Lecture: SCI intervention and Lab Flashcards
Acute Management of SCI
Pharmacologic management
Surgical realignment and stabilization
Prevention of secondary complications
Surgical management of non-traumatic SCI
Laminectomy
Spinal fusion
Mobility Training for Plasticity vs Compensation
Compensatory techniques can always be added, may be difficult to overcome maladaptive plasticity
When selecting intervention technique, for SCI consider:
Anticipated functional outcomes
Time since injury
Completeness of injury
UE considerations for mat skills
Need 70-90 degrees of wrist extension
Preserve tenodesis
During mobility requiring UE support on surface, keep fingers in flexion
Long sitting vs ring sitting, which one is prefered
Long sitting Needed for: -Dressing -Transfers -Helps UE mobility -Hamstring stretch-good for mobility
Why would someone ring sit
if hamstrings will not allow it
also to off load UEs (used for tetraplegia balance training)
Why emphasize trunk control in strength training for high SCI level?
- 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
UE concerns with SCI pts
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
Wheelchair Propulsion Patterns - what are the 4 types and which ones are prefered
- arc
- single loop
- double loop
- semicircular
double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power.
WC elevator negotiation
Ride in the elevator facing forward in order to exit safely in case of an emergency
Back in
FES is not indicated for people with
FES will not override spasticity
What’s better body weight supported treadmill training or overground
For task specificity over ground training is better.
3 Principles of Compensatory Techniques
- Muscle substitution
- Angular momentum
- Head-hips relationship:
SCI Compensatory Technique for forearm pronation
Shoulder abduction and internal rotation will cause forearm pronation.
SCI Compensatory Technique for grasping
Extensor carpi radialis longus and brevis will extend the wrist and flex the fingers for a “tenodesis grasp” when extrinsic finger flexors are tight.
SCI Compensatory Technique for elbow extension
Shoulder flexion, external rotation, and adduction can be used to extend the elbow if the hand is stabilized.
SCI Compensatory Technique, Head-hips relationship
Move hips/buttocks by moving the head in the opposite direction.
Can SCI pts without UE still use momentum to roll
Pts without UEs can use head momentum to assist in their rolling
Why is prone positioning good for SCI pts
- Preserve hip ROM
- Strengthen UEs
- Practice breathing techniques
What is irradiation
The application of high resistance to stronger muscles causes overflow/increased activity in weaker muscles within the same pattern of movement.
WC negotiation and ascending ramps vs descending ramps
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.
