L9 Compensatory Strategies Flashcards
What are the choices when it comes to selecting an intervention for SCI?
- mobility training
- Therex
- Equipment selection
- Education
Capacity of recovery of mobility is dictated by
the amount of voluntary motor function that is preserved after injury
Activity Training Tips
Progressively build more challenging skills
Demonstrate and explain the skill
Do not give up on training if they fail, it takes a long time
Do a movement analysis to determine what is happening
Substitution
use of tension in passive structures to create movement
Compensatory Strategies
Substitution
Angular Momentum
Head Hips
Strengthening of preserved musculature
Development and preservation of ROM
Use of equipment
What pts will need compensatory strategies for rolling?
ASIA A or B, T6 and higher are most likely to benefit
pts with C5-C6 will need equipment
pts with above C4 will be dependent
Compensatory strategies for rolling
angular momentum
use of equipment to allow biceps to assist
How to recognize if activity is too hard or easy
pt perception of exertion
more erros than desirable
cant complete task
can only do the activity once
activity causes pain or other distress
Long sit w/T1 complete SCI
hamstrings and lumbar paraspinals will help individual from falling forward
sitting tall would cause the pt to fall backwards
flexing knees could cause the pt to fall
Why do you need long sitting?
getting dressed
to prepare for transfer out of bed
mid thoracic to C5 pts would benefit from long sitting
To practice gross mobility in sitting, the pt has to be able to
tolerate an upright sitting position
prop on their arms with elbows extended
lift or unweight their buttocks in long sitting
Progression/REgression of Long Sit
arm support (double, single, none)
Explore the LOS
Static to dynamic activity
Why would you need to short sit?
prepare for transfers
prepare for sitting in W/C
Pt must be able to ____ to short sit
tolerate upright position
prop on UE with elbows extended
Why do you need to be able to transfer with SCI?
transfer between two surfaces, either laterally or vertically
Transfers require…
patient to tolerate upright
prop on UE with elbows extended
perform pelvic lift w/heads hips technique
Can someone without triceps perform a lateral transfer?
very unusual to do it independently
patients with injury above C5 will be dependent
Locomotion
ability to move from one place to another
manual, power assist, power W/c, gait training for SCI
Outcome measures for w/c
6 minute roll test
Craig handicap (CHART)–measures activity and participation
Spinal Cord Injury Independence–activity measurement
To propel a w/c, patient has to be able to
tolerate upright sitting
be able to position self and maintain position
perform pressure relief
handle w/c
drive w/c
Easier to propel w/c
friction increasing tools
tubing wrapped on wheel rim
fingerless gloves
If hand function is compromised, what are the options for w/c?
wrists splints to allow for base of hand propulsion
propulsion with hand rim projections
power assist w/c
Prediction of ambulation
age
motor and sensory function–> L3 and S1 dermatome and myotomes
accurate for Ais A and D
Gait Training Cost
-pts with complete or AIS B are less likely to return to walking
-energy cost is high, price of orthotics, risk of falls
-can help with spasticity, bowel and bladder function, pain
Orthotics for Gait
can prevent, limit, assist, or resist movement of joints
AFO = controls ankle, for L4-S1
KAFO = controls knee and ankle, T12-L3
HKAFO = controls hip, knee, ankle, T1-T12
ADs for Gait
many pts will require an AD to off load LE and provide stability during gait
the more motor preservation, the least restrictive the device can be
FWW, Forearm crutches, SPC
Training of Gait
start in parallel bars with orthoses
very close guarding
use feedback, and try to help them find stable point with passive tension
Jackknife
if COM is anterior to the hips, they have not muscular control to recover balance
After parallel bars
can transition to crutches or FWW once they can maintain standing will little pulling
use a swing to gait (LESS STABLE) or swing through gait when HKAFO or KAFO are used
must teach how to take off orthotics, sit to stand, and floor transfer for falls
Reach and Grasp
needed for eating, dressing, manipulating objects
pt needs innervation to UE and control of posture within LOS
Central Cord Syndrome
most common incomplete cervical SCI
caused by hyperextension and trauma, often with older adults
presents as weakness of UE, more than LE. Loss of pain and temperautre in UE
Compensatory strategies for Reach and Grasp
tenodesis grip
orthotics and ADs
strengthening of muscles
referral to OT
medical procedure to transfer high functioning tendons to less functioning tendons
