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SCI > Lab 6: Pulmonary and Wheelchairs > Flashcards

Lab 6: Pulmonary and Wheelchairs Flashcards

1
Q

What is the pt position for teaching diaphragmatic breathing?

A

Supine

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2
Q

How should you modify teaching diaphragmatic breathing with a pt with SCI?

A

Focus on strategies that use visual and verbal cues instead of tactile

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3
Q

How can you facilitate diaphragmatic breathing?

A

Quick stretch to diaphragm - push epigastric area in and rostrally immediately asking for inspiratory effort

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4
Q

What is upper chest breathing?

A

Use of accessory muscles to increase volume to enhance cough, support breath for speech or increased activity

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5
Q

How do you facilitate upper chest breathing?

A

Put hands on upper chest and have patient push into you as they breathe deeply

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6
Q

How do you perform a quick stretch to encourage upper chest breathing?

A

Push upper chest in and caudally just before asking for inspiration

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7
Q

What muscles are used for upper chest breathing?

A

Pec major, SCM, scalenes

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8
Q

What is diaphragmatic resistance?

A

Applying resistance to abdomen while patient breathes deeply

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9
Q

Describe the progression of inspiratory muscle training

A

Adjust the resistance to patient’s ability and progressively increase with improvement

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10
Q

How can you perform aerobic training with a pt with SCI?

A

Arm ergomoter and wheelchair

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11
Q

How do you assess for eccentric control of exhalation?

A

Inhale maximally and say ah for as long as possible - should be 10-12 seconds

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12
Q

What is glossopharyngeal breathing?

A

Rescue “gup” breathing to sip air if ventilator malfunctions

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13
Q

How do you perform an abdominal thrust to assist with coughing?

A

Push up and under diaphragm during cough expulsion while avoiding xiphoid process

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14
Q

How do you do a costophrenic assist for coughing?

A

Hands on lateral aspect of lower ribs and apply graded pressure down and in towards navel on exhalation

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15
Q

What are the four pt positions for self cough techniques?

A
  1. Prone on elbows
  2. Long sitting
  3. Sitting
  4. Short sitting
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16
Q

How does a pt perform a self cough technique when in prone?

A

Surface is applying pressure to abdomen, pt lifts head when they inhale followed by flexing their head as they exhale and cough

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17
Q

How does a pt perform a self cough technique in long sitting?

A

Lifts head with inhalation and then flexes head and trunk as they cough and exhale

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18
Q

What PNF pattern is used for a self cough techique when sitting?

A

D2 flexion/extension

19
Q

Describe how to perform a self cough technique in sitting

A

Stabilize with one arm on chair, then lift other arm in D2 flexion while inhaling, forcefully go into D2 extension to produce cough

20
Q

Describe how to perform a self cough technique in short sitting with an abdominal thrust

A

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

21
Q

What is the expected function outcome for a C5 LOI for wheelchair propulsion?

A

Independent or some assistance indoors on uncarpeted surface, will have high friction or pegged handrims

22
Q

What is the expected function outcome for a C6 LOI for wheelchair propulsion?

A

Independent indoors on uncarpeted surface, may be independent in community, high friction handrims

23
Q

What is the expected function outcome for a C7 LOI for wheelchair propulsion?

A

Independent indoors and outdoors on level terrain

24
Q

Without finger flexors, describe how to move forward with a wheelchair

A
  • 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
25
Q

What are the three techniques to move backward in a wheelchair without finger flexors?

A
  • 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
26
Q

What is a long arc turn?

A

Push one wheel harder than the other

27
Q

What is a tight turn?

A

Push one wheel forward and the other backward

28
Q

How can the wheelchair be modified to make propulsion easier due to weakness or limited ROM?

A

Handrim projections - pegs

29
Q

How do you propel forward with a wheelchair with pegs?

A

Place palms behind pegs posterior to buttocks and pull forward on the pegs using shoulder and elbow flexion

30
Q

How do you propel backwards with a wheelchair with pegs?

A

Place hands against front of pegs and pull back using shoulder extension and scap ADD

31
Q

What is a a prerequisite skill for negotiating uneven terrain, curbs, ramps, or stairs?

A

Wheelies

32
Q

How do you guard when teaching a wheelie?

A

Behind the chair with the gait belt secured to the wheelchair frame

33
Q

How do you assume the wheelie position?

A

Grasp posterior handrims then pull forward quickly and forcefully

34
Q

How do you maintain balance in a wheelie position?

A

Find the balance point then practice pulling wheels forward and back to find balance

35
Q

How do you glide forward in a wheelie?

A

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

36
Q

How do you ascend a ramp?

A

Use shorter stroke and reposition hands between pushes

37
Q

How do you prevent backwards tipping when going up a ramp in a wheelchair?

A

Forward leaning head and trunk

38
Q

How do you descend a ramp?

A

Grip handrims loosely and allow it to slide with resistance to control descent - press palms against handrims

39
Q

How do you ascend a curb from a stationary position?

A

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

40
Q

How do you ascend a curb using momentum?

A

Same as from stationary but do not stop before or when casters are on curb, just faster

41
Q

How do you descend backwards from a curb?

A

Back the chair to the edge, after the wheels pass the curb, control the descent by resisting the handrims - low curbs

42
Q

How do you reduce risk of tipping when descending a curb backwards?

A

Lean forward with head and trunk

43
Q

What are the two options to fall safely from a wheelchair?

A
  1. Tuck head and hold wheels
  2. Tuck head, hold one wheel, and reach across lap to grab opposite armrest or seat
44
Q

What are the two methods of getting back into a wheelchair after falling?

A
  1. Get out of chair and perform floor to chair transfer
  2. Right wheelchair while staying in the chair

SCI (6 decks)

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