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NeuroPT2 > PT Mgmt of Pts w/ SCI > Flashcards

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
Q

Clinical SCI Syndromes

Posterior Cord Syndrome

*Presentation

A
  • 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
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26
Q

Clinical SCI Syndromes

Cauda Equina Syndrome

*FACTS/Presentation

A
  • 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
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27
Q

Review Tracts:

Corticospinal Tract

A

Motor

Descending

*crosses @ decussation of Pyramids

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28
Q

Review Tracts: Dorsal Column (DCML)

A

Sensory

Ascending

*Crosses @ Brainstem

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29
Q

Review Tracts:

Spinothalamic (Anterolateral) Tract

A

Sensory

Ascending

*Crosses in SC @ Ant Commissure AFTER ascending 1-2 lvls THEN to Thalamus

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30
Q

SCI Stats

A

more than ⅓ people w/ SCI are re-hospitalized w/in 1st year after injury

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31
Q

SCI Stats

Most common reasons for re-hospitalized

A
  • Genitourinary
    • UTI
  • Respiratory
    • lungs
  • Integumentary
    • Wounds
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32
Q

SCI Stats

those rehospitalized are more likely….

A

Younger

female

unemployed/retired

covered by medicaid

Discharged to SNF after first hospitalization***

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33
Q

SCI Stats

Longer rehab stays….

A

Longer rehab stays are assoc’d w/ DECd likelihood of rehospitalization

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34
Q

Complications of SCI

A

Several

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35
Q

Living w/ SCI

Autonomic Dysreflexia

MEDICAL EMERGENCY!!!

A
  • Typ occurs in injuries ABOVE T6→ Above splanchnic outflow
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36
Q

Autonomic Dysreflexia

MEDICAL EMERGENCY!!!

What to do…

A
  • 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
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37
Q

Living w/ SCI

CV Dis Mgmt

A
  • 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
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38
Q

Respiratory Muscle Weakness

C1-2 to T11 and below

Inspiratory mm’s vs. Forced Expiratory mm’s

A

See Chart

NOTE:** Lower-lvl SCI have **intact innervation** to muscles **above lvl of SCI ***

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39
Q

Resp muscle weakness

C1-C2

*vent dependent

A
  • Inspiratory
    • SCM and upper traps (accessory cranial nerve)
  • Forced Exp mm’s
    • none
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40
Q

Resp muscle weakness

C3-C4

A
  • Inspiratory
    • partial diaphragm (C3-C5)
    • partial levator scap (C3-C5)
    • partial scalenes (C3-C8)
  • Expiratory
    • none
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41
Q

Resp muscle weakness

C5

A
  • Inspiratory
    • Diaphragm (C3-C5)
      • C3, C4, C5 keeps diaphragm alive!!
  • Expiratory
    • Pec major-clavicular head (C5-C6)
      • remember this is accessory!
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42
Q

Resp muscle weakness

C6-C8

A
  • Inspiratory
    • Pec major-sternal head (C7-T1)
    • Pec minor (C6-T1)
    • Serratus ant (C5-C7)
  • Expiratory
    • none
43
Q

Resp muscle weakness

T1-T5

A
  • Insp
    • Intercostals (T1-T11)
    • Serratus post sup (T1-T3)
  • Exp (really starts here)
    • Intercostals (T1-T11)
44
Q

Resp muscle weakness

T6-T10

A
  • Insp
    • Abdoms (T6-L1)
  • Exp
    • Abdoms (T6-T1)
    • Serratus post inf (T9-T12)
45
Q

Resp muscle weakness

T11 and below

A
  • Insp
    • all lvls above SCI
  • Exp
    • all lvls above SCI
46
Q

Spastic HypERtonia

A
  • 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
Q

SCI and Integumentary System

A

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
Q

Integumentary System and SCI

Impaired Temp Control

A

Impaired temp control

  • due to autonomic dysfunction resulting in altered thermoreg.
  • Caution must be taken when pt might become hypER/hypOthermic
49
Q

Pain and Pain Mgmt w/ SCI

*exp’d by high % people w/ SCI

2 Main Types:

A
  1. Musculoskeletal or Visceral pain
  2. Neuropathic pain
50
Q

Pain and Pain Mgmt w/ SCI

*MSK or Visceral pain

A
  • 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
Q

Pain and Pain Mgmt w/ SCI

*Neuropathic pain

A
  • May be due to elevated sensitivity of nociceptors or painful perception of non-nociceptive stimuli
  • Tx req’s eclectic approach
52
Q

SCI and Genitourinary System

B&B

A
  • Flaccid or spastic bladder
  • Flaccid or spastic bowels
  • Sexuality and sexual function/dysfunction
53
Q

Living w/ SCI

Aging w/ SCI

A

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
Q

Expected Functional Outcomes After SCI

A

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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

A

see pics

*Table 20.5 in O’Sullivan, Schmitz & Fulk

*Table 12-11 in Nichols-Larsen et al

56
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C1-4

C5

A

see pics

57
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C6

C7-8

A

see pics

58
Q

Description of injuries @ ea spinal lvl and their expected outcomes

T1-T9

T10-L1

A

see pics

59
Q

Description of injuries @ ea spinal lvl and their expected outcomes

L2-S5

A

see pics

60
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C1-C3

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C1-C3 contd

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C4

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C4 contd

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C5

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C5 contd

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C6

A
  • FULL innervation of scap mms, sternal pectoralis, lats
  • ECU/ECRL/ECRB allows for wrist EXT and grasp via tenodesis
67
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C6 contd

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C7

*THINK TRICEPS!!!

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

C8-T1

A
  • Full innervation of hand intrinsics
  • INDEP in WC wheelies to negotiate curbs/stairs
70
Q

Description of injuries @ ea spinal lvl and their expected outcomes

T2-T12

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

L1-L3

A
  • 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
Q

Description of injuries @ ea spinal lvl and their expected outcomes

L4-S2

A
  • 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
Q

PT Exam for Person w/ SCI

Tests & Measures

A

See pics

74
Q

PT Exam for Person w/ SCI

Exam Components

A
  • 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
Q

PT Exam for Person w/ SCI

Exam Components

A
  • 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
Q

PT Exam for Person w/ SCI

Exam Components

A
  • 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
Q

PT Exam for Person w/ SCI

Resp Function

A
  • chest excursion
  • auscultation
  • PFT
  • cough function→ is it productive?
78
Q

PT Exam for Person w/ SCI

Exam Components

A
  • 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
Q

Evaluate the Findings!!

A
  • 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
Q

Goal Setting for SCI

A

Examples!!!

81
Q

Spectrum of Rehab for SCI Pts

A
  • 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
Q

Issues for Pts w/ SCI

Pain and SCI

A
  • >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
Q

SCI Tx Considerations

A
  • 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
Q

Considerations for Retraining

A
  • 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
Q

Considerations for Retraining

A
  • 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
Q

Tx Considerations: ROM

A
  • 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
Q

Tx Considerations: Resp Activities

A
  • 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
Q

Tx Considerations: Resp Activities contd

A
  • 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
Q

Tx Considerations: Skin Protection

A
  • 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
Q

Other Considerations:

A
  • OH
  • HO → esp @ hips
  • Osteoporosis→ more susceptible
91
Q

Bed Mobility Training

A
  • 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
Q

Training Balance in Sitting

A
  • include short and long-sitting
  • Assist and add. ext support needed early on
  • Consider use of UEs for support****
93
Q

Transfer Training

A
  • 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
Q

Locomotion

A

see pics

95
Q

Locomotion: WC’s

A
  • 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
Q

Locomotion: WCs contd

A
  • Consider skills that pt will need
    • Propulsion:
      • lvl surfs
      • inclines
      • uneven surfs
    • wheelies
    • mnging wc
      • armrests/legrests
      • brakes
      • transporting WC
97
Q

Locomotion: Walking

*IMPORTANT*

A
  • 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
Q

Other Tx Issues:

A
  • 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
Q

Technology used:

A
  • FES
    • FES-based cycle ergometry→ UE or LE
  • BWSTT and Gait Training (BWSGT) w/ and w/out robotics
    • static vs dynamic
  • Robotics
    • exoskeletons
100
Q

Technology

A
  • Home Technology and Environmental aids to ADL
    • switches
    • voice
    • WC
  • medical vs commercial
101
Q

Discharge Planning Factors:

A
  • Psychosocial
    • motivation
    • family support
    • education
    • depression
  • Financial Resources
  • Discharge Loc
  • Anticipated recovery
  • Cognitive status
102
Q

Discharge Planning: DME

A
  • splints/orthoses
  • bathroom equip
  • EADLs
  • home mods
  • man vs power wc
  • adapted seating
  • specialty bed & mattress
  • transfer devices
  • adaptive devices
103
Q

Discharge Planning: DME

A
  • 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
Q

Discharge Planning: Life Skills

A
  • Return to work/school
  • Leisure acts
  • Adaptive sports
  • When to discharge→ IPE

NeuroPT2 (8 decks)

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