MIDTERMS: SCI

Question 1

32-year-old male, C2 injury, ventilator-dependent, total assist for ADLs.

Expected outcomes for respiratory, bed mobility, w/c propulsion?
Key equipment?

Answer 1

Respiratory: Ventilator, suction, backup power.
Bed Mobility: Total assist, electric bed with side rails.
W/C: Independent with power w/c (chin/breath control).
Equipment: Recline/tilt w/c, pressure-relief cushion, specialty mattress, 24/7 care.

Question 2

45-year-old female, C4 injury, partial respiratory function, uses power w/c with head control.

Assist needed for eating/grooming?
Equipment for pressure relief?

Answer 2

ADL Assist: Total assist for setup; adaptive devices for some independence.
Pressure Relief: Power recline/tilt w/c, pressure cushion, specialty bed.

Question 2

28-year-old male, C5 injury, intact shoulder/elbow flexion, uses manual w/c.

Equipment for eating/grooming?
Assist level for bed mobility/transfers?

Answer 2

Adaptive Devices: Long opponens splint, adaptive utensils.
Bed Mobility: Some assist with electric bed.
Transfers: Total assist with lift/transfer board.

Question 3

55-year-old female, C1 injury, 24-hour care needed, limited communication.

Communication aids?
Suitable transport?

Answer 3

Communication: Mouth stick, computer access, adaptive boards.
Transport: Attendant-operated van with lift.

Question 4

22-year-old male, C6 injury from a motorcycle accident. He has good shoulder function and limited wrist extension. He requires some assistance for ADLs.

What are his expected outcomes for bowel and bladder management?
What equipment would assist with his mobility?

Answer 4

Bowel/Bladder Management: Total assist; may benefit from adaptive devices for bladder management (e.g., leg bag emptier).
Mobility Equipment: Manual w/c (independent on flat surfaces), transfer board, power w/c with arm drive control.

Question 5

35-year-old female, T1 injury after a sports accident. She has full upper extremity function but limited trunk control. She is motivated to gain independence.

What assistive devices could enhance her independence?
What are her expected outcomes for pressure relief?

Answer 5

Assistive Devices: Wheelchair with elevated leg rests, adaptive eating utensils, and grooming tools.
Pressure Relief: Independent with equipment; may use power recline/tilt w/c and pressure-relief cushions.

Question 6

What are the key steps in pre-hospital care for suspected spinal cord injury (SCI)?

Answer 6

Ensure adequate airway, breathing, and circulation; immobilize the spine in a neutral supine position using a neck brace; transport to trauma center immediately; perform CT, MRI, and X-ray as needed (usually done by paramedics).

Question 6

29-year-old female, L1 injury due to a skiing accident. She has intact hip and knee function and is motivated to walk with assistive devices.

What are her goals for ambulation and independence?
What rehabilitation strategies might support her progress?

Answer 6

Ambulation Goals: Independent ambulation with assistive devices; may use a walker initially.
Rehabilitation Strategies: Strength training for lower extremities, balance training, gait training, and functional activities to enhance mobility.

Question 6

30-year-old female, T10 injury from a car accident. She has some trunk control and can perform transfers with minimal assistance.

What assist is required for self-care activities?
What equipment would be beneficial for her daily activities?

Answer 6

Self-Care Assist: Some to total assist for dressing and grooming; may use adaptive devices for independence.
Beneficial Equipment: Transfer board, shower chair, adaptive utensils, and handheld shower.

Question 6

Expected outcomes for: C6 Injury

Elbow flexion present
Decreased respiratory endurance
Bowel & bladder: Some to total assist
Bed mobility: Some assist
Transfers: Some assist - independent on level
Standing: Total assist

Answer 6

Expected Outcomes:

Respiratory: May need secretion clearance assist
Bowel/Bladder: Some to total assist, adaptive devices
Transfers: Independent on level; some assist uneven
Eating/Grooming/Bathing: Independent with adaptive devices

Question 6

40-year-old male, L3 injury from a fall. He has intact hip flexors and knee extensors, enabling some ambulation.

What are the expected outcomes for standing and ambulation?
What assistive devices might he use?

Answer 6

Standing/Ambulation: Can stand with assistance; may use walker or crutches for ambulation with total assistance as needed.
Assistive Devices: AFO (ankle-foot orthosis), walker or crutches, power wheelchair for longer distances.

Question 7

50-year-old male, C7 injury, independent in daily routines but has decreased endurance.

What are his expected outcomes for respiratory function and communication?
How might he manage fatigue during activities?

Answer 7

Respiratory Function: Able to breathe without a ventilator; requires assist to clear secretions.
Communication: Independent with equipment setup; uses adaptive devices for phone and computer.
Fatigue Management: Scheduled rest breaks, paced activities, and energy conservation techniques.

Question 8

Expected outcomes for:Case: T1-T9 Injury

Compromised respiratory endurance
Bowel & bladder: Independent
Bed mobility: Independent
Transfers: Independent
Pressure relief: Independent with equipment
Standing: Independent

Answer 8

Expected Outcomes:

Respiratory: May need secretion clearance assist
Bowel/Bladder: Independent, adaptive devices as needed
W/C Propulsion: Independent with lightweight wheelchair
Eating/Grooming/Bathing: Independent

Question 8

Expected outcomes for: T10-L1 Injury

All activities: Independent
Ambulation: Not functional
Standing: Independent

Answer 8

Expected Outcomes:

Respiratory: May need secretion clearance assist
Bowel/Bladder: Independent, adaptive devices as needed
Transfers: Independent; may need transfer board
Eating/Grooming/Bathing: Independent

Question 8

Expected outcomes for: C7-C8 Injury

Wrist extension & finger flexion
Ventilator-dependent
Bowel & bladder: Some to total assist
Bed mobility: Independent to some assist
Transfers: Independent to some assist
Standing: Independent to some assist

Answer 8

Expected Outcomes:

Respiratory: May need secretion clearance assist
Bowel/Bladder: Some to total assist, adaptive devices
Transfers: Independent level; some assist uneven
Eating/Grooming: Independent with adaptive devices

Question 9

What is the purpose of tongs in spinal surgery?

Answer 9

Tongs are inserted laterally on the skull to stabilize and align the spine; they can be administered before injury to ensure stability. Delayed surgery can lead to pneumonia and longer hospital stays.

Question 10

What is the standard pharmacological treatment for spinal cord injury?

Answer 10

Methylprednisolone: given as a 30 mg/kg loading dose over 1 hour, followed by 5.4 mg/kg over 23 hours to prevent secondary injury and reduce free radicals. GM1 ganglioside may aid in neural regeneration.

Question 11

Expected outcomes for: L2-S5 Injury

All activities: Independent
Optional ambulation
L2-L3: Household ambulation
L3 and below: Community ambulation

Answer 11

Respiratory: No assist needed
Bowel/Bladder: Independent
Transfers: Independent
Eating/Grooming/Bathing: Independent

Question 12

What devices are used for immobilization after spinal injuries?

Answer 12

Tongs, halo devices, and turning frames are used to stabilize the spine; halo devices stabilize cervical fractures and are contraindicated with respiratory involvement.

Question 13

What are the primary goals of respiratory management in SCI patients?

Answer 13

Improve ventilation and cough effectiveness, prevent chest tightness and ineffective breathing patterns; patients with C8 injuries and above often have shallow breathing.

Question 13

What types of exercises are beneficial for respiratory management?

Answer 13

Deep breathing (diaphragmatic exercises), glossopharyngeal breathing (improves respiratory muscle function), and assisted coughing (manual contacts over the epigastric area to aid coughing).

Question 13

What is the primary goal of Passive Range of Motion (PROM)?

Answer 13

To decrease complications from immobilization, such as cartilage degeneration, adhesion, contracture formation, and sluggish circulation.

Question 13

What is the principle behind muscle strengthening after injury?

Answer 13

The neuromuscular system can adapt to exercise stress, allowing for muscle strengthening.

Question 14

What stretching techniques are beneficial for chest tightness?

Answer 14

Manual stretching of pectoral muscles, selective stretching, modified postural drainage, and using ankle boots or splints to prevent heel cord tightness.

Question 14

What ROM considerations apply to immobilized patients?

Answer 14

Full ROM should be performed daily; specific motions are contraindicated for paraplegia (trunk and hip) and tetraplegia (head and neck). Tightness can improve seating capacity.

Question 14

What are the contraindications for performing PROM?

Answer 14

Unstable fractures, deep vein thrombosis (DVT), active heterotopic ossification, and osteoporosis.

Question 14

What are the types of strength training approaches?

Answer 14

Isometric, isotonic, isokinetic exercises, electrical stimulation, and a focus on endurance training after initial strength training.

Question 15

What complications can arise during strength training?

Answer 15

Spasticity, muscle substitution, reversed origin insertion, effects of drugs (like steroids), and alcohol abuse.

Question 15

What is the primary goal concerning skin integrity in SCI patients?

Answer 15

Prevent pressure ulcers through regular skin inspection; C5 patients may need assistance, while C7 and below can be independent.

Question 15

What is the emphasis during the active rehabilitation phase?

Answer 15

Maximizing functional independence and skills necessary for daily activities, while continuing and expanding upon the resistive exercises from the acute phase.

Question 15

What is the focus of rehabilitation after spinal cord injury?

Answer 15

Emphasize exercise for optimal function and health; focus on respiratory management, preventing indirect impairments, maintaining ROM, and facilitating active movement. Discharge can occur within 2 weeks post-stabilization.

Question 16

What strategies can be used in functional training?

Answer 16

Build a foundation using remaining muscle strength, break down activities into components, simplify tasks, and learn skills in reverse.

Question 17

What are some principles of muscle substitution during rehabilitation?

Answer 17

Substitute by agonists, gravity, passive structures, or fixating the distal extremity to stabilize and strengthen proximal muscles.

Question 18

What does the prone on elbows (POE) position achieve?

Answer 18

: Facilitates head control, proximal stability of glenohumeral and scapular muscles, and prepares for quadruped and sitting positions.