Lab 6: Pulmonary and Wheelchairs Flashcards
What is the pt position for teaching diaphragmatic breathing?
Supine
How should you modify teaching diaphragmatic breathing with a pt with SCI?
Focus on strategies that use visual and verbal cues instead of tactile
How can you facilitate diaphragmatic breathing?
Quick stretch to diaphragm - push epigastric area in and rostrally immediately asking for inspiratory effort
What is upper chest breathing?
Use of accessory muscles to increase volume to enhance cough, support breath for speech or increased activity
How do you facilitate upper chest breathing?
Put hands on upper chest and have patient push into you as they breathe deeply
How do you perform a quick stretch to encourage upper chest breathing?
Push upper chest in and caudally just before asking for inspiration
What muscles are used for upper chest breathing?
Pec major, SCM, scalenes
What is diaphragmatic resistance?
Applying resistance to abdomen while patient breathes deeply
Describe the progression of inspiratory muscle training
Adjust the resistance to patient’s ability and progressively increase with improvement
How can you perform aerobic training with a pt with SCI?
Arm ergomoter and wheelchair
How do you assess for eccentric control of exhalation?
Inhale maximally and say ah for as long as possible - should be 10-12 seconds
What is glossopharyngeal breathing?
Rescue “gup” breathing to sip air if ventilator malfunctions
How do you perform an abdominal thrust to assist with coughing?
Push up and under diaphragm during cough expulsion while avoiding xiphoid process
How do you do a costophrenic assist for coughing?
Hands on lateral aspect of lower ribs and apply graded pressure down and in towards navel on exhalation
What are the four pt positions for self cough techniques?
- Prone on elbows
- Long sitting
- Sitting
- Short sitting
How does a pt perform a self cough technique when in prone?
Surface is applying pressure to abdomen, pt lifts head when they inhale followed by flexing their head as they exhale and cough
How does a pt perform a self cough technique in long sitting?
Lifts head with inhalation and then flexes head and trunk as they cough and exhale
What PNF pattern is used for a self cough techique when sitting?
D2 flexion/extension
Describe how to perform a self cough technique in sitting
Stabilize with one arm on chair, then lift other arm in D2 flexion while inhaling, forcefully go into D2 extension to produce cough
Describe how to perform a self cough technique in short sitting with an abdominal thrust
Have pt sit with their hands on their lower abdomen, after their third inhalation, have them thrust their hand up and under their diaphragm to assist with their cough
What is the expected function outcome for a C5 LOI for wheelchair propulsion?
Independent or some assistance indoors on uncarpeted surface, will have high friction or pegged handrims
What is the expected function outcome for a C6 LOI for wheelchair propulsion?
Independent indoors on uncarpeted surface, may be independent in community, high friction handrims
What is the expected function outcome for a C7 LOI for wheelchair propulsion?
Independent indoors and outdoors on level terrain
Without finger flexors, describe how to move forward with a wheelchair
- Palms against lateral surface of handrims with elbows flexed and shoulders IR
- Push forward using elbow extension combined with shoulder ADD, ER, and flexion
- Hands drift down and back
What are the three techniques to move backward in a wheelchair without finger flexors?
- Palms on outer handrim, squeeze in and pull back
- Palms on top of tire, push back by extending elbow
- Palms on top of tire, shoulder ER and elbows locked, push back by depressing scap
What is a long arc turn?
Push one wheel harder than the other
What is a tight turn?
Push one wheel forward and the other backward
How can the wheelchair be modified to make propulsion easier due to weakness or limited ROM?
Handrim projections - pegs
How do you propel forward with a wheelchair with pegs?
Place palms behind pegs posterior to buttocks and pull forward on the pegs using shoulder and elbow flexion
How do you propel backwards with a wheelchair with pegs?
Place hands against front of pegs and pull back using shoulder extension and scap ADD
What is a a prerequisite skill for negotiating uneven terrain, curbs, ramps, or stairs?
Wheelies
How do you guard when teaching a wheelie?
Behind the chair with the gait belt secured to the wheelchair frame
How do you assume the wheelie position?
Grasp posterior handrims then pull forward quickly and forcefully
How do you maintain balance in a wheelie position?
Find the balance point then practice pulling wheels forward and back to find balance
How do you glide forward in a wheelie?
Find a balance point, then tip the chair slightly forward and push forward on the handrims, then allow the handrims to slide through hands and find the balance point again
How do you ascend a ramp?
Use shorter stroke and reposition hands between pushes
How do you prevent backwards tipping when going up a ramp in a wheelchair?
Forward leaning head and trunk
How do you descend a ramp?
Grip handrims loosely and allow it to slide with resistance to control descent - press palms against handrims
How do you ascend a curb from a stationary position?
Hands on back handrims and pull forward to lift castors, position so castors are on the edge and pull forward while flexing to bring chair up
How do you ascend a curb using momentum?
Same as from stationary but do not stop before or when casters are on curb, just faster
How do you descend backwards from a curb?
Back the chair to the edge, after the wheels pass the curb, control the descent by resisting the handrims - low curbs
How do you reduce risk of tipping when descending a curb backwards?
Lean forward with head and trunk
What are the two options to fall safely from a wheelchair?
- Tuck head and hold wheels
- Tuck head, hold one wheel, and reach across lap to grab opposite armrest or seat
What are the two methods of getting back into a wheelchair after falling?
- Get out of chair and perform floor to chair transfer
- Right wheelchair while staying in the chair
