the cerebellum via the inferior cerebellar peduncle
Anterior spino-cerebellar tract- this is a tract in which most fibres cross the spinal cord at entry level and then crosses back just before entering the cerebellum via the superior cerebellar peduncle. Those fibres that do not cross at the level of entry to the spinal cord rise ipsilaterally and enter the cerebellum via the superior cerebellar peduncle also
It doesn’t cross at all and carries information at the same side (damage effect same side)

Question 43

spinal stabilisation surgery

Answer 43

Includes instrumentation and fusion. instrumentations refers to different types of implantable devices, such as rods/screws/plates or interbody cages. Spinal fusion involved autofraft (your own bone) or allograft (donor bone) that is packed into and around the instrumentation to stimulate bone growth/healing.

Question 44

Spinal decompression surgery and fusion

Answer 44

goal is to relieve pressure on SC and nerves. This can be accomplished by removing damaged structures or soft tissue pressing on the cord and nerves- creating space.