Final - Preserving UE & Complications after SCI Flashcards
prevention
modification of task
work at or below shoulder height
scapular stabilizing and tooter cuff strengthening
high risk areas of pain
joints - shoulders, elbows, wrist, fingers
12 tips for preserving UE functions
- decide power or manual wheelchair
- get ultralight w/c (K5 or K9)
- make sure chair fits
- keep tires inflated
- use long smooth strokes when pushing
- pressure relief that is gentle to the arms
- elevate chair and avoid hand above shoulder
- use adaptive equipment
- power lift when necessary
- change environment
- mental health and coping
- exercise, stretch, strengthen
muscles involved in respiration
diaphragm - C4
intercostals - T1-11
abs - T7-12
OT evaluation of respiratory issues
- Breathing pattern
- Chest excursion
- Respiratory rate
- Cough
- Pulmonary function tests
- Posture
- Breath support for speech
OT intervention for respiratory issues
Clearing secretions:
o Teach assisted coughing (“quad coughs”).
o Teach importance of a regular turning schedule. o Begin OOB activity as soon as possible.
Breathing capacity:
o Teach deep-breathing exercises.
o Teach importance of good posture.
o Use an abdominal binder during initial OOB activities.
o Strengthen muscles for inhalation, exhalation, and posture.
How to complete a manually assisted cough (quad cough) (and levels)
(C4-T12)
- Instruct the patient to breathe in as deeply as he can.
- Have patient hold his breath briefly. Allow adequate time for inspiration prior to the “hold” phase of the cough.
- Instruct the patient to cough. The helper should apply the cough-assist forces just prior to the opening of the glottis and continue force as the patient coughs.
What is HO?
heterotrophic ossification
• Condition in which connective tissue calcifies around the joint.
• Usually appears 1-4 months after injury.
• Recorded in 16-53% of SCI cases.
• Cause is unknown.
What are symptoms of HO?
- Warm swollen extremity
- Fever
- Range of motion limitations (hips, knees, shoulders, elbows most often)
- PAIN
What should you do with HO
PRIMARY TREATMENT IS PREVENTION.
• Positioning
• Daily ROM (AAROM/PROM after NSAIDS)
• Compensatory techniques for decreased ROM/pain
• Recommend specialized seating system for pressure relief (when hip involved)
• Monitor joint ranges
What is AD and who is at risk?
know level
- Results from a “disconnection” between the brain and sympathetic neurons in thoracolumbar cord
- Occurs when a noxious stimulus below the lesion triggers an excessive sympathetic response • Occurs in 10-85% of SCI T6 and above (more common in complete tetraplegia)
- LIFE-THREATENING EMERGENCY (can lead to stroke)
symptoms of AD
Sudden increase in blood pressure
Bradycardia
Pounding HA
Flushing and profuse sweating above level of lesion
Additional symptoms: Flushing or sweating below the lesion, “goose bumps” above or sometimes below the lesion, blurred vision, spots in the visual fields, nasal congestion and cardiac arrythmias, occasionally NO SYMPTOMS.
What causes AD?
Bladder or rectal distension • Urinary tract infection • Bowel impaction Other Causes: Pressure ulcers, muscle spasm, fractures, ingrown toenails, ROM exercises, functional e- stim, electroejaculation, vaginitis, scrotal compression, sexual intercourse, labor, surgical procedures
What to do with AD
- Stop any ongoing activity, as it may á BP.
- Sit patient upright.
- Check BP every 5 minutes and try to locate cause.
- Loosen clothing, abdominal binder, and any other constrictive devices
- Check urinary catheter for kinks or folds and straighten any.
- If increased BP continues, seek medical assistance.
- May include bladder irrigation, manual fecal evacuation, medications.
What is OH?
Sudden drop in BP occurring when a person assumes an upright position. Caused by impaired autonomic regulation.
̄ blood supply returning to the heart
COMMONLY EXPERIENCED IN PATIENTS AFTER PROLONGED STAY IN BED.
symptoms of OH
- Lightheadedness
- Feeling dizzy
- Pallor
- Visual changes
causes of OH
Moving to a more upright position, e.g.: o Raising the HOB
o Supine to sit
o Sit to stand
what to do with OH
Check BP.
- If the person is in bed, lower the head of the bed.
- If the person is in a wheelchair, lift legs and observe for signs of relief.
- If symptoms persist, recline the wheelchair or put the patient in bed.
- Continue to monitor BP and seek medical assistance.
- Do not leave the patient unattended.
What can you do to prevent OH during treatment?
- Assume gradual upright position (raising HOB, using reclining w/c with elevating leg rests)
- Thigh-high anti-embolic stockings
- ACE wraps
- Abdominal binder
what is a DVT?
Formation of a blood clot, most often in the LE
A clot may dislodge from the venous wall forming an embolus POTENTIALLY LIFE-THREATENING - can lead to pulmonary embolism
o 2-16% of people with SCI die from PE within the first 3 months after injury. o Rare in chronic SCI, highest incidence 72hrs to 2wks post injury
symptoms fo DVT
(can be UE too) Calf pain and tenderness • Leg swelling • Leg discoloration (blue or red) • Increased warmth in the leg
What is a PE?
Pulmonary embolism = DVT that has propagated to vessels of lungs
• = High mortality
• Symptoms: Decreased O2 sats, SOB, Tachypnea, Tachycardia, Hypotension
What increases risk for DVT?
Immobilization • Having undergone a surgical procedure • Having been subjected to major trauma • Increasing age • Malignancy (cancerous tumor) • Heart failure • A previous bout with deep vein thrombosis • The use of oral contraceptives • Pregnancy • Diabetes • Obesity • Childbirth • Tobacco smoking
what to do with a DVT
• Observe any asymmetry in the LE in color, size, temperature. Report to MD.
• If DVT identified via ultrasound, discontinue OOB treatments until medically cleared by
MD.
- do not move that limb!
