Module 2 Flashcards
In clients with altered cardiac sympathetic drive, evidence indicates that practitioners who wish to monitor exercise intensity:
A) Have no valid alternative to heart rate and should just ensure intensity is very light.
B) Can use Borg’s Rating of Perceived Exertion to gauge exercise intensity.
C) Should keep a meticulous qualitative record of factors such as breathing rate and sweet rate rather than use heart rate.
B
The physical work capacity of a person with neurologically limited maximum heart rate will be:
A) Reduced
B) Increased
C) Unable to predict
D) Unaffected
A
Cardiac sympathetic drive will be either reduced or absent in people who have a spinal cord injury at or above:
a) Segmental level TI
b) segmental level T5;
c) Segmental level T3;
d) Segmental level C7;
e) All of the above.
E
You have two clients with complete spinal cord injuries, one whose lowest intact segmental level is C5 and one whose is C8. Based on table 1 in the ESSA position statement on exercise and spinal cord injury, describe what the main differences in motor function are likely to be between these two people in relation to functional grasp, mobility, transfers from chair to bench and getting from lying to sitting.
C5: No function grasp, will need either a power or hand-rimmed propelled wheelchair, will require some assistance moving from chair to bench and is independent for moving from floor to chair, and needs moderate assistance moving from lying to sitting.
C8: Reduced functional grasp, can use hand-rim propelled wheelchair, will need some assistance moving from chair to bench and floor to chair, and is independent in moving from lying to sitting.
Explain how these differences might affect exercise programming for these people.
C5 person will have limited capacity to do exercises that require manipulation of objects due to their lack of functional grasp, or they will need assistive equipment like specialised mitts or straps, whereas the C8 person will likely be able to do such exercises with greater ease.
Explain what syringomyelia is, two (2) signs or symptoms would make you suspect the presence of one and what action you, as an exercise physiologist, would take in the event someone had those signs and symptoms.
It is a neurological disorder in which abnormal fluid-filled cavities (syrinx) appear within the spinal cord. The syrinx can then grow over time and begin compressing and injure the spinal nerves.
1. Dull/aching/burning pain and sensory loss above the level of injury that can be exacerbated by coughing, sneezing or straining.
2. Progressive asymmetrical weakening.
As an EP, if new pains, sensory loss, or progress asymmetrical weakness occurs, I would refer them to a specialist or GP for further investigation into their condition which can then help inform my prescription of exercise.
According to the conclusions presented in the abstract of the 2012 Study by Chang et al on QOL and SCI, what variables factors exert the strongest influence on QOL following spinal cord injury?
Outline three variables.
Name one variable that does not directly influence QOL?
- Marital status
- Participation
- Activity
Impairment does not directly influence QOL.
Outline two (2) strategies and solutions could you employ to assist someone with a mid-thoracic spinal cord injury to overcome problems with sitting balance in an exercise situation.
- Ensure proper seating position, and wheelchair construction with reclined seat surface and high back rest such that the knees rest above the hips.
- Use adapted exercise equipment such as wheelchair straps, seats with high backrests and wide benches to maximise stability during dynamic movement.
Explain what a pressure sore is and why people with spinal cord injuries are susceptible to them?
Skin and soft tissue injuries that develop due to prolonged pressure exerted over specific areas of the body, resulting in blood occlusion to this area which causes hypoxic and necrotic tissue damage.
People with SCI are particularly susceptible to these due to the absence of afferent input from pressure and pain receptors therefore unable to tell damage could be occurring.
Where do the sores commonly occur and why?
Around bony prominences like the tailbone and heels. With the bone being closer to the surface of the body, greater pressure is applied to the little soft tissue that covers these areas which increases the risk of these sores.
How could you assess whether a red area on the skin required further investigation and what action would you take if it did?
Press your finger in the middle of the red area. If after a minute the area returns back to red, the sore is likely of little concern and you should treat the person by minimising pressure applied to this area and encourage regular repositioning.
If the area goes white, this indicates that the blood is not circulating in this area and complications are likely to occur, therefore refer to medical professional. Until it can be further inspected, treat similarly to other red area.
Explain why wheelchair users have an increased incidence of shoulder pain and describe two (2) strategies and solutions that you could employ to help to prevent this problem.
Due to using their upper limbs for heavy, highly repetitive tasks that they are not designed for, which can result in joint pathology or referred pain from the spine.
1. Exercises that mimic the posture and movement patterns that the person usually performs in ADLs or in their sport should be prescribed.
2. Exercises that minimise neck hypertension, strengthen scapula stabilisers + rotator cuffs, and improve positioning of the humeral head and stability of the glenohumeral joint should be prescribed.
Explain why a spinal cord injury at C2 or above might be fatal?
A SCI in the high cervical nerves can result in severe impairment that will require 24hr personal care as a person will be completely paralysed from the head down.
Independent breathing, bowel, and bladder control will be impaired as the nerves responsible for these actions originate in these higher cervical areas.
Almost completely paralysed and have no control of many vital organ systems, the chances of this injury proving to be fatal are high.
