MIDTERMS: SCI Flashcards
32-year-old male, C2 injury, ventilator-dependent, total assist for ADLs.
Expected outcomes for respiratory, bed mobility, w/c propulsion?
Key equipment?
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.
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?
ADL Assist: Total assist for setup; adaptive devices for some independence.
Pressure Relief: Power recline/tilt w/c, pressure cushion, specialty bed.
28-year-old male, C5 injury, intact shoulder/elbow flexion, uses manual w/c.
Equipment for eating/grooming?
Assist level for bed mobility/transfers?
Adaptive Devices: Long opponens splint, adaptive utensils.
Bed Mobility: Some assist with electric bed.
Transfers: Total assist with lift/transfer board.
55-year-old female, C1 injury, 24-hour care needed, limited communication.
Communication aids?
Suitable transport?
Communication: Mouth stick, computer access, adaptive boards.
Transport: Attendant-operated van with lift.
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?
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.
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?
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.
What are the key steps in pre-hospital care for suspected spinal cord injury (SCI)?
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).
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?
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.
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?
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.
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
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
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?
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.
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?
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.
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
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
Expected outcomes for: T10-L1 Injury
All activities: Independent
Ambulation: Not functional
Standing: Independent
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
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
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
What is the purpose of tongs in spinal surgery?
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.
What is the standard pharmacological treatment for spinal cord injury?
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.
Expected outcomes for: L2-S5 Injury
All activities: Independent
Optional ambulation
L2-L3: Household ambulation
L3 and below: Community ambulation
Respiratory: No assist needed
Bowel/Bladder: Independent
Transfers: Independent
Eating/Grooming/Bathing: Independent
What devices are used for immobilization after spinal injuries?
Tongs, halo devices, and turning frames are used to stabilize the spine; halo devices stabilize cervical fractures and are contraindicated with respiratory involvement.
What are the primary goals of respiratory management in SCI patients?
Improve ventilation and cough effectiveness, prevent chest tightness and ineffective breathing patterns; patients with C8 injuries and above often have shallow breathing.
What types of exercises are beneficial for respiratory management?
Deep breathing (diaphragmatic exercises), glossopharyngeal breathing (improves respiratory muscle function), and assisted coughing (manual contacts over the epigastric area to aid coughing).
What is the primary goal of Passive Range of Motion (PROM)?
To decrease complications from immobilization, such as cartilage degeneration, adhesion, contracture formation, and sluggish circulation.
What is the principle behind muscle strengthening after injury?
The neuromuscular system can adapt to exercise stress, allowing for muscle strengthening.
What stretching techniques are beneficial for chest tightness?
Manual stretching of pectoral muscles, selective stretching, modified postural drainage, and using ankle boots or splints to prevent heel cord tightness.
