PT Management of pt with SCI Flashcards
skin care
passive pressure relief initially
observe/monitor
pt education to self monitor ASAP; teach active pressure relief techniques
order WC cushion or other to relief pressure (heel protectors)
Early intervention pressure relief
turn pt q 2 hours
check skin each time
avoid direct sidelying position
use pillows, foam, blocks to protect bony landmarks
types of beds for pressure relief
low-air-loss bed
rotating bed
air-fluidized bed (clinitron- beads floating)
Active pressure relief techniques
WC pushups- C7 for triceps, trunk leans forward
forward leans- C5-C6
side leans C5- biceps
Devices to help respiration
positive pressure ventilators (PPV)- helps inhalation; uses trach
non-invasive positive pressure ventilators (NPPV)- through face mask
phrenic N stimulator- Sx puts electrode on diaphragm, must have intact nerve
GPB
glossopharyngeal breath; for high level C injuries
pt inspire small amts air repeatedly using sip or gulp
improves chest expansion, voice volume
pt still has trach for breathing
PT way to help respiration
encourage diaphragmatic breathing- visual FB
quick stretch to diaphragm; breathe with resistance to help strengthen
quick stretch to accessory ms
Strengthening exercises for breathing
diaphragm- MR, weights
trainers- dial changes resistance of inhalation
Assisted cough
assists mvt of secretions
pt pushed in and up on epigastric area
use abdominal binder- helps resting position of diaphragm and helps postural hypotension
tolerance to vertical
gradual acclimation- elevate head of bed, tilt table, back support, reclining WC most common
monitor vitals- BP
use compression garments
ROM post SCI
begin PROM/ positioning don't overstretch low back or long finger FL instruct pt/caregiver in self ROM splint/ brace to protect ROM may need substitution techniques
selective stretching C7 above fingers
no long finger FL preserve tenodesis stretch finger Ext with wrist fully FL stretch finger FL with wrist fully Ext IP flexed with WB activities don't overstretch wrist Ext
Selective stretching C7 above back
keep some tightness n low back don't dissociate upper/lower trunk important for stability/transfers stretch HS in supine (100 degrees) avoid long-sitting with short hamstrings (uses back)
Strengthening program options
isometric PRE (conc/ecc) through functional activities PNF FES avoid stress on unstable vertebral areas
Exercise guidelines
check chart for contraindications monitor response to activity watch for autonomic dysreflexia acute- avoid ex that are assymmetrical or rotational forces on spine until stable warm up, activity, cool down phases vary pt position incorporate breathing ex amap be creative individual vs group include function address life long fitness needs
pool therapy
increase mobility buoyancy resistance relaxation for painful WB endurance psychological, socialization, fun, variety
pool contraindications
open wound
colostomy/ bowel incontinence
fear
temp regulation above T6
balance training
learn to manage new COM determine LOS impact of orthotics, body type long sitting, short sitting, POE during transfers recovery/protective responses must be taught- let em fall
mobility skills/ ADL
bed mobility transfers WC skills/ gait how to fall and get back up assess equipment needs work with OT/speech
Compensation vs restoration
compensation- motor function absent below lesion (ASIA A or B)
restoration- motor function preserved or neurons (ASIA C or D)
ms substitutions
using gravity: SH ABD/ IR for pronation
tenodesis
fixation of distal extremity- ant delt/ pec mj to ext elbow; SH ER/ ant delt to ext elbow
Head hips relationship
to move butt- move head in opposite direction
eg- to move butt up and left, move head down and right
start with head in direction you want to go and swing opp
momentum
mass+velocity
throwing vs placing extremity
rolling (throwing head and arms)
sitting to supine with leg loops
intertia
easier to keep object moving than start it moving
transfer with 2-3 long pushes vs short pushes
keep WC moving
Friction and vectors
friction- clothing, WC cushion, sliding board
vectors- use horizontal force to transfer if can’t lift
Mat activities
rolling
prone progression
supine progression- sup to supine on elbows to long sit
sitting progression
requirements for gait
ms strength- complete vs incomplete
ROM- hip ext
CV endurance
motivation
Gait complicating factors
spasticity pain loss of proprioception pressure ulcers HO- fx risk, limit ROM
predictors of ability to walk
paraplegia- incomplete 76% community amb
tetraplegia- ASIA D 100%
ASIA C (50 yo) 42%
Orthotics
stability during stance
enhance swing
can prevent, limit, cause, or resist mvt around jt
Considerations for orthotic
adjustability weight durability impact on skin ease of donning/ doffing cosmesis cost
+/- for conventional orthotic
+ strong, durable adjustable
- heavy, att to shoe, bulky, poor contour to limb, increase energy expenditure
AFO
pt usually can stabilize knee
can be used to control mvt at knee
can assist or stop DF/PF
if hinge, can control ankle and knee (DF causes knee FL)
Scott craig KAFO
max stability at foot ankle- walk with swing through
locks knee, can unlock to sit
ankle immobile 5-10 deg of ADF
allow balance in standing without UE support
HKAFO
controls hip
options- lock hip in ext, allow lmtd FL/Ext, cause reciprocal motion
Types of THKAFO’s
HGO- hip guidance orthosis
RGO- reciprocating gait orthosis- cables work together
Practice with orthotics
parallel bar, RW, crutches, Lofstran crutches donning/ doffing sit<>stand trunk balancing- wt shift turning around jack-knifing ambulation falling- how to get back up
Exoskeleton
provide power for walking/standing
reciprocal gait
adjustable parameters
top speed .46-.66 m/s
exoskeleton requirements
5'2"-6'2" wt<220 lbs near normal ROM UE manageable spasticity UE strength (triceps) able to be FWB
