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PT Mgmt of Pts w/ SCI Flashcards

1
Q

SCI Stats

A

~13000 new SCI/year

~300,000 persons living w/ SCI

NOTE: LOS 1970s vs. now→ relevant due to their goals and time we get to spend w/ them!!!

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2
Q

STATS

A

see pics

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3
Q

STATS

A
  • Life expectancy
    • Mortality rates highest in 1st yr after injury
    • Cause of death generally from pneumonia or septicemia
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4
Q

Classification of SCI

*components

A
  • Lvl on injury
  • Complete vs. Incomplete injury
  • ASIA/AIS Scale
    • A→ Complete
    • E→ Normal
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5
Q

ASIA/AIS ISNCSCI Form

A

see pics

*also on Canvas

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6
Q

ASIA Scale

*Sensory Testing

A
  • Based on 28 dermatomes
    • Lt touch AND sharp/dull
    • Grading
      • 2= intact
      • 1= impaired
      • 0=absent
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7
Q

ASIA Scale

Sensory Testing

Grading Scale described

A
  • 2= Intact
    • report touch & describe it feels same as face
      • face bc want to compare to somewhere neutral
  • 1= Impaired
    • report touch but does NOT feel same as face
  • 0= Absent
    • Not correctly/reliably reporting being touched
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8
Q

ASIA Scale

Motor Testing

A
  • Confounded by mult. lvl innervation of mm’s
    • Muscle tests may reflect function of 2 or more cord segments
  • Muscle tests are NOT standard MMTs that PTs reg. perform
    • pt is supine
    • Looking @ is mm neurologically intact?
  • To determine level of innervation→ tester looks for strength of 3/5 in one muscle and at least 4/5 in the next most rostral (sup.) muscle
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9
Q

ASIA Scale Motor Testing

Muscle Grades described..

A
  • 0= NO mm contraction
  • 1= Any visible or palpable contraction
  • 2= Able to move @ least 1x thru full ROM in gravity eliminated pos.
  • 3= Full ROM against gravity
  • 4= Full ROM w/ some resistance
  • 5= Full ROM w/ full resistance
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10
Q

ASIA Scale:

Key Muscles

A
  • C5→ Elbow FLEX
  • C6→ Wrist EXT
  • C7→ Elbow EXT
  • C8→ DIP flex of middle digit (hand intrinsics)
  • T1→ 5th digit ABD
  • L2→ Hip FLEX
  • L3→ Knee EXT
  • L4→ Ankle DF
  • L5→ Long toe EXT
  • S1→ Ankle PF
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11
Q

ASIA Scale

*Key Muscles

Describe the Anal-Rectal Muscle Test

A
  • Looks @ deep anal pressure/contraction
  • Anal-Rectal Muscle Test
    • finger in rectum
      • sensation? contraction?
      • *Helps det. classification of exam and SCI
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12
Q

Severity of SCI Injury Classification

*NOTE about Deep anal pressure

A

For injury to be INCOMPLETE→ Pt HAS to be able to detect deep anal pressure

*NO anal contraction, but do have deep anal PRESSURE

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13
Q

Severity of Injury Classification

ASIA A = COMPLETE

A

COMPLETE

  • NO motor OR sensory function is preserved in the sacral segments S4-S5
    • aka NO anal-rectal function (No sacral sparing***)
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14
Q

Severity of Injury Class.

ASIA B= INCOMPLETE

A

INCOMPLETE

  • Sensory, BUT NOT Motor function is preserved BELOW the neuro lvl and includes the sacral segments S4-S5
    • they can detect deep anal pressure, BUT NO ANAL CONTRACTION
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15
Q

Severity of Injury Class.

ASIA C= INCOMPLETE

A

INCOMPLETE

  • Motor function IS PRESERVED below neuro lvl, and More than HALF of key muscles BELOW neuro lvl have a mm grade LESS THAN 3
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16
Q

Severity of Injury Class.

ASIA D= INCOMPLETE

A

INCOMPLETE

  • Motor function IS preserved BELOW neuro lvl, and at least HALF of key muscles BELOW neuro lvl have a muscle grade of 3 OR MORE
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17
Q

Severity of Injury Class.

ASIA E= NORMAL

A

NORMAL

  • Motor AND Sensory function are Normal
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18
Q

Clinical SCI Syndromes

Anterior Cord Syndrome

Facts:

A
  • Most common incomplete syndrome
  • Usually due to:
    • head on collision
    • Blow to back of head
  • Common assoc’d fx:
    • Ant. Wedge Fx
    • Fx of Post. elements
      • SP, laminae and pedicles
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19
Q

Clinical SCI Syndromes

Anterior Cord Syndrome

*Presentation

A
  • Loss of motor function
    • Dmg to corticospinal tract
  • Loss of pain and temp sensation
    • Dmg to spinothalamic tract
  • Proprio and Kinesthesia INTACT**
    • DCML spared
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20
Q

Clinical SCI Syndromes

Central Cord Syndrome

*FACTS

A
  • Common w/ C/S hyperextension
  • Assoc’d w/ a narrowed vert. canal
    • older adults→ stenosis
  • Freq caused by:
    • rear end MVA
    • Fall in which chin strikes stationary obj
  • *Results in:
    • edema and/or bleeding INTO central grey matter of SC
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21
Q

Clinical SCI Syndromes

Central Cord Syndrome

*Presentation

think “sacral sparing”

A
  • Injury most often in the cervical region
  • Loss of UE function w/ relative sparing of LEs
    • Pts often ambulatory
  • INC risk of falls and injury from falls 2* to absent UE protective EXT
  • diff. utilizing ADs
  • AKA “Walking Quad”
    • zero arm function BUT can ambulate
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22
Q

Clinical SCI Syndromes

Hemi-cord (Brown-Sequard) Syndrome

*“Hemi”→ think “HALF”

FACTS

A
  • Often caused by a penetrating wound to cord
  • Prognosis is generally good for regaining ambulation, hand and B&B function
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23
Q

Clinical SCI Syndromes

Hemi-Cord (Brown-Sequard) Syndrome

*Presentation

A
  • IPSILATERAL LOSS of motor function and pos. sense BELOW LVL OF LESION
    • Dmg to corticospinal tract and DCML
      • Ipsilateral bc look @ where tract crosses
  • CONTRALATERAL LOSS of pain and temperature sensation beginning a few lvls below lesion
    • Dmg to spinothalamic tract, which ASCENDS IPSILAT. for a few segments before crossing
      • this is why its a few lvls down
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24
Q

Clinical SCI Syndromes

Posterior Cord Syndrome

FACTS

A
  • LESS COMMON THAN OTHERS
  • Usually caused by compromise of Post. Spinal Artery
  • Often a long-term consequence of Tabes Dorsalis
    • *untreated Syphilis
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25
Clinical SCI Syndromes ## Footnote **Posterior Cord Syndrome** **\*Presentation**
* Dmg primarily to **DCML (Dorsal Columns)** * Loss of **Somatosensation BELOW the lvl of injury→** Cannot feel position of LEGS * **Wide based gait** * **_Distal_ signs of Ataxia**
26
Clinical SCI Syndromes ## Footnote **Cauda Equina Syndrome** **\*FACTS/Presentation**
* **Below lvl of L1** * **NOT a CNS injury** * Results in **LMN Syndrome** * Complete lesion is **rare** bc of # of nerve roots and the area they encompass * **Bc it is a _peripheral nerve injury_**→ SOME possibility for **regeneration**
27
Review Tracts: ## Footnote **Corticospinal Tract**
Motor Descending \***crosses @ decussation of _Pyramids_**
28
Review Tracts: **Dorsal Column (DCML)**
Sensory Ascending \***Crosses @ _Brainstem_**
29
Review Tracts: ## Footnote **Spinothalamic (Anterolateral) Tract**
Sensory Ascending **\*Crosses in SC @ _Ant Commissure_ AFTER ascending 1-2 lvls THEN to _Thalamus_**
30
SCI Stats
more than ⅓ people w/ SCI are **re-hospitalized w/in 1st year after injury**
31
SCI Stats ## Footnote **Most common reasons for re-hospitalized**
* Genitourinary * UTI * Respiratory * lungs * Integumentary * Wounds
32
SCI Stats ## Footnote **those rehospitalized are more likely….**
Younger female unemployed/retired covered by **medicaid** **Discharged to SNF after first hospitalization\*\*\***
33
SCI Stats ## Footnote **Longer rehab stays….**
**Longer rehab stays** are assoc'd w/ **DECd likelihood of rehospitalization**
34
Complications of SCI
Several
35
Living w/ **SCI** ## Footnote **Autonomic Dysreflexia** **MEDICAL EMERGENCY!!!**
* Typ occurs in injuries **ABOVE T6→** Above **splanchnic outflow**
36
Autonomic Dysreflexia MEDICAL EMERGENCY!!! **What to do…**
* Find noxious stimuli * sit pt **upright** * loosen tight clothing * Monitor HR and BP * Ask about **triggers** * bladder distention * bowel impaction * restricting items (catheter, abd binder, etc.) * **seek med. help if sx's do not resolve quickly**
37
Living w/ **SCI** ## Footnote **CV Dis Mgmt**
* CV issues are **leading cause of death following SCI\*\*\*\*** * Incd risk of **CV disease** (2.72 OR) and **stroke** (3.72 OR) following SCI * Changes to the **ANS** after SCI can INC risk of CV sequelae * abnorm BP * HR variability * arrythmias * **altered CV response to exercise**
38
Respiratory Muscle Weakness C1-2 to T11 and below **Inspiratory mm's vs. Forced Expiratory mm's**
See Chart ***NOTE:** Lower-lvl SCI have **intact innervation** to muscles **above lvl of SCI*** **\*\*\***
39
Resp muscle weakness ## Footnote **C1-C2** **\*vent dependent**
* **Inspiratory** * SCM and upper traps (accessory cranial nerve) * **Forced Exp mm's** * none
40
Resp muscle weakness C3-C4
* **Inspiratory** * partial diaphragm (C3-C5) * partial levator scap (C3-C5) * partial scalenes (C3-C8) * **Expiratory** * none
41
Resp muscle weakness C5
* **Inspiratory** * Diaphragm (C3-C5) * **C3, C4, C5 keeps diaphragm alive!!** * **Expiratory** * Pec major-clavicular head (C5-C6) * remember this is accessory!
42
Resp muscle weakness C6-C8
* **Inspiratory** * Pec major-sternal head (C7-T1) * Pec minor (C6-T1) * Serratus ant (C5-C7) * **Expiratory** * none
43
Resp muscle weakness T1-T5
* **Insp** * Intercostals (T1-T11) * Serratus post sup (T1-T3) * **Exp (really starts here)** * Intercostals (T1-T11)
44
Resp muscle weakness T6-T10
* **Insp** * Abdoms (T6-L1) * **Exp** * Abdoms (T6-T1) * Serratus post inf (T9-T12)
45
Resp muscle weakness ## Footnote **T11 and below**
* **Insp** * all lvls above SCI * **Exp** * all lvls above SCI
46
Spastic HypERtonia
* typ presentation is a **gradual inc** w/in **first 6mos post-injury** with a **plateau reached by one year** * Is problematic in ~50% people w/ SCI * Some may learn to **elicit spasticity or spasms** to **assist w/ function,** but TOO MUCH typ results in **poorer function** * Is trad. mngd through **stretching, meds, therapeutic modals**
47
SCI and Integumentary System
**Pressure sores** are likely \*if to bone→ sx req'd **Areas most susceptible to pressure in _Recumbent Pos's_→ SEE CHART** **\*MOST COMMON=** Sacrum, Coccyx
48
Integumentary System and SCI ## Footnote **Impaired Temp Control**
Impaired temp control * due to **autonomic dysfunction** resulting in **altered thermoreg.** * Caution must be taken when pt might become hypER/hypOthermic
49
Pain and Pain Mgmt w/ SCI \*exp'd by high % people w/ SCI **2 Main Types:**
1. Musculoskeletal or Visceral pain 2. Neuropathic pain
50
Pain and Pain Mgmt w/ SCI \***MSK or Visceral pain**
* may be caused by **repetitive stress, poor biomech pos'ing, reverse action use of UEs, AD use** * **Common probs:** * biceps tendinitis * lateral epicondylitis (tennis elbow) * shoulder impinge and RTC tear * CTS * wrist tendonitis
51
Pain and Pain Mgmt w/ SCI ## Footnote **\*Neuropathic pain**
* May be due to **elevated sensitivity of nociceptors** or **painful perception of non-nociceptive stimuli** * Tx req's **eclectic approach**
52
SCI and **Genitourinary System** ## Footnote **B&B**
* Flaccid or spastic bladder * Flaccid or spastic bowels * Sexuality and sexual function/dysfunction
53
Living w/ SCI ## Footnote **Aging w/ SCI**
Aging w/ SCI * Changes happen to ALL SYSTEMS in body w/ **effects multiplied by _SCI sequelae_** * must be considered during **all phases of rehab** * Incd diff w/ **sleep** * Work on acts to inc **life satisfaction w/ aging**
54
Expected Functional Outcomes After SCI
Lets Review… * Pt dx with a **Lvl of Injury (LOI)** * Pt dx w/ an **ASIA/AIS Impairment Score (A→E)** * ISNCSCI * L/R * Sensory/Motor * **Most caudal lvl of intact neuro. lvl** * Consider ASIA/AIS Score vs. Function
55
Description of **injuries @ ea spinal lvl and their expected outcomes**
see pics \*Table 20.5 in O'Sullivan, Schmitz & Fulk \*Table 12-11 in Nichols-Larsen et al
56
Description of **injuries @ ea spinal lvl and their expected outcomes** C1-4 C5
see pics
57
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C6** **C7-8**
see pics
58
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **T1-T9** **T10-L1**
see pics
59
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **L2-S5**
see pics
60
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C1-C3**
* Respirator dependent (**def C1-C2)** due to **phrenic nerve involve.** * w/ **training of access mm's of resp→** pt may come off respirator for brief pds of time * Req's **tracheostomy, w/ secretion mgmt as MAJOR goal**
61
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C1-C3 contd**
* pt req's **total assist in transfers, ADLs, and _all_ aspects of mobility→** Goals focusing on directing care * W/C mobility is via power w/c * **MIN A** to set up for **Environmental Aide to Daily Living (EADL)** * Voice intact BUT limtd by poor breath support * **Facial mm's,** and some **neck flexors and extensors are partially to fully innervated**
62
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C4**
* NOT vent dependent, BUT sig'ly **incd risk for resp compromise** * **Limtd shoulder mvmts** * Some scap mm's are avail, but **only partially innervated** * Supraspin, infraspn, teres major, rhomboids * **can use traps and SCM in reverse action to enhance shoulder mobility** * Almost complete innervation of neck * well-dev'd head control may enhance mobility and balance by learning to use neck mm's in reverse action
63
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C4 contd**
* Power chair driven w/ chin control, sip and puff, head array * **Dependent for transfers, ADLs, bed mobility** * GOALS focus on directing care * Overuse syndromes are concern \*\*\*
64
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C5**
* Innervation of **biceps, brachiorad, delts, pec major (clavicular)** * partial shoulder horiz ADD, elbow flex, forearm sup, * limtd shoulder flex, ABD, ER * Able to incorp shoulder girdle into balance and mobility tasks
65
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C5 contd**
* May be able to perform WC transfers w/ **max assist** w/ a slide board * **Dependent w/ dressing** * Potential to be set up for ADLs using universal cuff or AE * Can **propel WC short dist's but w/ high energy cost**
66
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C6**
* FULL innervation of scap mms, sternal pectoralis, lats * ECU/ECRL/ECRB allows for **wrist EXT and grasp via _tenodesis_**
67
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C6 contd**
* Transfers **typ req assist,** though some people may be able to transfer INDEP * Indep dressing and feeding become poss w/ AE * **Will still req adapted WC**
68
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C7** **\*THINK TRICEPS!!!**
* **Triceps,** finger EXTs, wrist Flexors innervated * Good probability for **INDEP transfers, bed mobility, wc mobility and most aspects of indep living in an adapted apartment w/ ADs** * **W/out full resp access. mm's→ may still be @ risk for resp comps**
69
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **C8-T1**
* Full innervation of **hand intrinsics** * **INDEP in WC wheelies to negotiate curbs/stairs**
70
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **T2-T12**
* **T2-T8→** Partial innervation of intercostals and erector spinae * **T9-T12→** * FULLER innervation of intercostals and erector spinae * **Can use abdominals as hip flexors to assist ambulation** * **Functional ambulation _rare_ due to high energy cost**
71
Description of **injuries @ ea spinal lvl and their expected outcomes** ## Footnote **L1-L3**
* **L1→** Partially innervated hip flexors (iliopsoas) * **L2→** Partial innervation of hip ADDs (gracilis), rectus femoris, and QL * **DECd energy cost of walking, BUT KAFOs and a walker or LFSCs still reqd** * **L3→** Same mm's as L2, but w/ **full innervation**
72
Description of **injuries @ ea spinal lvl and their expected outcomes** **L4-S2**
* **L4→** Weak hip ABDs and ERs, weak HS's, peroneals, tib Ant * **L5→** * Gastroc/soleus innervated * WEAK innervation of Glute max * **ambulation w/ AFOs only becomes possible** * **S1-2→** Foot mm's and intrinsics **partially innervated**
73
PT Exam for Person w/ SCI Tests & Measures
See pics
74
PT Exam for Person w/ SCI ## Footnote **Exam Components**
* Motor function and Strength testing * Motor control and strength * **consider key mm groups from ASIA ISNCSCI for** * **comprehensive assess.** * ROM and jt mobility * Reflex/Tone testing * **Mod Ashworth Scale (review!!!)** * **DTRs** * Muscle spasms→ use Penn Spasm Freq Scale
75
PT Exam for Person w/ SCI ## Footnote **Exam Components**
* Sensory testing * ASIA ISNCSCI form * comprehensive * Aerobic capacity/endurance * 6MWT or 6min arm test (UBE) * Integumentary * prevent/ID pressure sores * Cognition * **Up to 60% people w/ SCI sustain some form of BI** * MMSE or MoCA
76
PT Exam for Person w/ SCI ## Footnote **Exam Components**
* Balance * sitting balance can be tested w/ sitting **Functional Reach** * BBS or other standing tests may be approp * Assistive Tech or Orthotics * Locomotion aids * power/manual wc * Walking ADs * Orthotics/braces→ stand/walk * Exoskeletons * Other ADs * environmental control * speech recognition or comm. devices * rails/bars for safety * reachers
77
PT Exam for Person w/ SCI ## Footnote **Resp Function**
* chest excursion * auscultation * PFT * cough function→ is it productive?
78
PT Exam for Person w/ SCI ## Footnote **Exam Components**
* Functional Mobility * bed mob/transfers * environmental impacts * set them up for success!! * Locomotion * **Gait/Walking** * observational analysis * standardized testing * Time tests (6MWT) or Distance (10MWT) * SCI Functional Ambulation Inventory * **WC Use** * **skills** * **mgmt of device** * **distance wheeled**
79
Evaluate the Findings!!
* **Important Issues for People w/ SCI?** * restore **UE function for pts w/ tetraplegia** * restore **functional mobility** * recovery of **locomotor function** * maximize **resp function** * restore **B&B function** * **Life participation→ employment/leisure**
80
**Goal Setting for SCI**
Examples!!!
81
Spectrum of Rehab for SCI Pts
* Acute care * Inpatient acute/subacute rehab * **3+ hrs PT** * **prepares for next step** * SNF/long-term care * **shorter duration PT** * Home care * OP * Day hospital * **intensity of IP but leave @ night** * Wellness center * Alt. therapeutic intervents * Lifetime follow-up care
82
Issues for Pts w/ SCI ## Footnote **Pain and SCI**
* \>80% exp pain * 77% have pain interfere w/ 1 or more daily acts * 10-30% w/ SCI have pain severe enough to interfere w/ ADLs * Both **Central** and **Peripheral causes**
83
SCI Tx Considerations
* Needed to get pt as **safe and functional** as possible **for the next lvl of care?** * When working w/ SCI Pt, there is a **greater likelihood that we will use** ***_compensatory_*** **_techniques_ rather than** ***_restorative_*** **_techniques_\*\*\*\*\*\*\*\***
84
Considerations for **Retraining**
* Use principles of **motor skill teaching and learning** * Modify task * shorten Arc of Motion * Pts may benefit from **impairment/component lvl training** as intermed step to task practice * strengthening * ROM/jt mob * Endurance
85
Considerations for Retraining
* **Head-Hips Relationship\*\*\*** * move _opposite directions_ * **Momentum** * momentum in one pt of body is used to **facilitate mvmt in other parts** * **Muscle substitution** * \*_Key for C5-6 bc no triceps!!!_ * Intact mm's used to **substitute for denervated mm's,** and should be incorporated in functional mvmts * Use approp adaptive equip.
86
Tx Considerations: **ROM**
* **Selective Stretching** * maintain **tenodesis** where approp * **HS ROM** * need ~100 degs\*\*\* * **more or less limits long sitting** * **Maint normal thoracic mobility** * **Stretch hip flexors, ant trunk/chest, knees, ankles** * **Resting/functional splints**
87
Tx Considerations: **Resp Activities**
* Insp/Exp mm training * Assisted coughing * **Abdominal binder** * provides intra-abdominal pressure in absence of strength * improve resp function, cough, speech * **more optimal diaphragmatic excursion**
88
Tx Considerations: **Resp Activities contd**
* Develop tech: **Acute Intermittent Hypoxia** * exposure to Low 02 lvls in **single** (acute exposure) or **multiple** (chronic exposure) sessions * Brief repeated admins of hypoxia interspersed w/ breathing normoxic air * fosters improved plasticity in the resp centers * Research happening now!
89
Tx Considerations: **Skin Protection**
* Prevent pressure sores is critical * Consider: * passive pos'ing in bed or wc * supportive/protective equip * maximize indep in mobility for pressure relief * WC seating/pos'ing and approp cushioning
90
Other Considerations:
* OH * HO → esp @ hips * Osteoporosis→ more susceptible
91
Bed Mobility Training
* A step to Indep in other acts * Rolling supine to/from SL * Rolling supine/SL to/from prone * Supine to/from Long-sitting * Suping to/from short-sitting
92
Training Balance in Sitting
* include short and long-sitting * Assist and add. ext support needed early on * **Consider use of UEs for support\*\*\*\***
93
Transfer Training
* Includes **lateral transfers of all types** * wc to/from mat, bed, toilet, car, etc. * include floor to wc or mat transfers * **head-hips relationship!!! (opp directions w/ transfers)** * **transfers become substantially easier if person have _adequate strength in the triceps\*\*\*_ (C7 and below)** * **include sit to/from stands**
94
Locomotion
see pics
95
Locomotion: **WC's**
* Foundations II\*\*\* * Equipment: * power vs manual * rigid or folding * usefulness of ea part * armrests, foot riggings, locks, anti-tippers * seating and pos'ing for posture/pressure mgmt * mult wc for diff uses
96
Locomotion: **WCs contd**
* Consider **skills** that **pt will need** * Propulsion: * lvl surfs * inclines * uneven surfs * wheelies * mnging wc * armrests/legrests * brakes * transporting WC
97
Locomotion: **Walking** \***IMPORTANT\***
* Consideration: Will walking be for **function** or **exercise??** * overuse syndromes * energy costs * practicality of walking * Consideration: Will walking be treated using **compensatory techs, rehabilitative techs, combination?** * **Compensatory→** includes more substantial orthotics and ADs and abnormal walking pattern * **Rehabilitative→** likely use BWS * **THINK:** what gives pt most INDEP and efficiency?→ TALK TO Pt!!!
98
Other Tx Issues:
* What does the pt **NEED to do** vs. what they **CAN do?** * Goals might need to pertain to: * directing assistance * family training * **Also, what does the pt WANT to do vs what they CAN do?** * **NEVER take away someones _Hope_→** This is what DRIVES them!!!
99
Technology used:
* FES * FES-based cycle ergometry→ UE or LE * BWSTT and Gait Training (BWSGT) w/ and w/out robotics * static vs dynamic * Robotics * exoskeletons
100
Technology
* Home Technology and Environmental aids to ADL * switches * voice * WC * medical vs commercial
101
Discharge Planning Factors:
* **Psychosocial** * motivation * family support * education * depression * **Financial Resources** * **Discharge Loc** * **Anticipated recovery** * **Cognitive status**
102
Discharge Planning: **DME**
* splints/orthoses * bathroom equip * EADLs * home mods * man vs power wc * adapted seating * specialty bed & mattress * transfer devices * adaptive devices
103
Discharge Planning: **DME**
* Equipment ordering factors: * Does it **fit pts current needs?** * Can it be **changed to accommodate pts future needs?** * Does pt/caregiver **understand proper use/maintenance?** * Does pt/caregiver **know who to call if there is a problem w/ equipment?**
104
Discharge Planning: **Life Skills**
* Return to work/school * Leisure acts * Adaptive sports * When to discharge→ **IPE**

NeuroPT2 (8 decks)

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