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Neuro III > PT Management > Flashcards

PT Management Flashcards

1
Q

What is the management for skin care?

A

Passive pressure relief initially
Observe/monitor skin environment carefully
Instruct patient in self monitoring ASAP
Initiate active pressure relief techniques
Order WC cushion and/or pressure relieving mattress, or other devices
Pt education
(pressure, shear, moisture and heat)

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2
Q

What is early intervention for skin care?

A

Turn pt every 2 hours
Check skin each time
Avoid direct sidelying position (modified sidelying forward or backward)
Use of pillows, foam, blocks to protect bony prominences

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3
Q

What are types of beds/mattresses that help with pressure relief?

A

Low air loss bed
Air fluidized bed
Rotating bed

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4
Q

What are active pressure relief techniques?

A

Every 10 mins when sitting for 10-15 seconds
Wheelchair push-ups (need C7 and trunk control)
Forward leans (C5-C6 crawl down body, don’t just lean)
Side leans (C5 hook arm behind handle to reposition)

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5
Q

What are the respiratory management techniques?

A

Positive pressure ventilators (PPV)
Non-invasive positive-pressure ventilators (NPPV)
Phrenic nerve stimulator
(C4 and below will be able to breathe independently)

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6
Q

What is a positive pressure ventilator (PPV)?

A

Forces air into the lungs
Specific volume and intervals
Usually through a trach

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7
Q

What is non-invasive positive-pressure ventilator (NPPV)?

A

Inhalation
Total face mask or something other than a trach
Need to have staff that know what they are doing

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8
Q

What is a phrenic nerve stimulator?

A

E-stim to stimulate diaphragm
Uses an internal electrode
Need intact nerve

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9
Q

What is glossopharyngeal breathing (GPB)?

A

For high level cervical injuries
Pt inspire small amounts of air repeatedly using sipping or gulping pattern (can’t breathe all the time like this)
Improves chest expansion
Can help patient’s speaking volume

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10
Q

What are the general exercises for respiratory management?

A

Encourage diaphragmatic breathing (visual cue/feedback)
Quick strentch to diaphragm (in and upward immediately before pt breathes in)
Quickly stretch to accessory muscles (anterior chest)
Deep breathing exercises can increase ROM of rib cage

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11
Q

What are strengthening exercises for respiratory management?

A

Diaphragm- manual resistance/weights, breathe against resistance
Trainers- Pflex, breathing in against resistance, helps with inspiration
Trunk muscles- posture
Aerobic activity- as soon as stable
Eccentric control of exhalation- deep breathing and counting or saying “ahh”, allows pt to speak more in one breath

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12
Q

What is an assisted cough?

A

Need abdominals to have effective cough
Assists with coughing and movement of secretions
Pt pushes in and up on epigastric area (hold breath for quick second to close epiglottis)
Use of abdominal binder (helps with resting position of diaphragm, which helps with support and postural hypotension)

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13
Q

How do you gradually acclimate a patient’s tolerance to vertical

A

elevate head of trunk
tilt table
back support with long sitting
reclining wheelchair (most often)
monitor vital signs (ability to stabilize BP)
use of compression garments/abdominal binders (ace wrap from foot to hip bilaterally- toe to groin)

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14
Q

What is the PT management in ROM?

A

Begin with PROM/positioning in acute phase and progress (need ROM for compensation)
Do not overstretch low back or long finger flexors
Instruct pt in self-ROM
Instruct caregiver
Splint/brace when needed

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15
Q

Selective Stretching

A

??????

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16
Q

What are general theories for strengthening?

A

Assume you can strengthen muscles of T or greater (screen every week for improvement or decline)
Individual and group sessions
Don’t forget head/neck (when stable)
Use variety of techniques (manual, mechanical, gravity and body weight)

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17
Q

What should be included in a strengthening problems?

A 
Isometric
PREs (concentric/eccentric)
Functional activities
PNF
FES
Avoid stress on unstable vertebral areas
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18
Q

What are key muscles for function activities?

A

Lower traps, rhomboids, serratus anterior, lattisimus dorsi, biceps, triceps, ECR and ECU, abdominals, psoas major and quadriceps

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19
Q

What are the key muscle functions?

A 
scapular: depression, adduction, and abduction
shoulder extensors
elbow: flexors and extensors
wrist: extensors
trunk flexors
hip flexors
knee extensors
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20
Q

What are the exercise guidelines for SCI?

A

Check chart for contraindications/precautions (dependent on patient)
Monitor response to activity
Watch for signs of autonomic dysreflexia
Acute: avoid exercises which contribute to asymmetrical and/or rotational forces on the spine (until stable) work in straight lines
Warm-up, activity, cool-down phase
Vary pt position (long sitting, short sitting)
Incorporate breathing exercises into each activity as much as possible
Be creative
Individual vs group therapy
Include functional/recreational activity
Address life long fitness needs

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21
Q

What are benefits of pool therapy for a SCI?

A

increase mobility, buoyancy, resistance, relaxation, painful WB, and endurance

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22
Q

What are other benefits of pool therapy?

A

psychological
socialization
fun
variety

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23
Q

What are the contraindications for pool therapy?

A

Open wound/infection
Colostomy/bowel incontinence (can have indwelling catheter or trach)
Fear
Be careful about temperature regulation (especially T6 and above, 92-96 neutral warmth)

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24
Q

What does balance training include with a SCI?

A

learn to manage new COM (new balance point)
determine LOS (limits of stability)
impact of orthotics, body type
LSP, SSP, POE (long sitting position, short sitting position, prone on elbows)
during transfers
recovery/protective responses must be taught (let them fall or cause them to fail)

25
Q

What mobility skills/ADLs will you need to practice?

A

bed mobility, transfers, wheelchair skills/gait training, how to fall and get back up, assess equipment needs, and work with OT/speech

26
Q

Compensation vs Return?

A

Compensation: motor function absent below lesions (ASIA A/B)
Restoration: motor function preserved or returns (ASIA C/D)

27
Q

What are compensatory movement patterns?

A

movement pattern adaptations to decreased strength

use principles of physics and knowledge of anatomy to facilitate movement

28
Q

What are some common muscle substitutions?

A

Using gravity: shoulder abd/ IR- pronation
Tension in passive structures: tendonesis
Fixation of distal extremity
-anterior deltoid/pect major: extend elbow
-SH ER/anterior deltoid: elbow extension
(these are why you must maintain ROM)

29
Q

What is the head-hips relationship?

A

To move buttock, move head in opposite direction

to move up and to the left, move head down and to the right

30
Q

What are the momentum strategies for SCI?

A

mass + velocity
throwing vs placing extremity
rolling (throwing head and arms)
sitting to supine with leg loops

31
Q

What is the inertia strategy for SCI?

A

Easier to keep an object moving than to start the movement
Ex: initiate next push on WC wheel before it has stopped
Transfer with 2-3 long pushes instead of 8-9 pushes (compensation)

32
Q

What are the types of friction encountered with SCI?

A

type of clothing
WC cushion
sliding board

33
Q

What are the types of vectors encountered with SCI?

A

using horizontal force to transfer if can’t get lift or vertical force

34
Q

How do you manage muscle tone in a SCI?

A

use spasticity for function if possible
if it interferes with function, position/inhibit
FES to fatigue spastic muscles

35
Q

What are the matt activities you work with in SCI?

A 
rolling
prone progression
supine progression
sitting progression
important for function activities (LOL refers to level of lesion)
36
Q

When standing, what ROM should the patient have?

A

Hyperextension of the hip
patient would jack knife if they weren’t in extension
hanging on their y’s

37
Q

What are the benefits of walking/standing?

A

increase bone density
bowel and bladder (gravity)
psychological

38
Q

What are the requirements for gait in SCI?

A 
muscle strength
ROM
cardiovascular endurance
motivation
all depends on patient (gait patterns differ with every patient)
39
Q

What are complicating factors for gait in SCI?

A

spasticity (flexor)
pain
loss of proprioception (will accommodate in other parts)
pressure ulcers
HO (limits range and increases risk of fracture)

40
Q

What are the predictions of a paraplegia walking?

A

complete 5% community ambulators

incomplete 76% community ambulators

41
Q

What are the predictions of a tetraplegia walking?

A

ASIA D 100%

ASIA C 50yo 42%

42
Q

What kind of walking will a T4-T6 SCI be able to do?

A

physiological standing with THKAFO (need some abdominals to walk)

43
Q

What kind of walking will a T9-T12 be able to do?

A

household ambulation with HKAFO and AD

44
Q

What kind of walking will a L2-L4 be able to do?

A

functional ambulation with KAFO and crutches short distances (hip flexion, quads, and ankle DF)

45
Q

What kind of walking will a L4 or lower be able to do?

A

functional ambulation

46
Q

What characteristics do you need to look at before choosing an orthotic?

A

stability during stance
enhance swing
or both
(can prevent, limit, cause or resist movement around a joint)

47
Q

How do you decide to use an orthotic or not?

A

which joints will be spanned
what motions need to be controlled
orthotic components/materials
(team decisions)

48
Q

What are the considerations of orthotics do you need to be aware of?

A

adjustability, weight, durability, impact on skin, ease of donning/doffing, cosmesis, and cost

49
Q

What are the positives of a conventional orthotic?

A

strong
durable
adjustable

50
Q

What are the negatives of a conventional orthotic?

A 
heavy
attached at shoe
bulky under clothes
poor contour to limb
increase energy expenditure
51
Q

When do you use an AFO?

A

weakness around ankle, patient can stabilize knee but can use angle to control movement at knee, can assist or stop DF/PF
a hinge will stop (pin) or encourage (spring) movement

52
Q

What is the Scott-Craig KAFO?

A

Patient need complete control at ankle, ankle immobile 5-10 degrees of DF, allows balance in standing without UE support, has locks on braces, promotes hyperextension in hip

53
Q

What is a HKAFO?

A

controls the hip motion, options can lock the hip in extension, allow limited flexion/extension, cause reciprocal motion,

54
Q

What is the HGO?

A

a HKAFO
Hip guidance orthosis
bar at thoracic

55
Q

What is the RGO?

A

reciprocating gait orthosis (HKAFO)

allows reciprocal gait via bars or cables

56
Q

What is the progression of stability in gait training?

A

parallel bars
walker
crutches
cane

57
Q

What should a SCI practice with gait training?

A 
donning/doffing
sit<>stand
trunk balance
turning around
jack-knifing
ambulation
falling
ramps and curbs -advanced
58
Q

What are exoskeletons?

A

provides power for walking/standing (uses a computer strapped to patient’s back)
reciprocal gait patterns
adjustable parameters
top speed .46-.66 m/s (normal is 1.2m/s)

59
Q

What are the requirements for exoskeletons?

A 
5'2"-6'2"
wt  ROM UEs
manageable spasticity 
UE strength (functional triceps)
able to be FWB

Neuro III (7 decks)

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