Lecture: SCI intervention and Lab

Question 1

Acute Management of SCI

Answer 1

Pharmacologic management

Surgical realignment and stabilization

Prevention of secondary complications

Question 2

Surgical management of non-traumatic SCI

Answer 2

Laminectomy

Spinal fusion

Question 3

Mobility Training for Plasticity vs Compensation

Answer 3

Compensatory techniques can always be added, may be difficult to overcome maladaptive plasticity

Question 4

When selecting intervention technique, for SCI consider:

Answer 4

Anticipated functional outcomes

Time since injury

Completeness of injury

Question 5

UE considerations for mat skills

Answer 5

Need 70-90 degrees of wrist extension

Preserve tenodesis

During mobility requiring UE support on surface, keep fingers in flexion

Question 6

Long sitting vs ring sitting, which one is prefered

Answer 6

Long sitting
Needed for:
-Dressing
-Transfers
-Helps UE mobility 
-Hamstring stretch-good for mobility

Question 7

Why would someone ring sit

Answer 7

if hamstrings will not allow it

also to off load UEs (used for tetraplegia balance training)

Question 8

Why emphasize trunk control in strength training for high SCI level?

Answer 8

• Compensate for loss of postural muscles using non-postural muscles
• Train trade off between postural stability and trunk/UE movement
• Train tri-planar movements
• Address respiratory and scoliotic changes with SCI over time

Question 9

UE concerns with SCI pts

Answer 9

Pts are very dependent on their UEs
-Transfers, wheelchair propulsion, stability in sitting, pressure relief, ADLs/IADLs

Optimize UE function by strength training with high reps
-Strength train with active assistance from FES when possible

Splinting is common to protect weak joints, prevent contracture, compensate for lost function

Development of shoulder pain is very common
“Wheelchair user’s shoulder” in up to 100% of long-term WC users
Consider body positioning during all mobility tasks, use of appropriate equipment, avoid overuse

Question 10

Wheelchair Propulsion Patterns - what are the 4 types and which ones are prefered

Answer 10

• arc
• single loop
• double loop
• semicircular

double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power.

Question 11

WC elevator negotiation

Answer 11

Ride in the elevator facing forward in order to exit safely in case of an emergency

Back in

Question 12

FES is not indicated for people with

Answer 12

FES will not override spasticity

Question 13

What’s better body weight supported treadmill training or overground

Answer 13

For task specificity over ground training is better.

Question 14

3 Principles of Compensatory Techniques

Answer 14

• Muscle substitution
• Angular momentum
• Head-hips relationship:

Question 15

SCI Compensatory Technique for forearm pronation

Answer 15

Shoulder abduction and internal rotation will cause forearm pronation.

Question 16

SCI Compensatory Technique for grasping

Answer 16

Extensor carpi radialis longus and brevis will extend the wrist and flex the fingers for a “tenodesis grasp” when extrinsic finger flexors are tight.

Question 17

SCI Compensatory Technique for elbow extension

Answer 17

Shoulder flexion, external rotation, and adduction can be used to extend the elbow if the hand is stabilized.

Question 18

SCI Compensatory Technique, Head-hips relationship

Answer 18

Move hips/buttocks by moving the head in the opposite direction.

Question 19

Can SCI pts without UE still use momentum to roll

Answer 19

Pts without UEs can use head momentum to assist in their rolling

Question 20

Why is prone positioning good for SCI pts

Answer 20

• Preserve hip ROM
• Strengthen UEs
• Practice breathing techniques

Question 21

What is irradiation

Answer 21

The application of high resistance to stronger muscles causes overflow/increased activity in weaker muscles within the same pattern of movement.

Question 22

WC negotiation and ascending ramps vs descending ramps

Answer 22

Ascend Ramp
Push forward forcefully with a forward lean of the head and if possible the trunk. To avoid rolling backward between pushes, use shorter strokes and reposition hands quickly between pushes.

Descend Ramp
The safest way to initially learn is to descend backward. Control rate of descent by slowing the chair with the hand rims; lean forward to counterbalance the backward incline of the chair.