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Neuro III Exam 2 > PT Management of pt with SCI > Flashcards

PT Management of pt with SCI Flashcards

1
Q

skin care

A

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)

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2
Q

Early intervention pressure relief

A

turn pt q 2 hours
check skin each time
avoid direct sidelying position
use pillows, foam, blocks to protect bony landmarks

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3
Q

types of beds for pressure relief

A

low-air-loss bed
rotating bed
air-fluidized bed (clinitron- beads floating)

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4
Q

Active pressure relief techniques

A

WC pushups- C7 for triceps, trunk leans forward
forward leans- C5-C6
side leans C5- biceps

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5
Q

Devices to help respiration

A

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

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6
Q

GPB

A

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

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7
Q

PT way to help respiration

A

encourage diaphragmatic breathing- visual FB
quick stretch to diaphragm; breathe with resistance to help strengthen
quick stretch to accessory ms

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8
Q

Strengthening exercises for breathing

A

diaphragm- MR, weights

trainers- dial changes resistance of inhalation

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9
Q

Assisted cough

A

assists mvt of secretions
pt pushed in and up on epigastric area
use abdominal binder- helps resting position of diaphragm and helps postural hypotension

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10
Q

tolerance to vertical

A

gradual acclimation- elevate head of bed, tilt table, back support, reclining WC most common
monitor vitals- BP
use compression garments

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11
Q

ROM post SCI

A 
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
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12
Q

selective stretching C7 above fingers

A 
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
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13
Q

Selective stretching C7 above back

A 
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)
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14
Q

Strengthening program options

A 
isometric
PRE (conc/ecc)
through functional activities
PNF
FES
avoid stress on unstable vertebral areas
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15
Q

Exercise guidelines

A 
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
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16
Q

pool therapy

A 
increase mobility
buoyancy
resistance
relaxation
for painful WB
endurance
psychological, socialization, fun, variety
17
Q

pool contraindications

A

open wound
colostomy/ bowel incontinence
fear
temp regulation above T6

18
Q

balance training

A 
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
19
Q

mobility skills/ ADL

A 
bed mobility
transfers
WC skills/ gait
how to fall and get back up
assess equipment needs
work with OT/speech
20
Q

Compensation vs restoration

A

compensation- motor function absent below lesion (ASIA A or B)
restoration- motor function preserved or neurons (ASIA C or D)

21
Q

ms substitutions

A

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

22
Q

Head hips relationship

A

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

23
Q

momentum

A

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

24
Q

intertia

A

easier to keep object moving than start it moving
transfer with 2-3 long pushes vs short pushes
keep WC moving

25
Q

Friction and vectors

A

friction- clothing, WC cushion, sliding board

vectors- use horizontal force to transfer if can’t lift

26
Q

Mat activities

A

rolling
prone progression
supine progression- sup to supine on elbows to long sit
sitting progression

27
Q

requirements for gait

A

ms strength- complete vs incomplete
ROM- hip ext
CV endurance
motivation

28
Q

Gait complicating factors

A 
spasticity
pain
loss of proprioception
pressure ulcers
HO- fx risk, limit ROM
29
Q

predictors of ability to walk

A

paraplegia- incomplete 76% community amb
tetraplegia- ASIA D 100%
ASIA C (50 yo) 42%

30
Q

Orthotics

A

stability during stance
enhance swing
can prevent, limit, cause, or resist mvt around jt

31
Q

Considerations for orthotic

A 
adjustability
weight
durability
impact on skin
ease of donning/ doffing
cosmesis
cost
32
Q

+/- for conventional orthotic

A

+ strong, durable adjustable

- heavy, att to shoe, bulky, poor contour to limb, increase energy expenditure

33
Q

AFO

A

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)

34
Q

Scott craig KAFO

A

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

35
Q

HKAFO

A

controls hip

options- lock hip in ext, allow lmtd FL/Ext, cause reciprocal motion

36
Q

Types of THKAFO’s

A

HGO- hip guidance orthosis

RGO- reciprocating gait orthosis- cables work together

37
Q

Practice with orthotics

A 
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
38
Q

Exoskeleton

A

provide power for walking/standing
reciprocal gait
adjustable parameters
top speed .46-.66 m/s

39
Q

exoskeleton requirements

A 
5'2"-6'2"
wt<220 lbs
near normal ROM UE
manageable spasticity
UE strength (triceps)
able to be FWB

Neuro III Exam 2 (3 decks)

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