SCI Flashcards

Question

Evaluation process for SCI

Answer 1

Top down is recommended but we also look at bottom up 1. What did they do before, what will they be returning to? 2. Physical status - Assess PROM first to determine pain, contractures - Then AROM and MMT - Be reasonable - Shoulder Movement and Pain- just like CVA’s this is a problem - Spasticity - Hand and wrist function - Sensation - Endurance - Cognition * Determine type of wheelchair they should use, bowel and bladder programs, self-catheterization 3. Functional Status - What are they doing - Endurance

Answer 2

Acute and Early Phase 1. Maintain or increase ROM 2. Positioning - Splinting or in bed - Shoulder * With tetraplegia shoulder pain is common, should periodically be positioned in 80º of shoulder abduction, external rotation, and full elbow extension - Wrists * If they don’t have 3+ for wrist extensors the go in resting hand splint * Dorsal splints are preferred (why??) * C5: universal cuff * C6-7: tenodesis action 3. AROM and AAROM, muscle re-education and strengthening Remember you can’t re-educate a muscle that isn’t innervated!

Answer 3

Once cleared to move about Client in wheelchair Orthostatic hypotension Transfers – sliding board Tenodesis action (C6-7) - Wrist is flexed when digits are extended. - Wrist is extended when digits are flexed. Strengthening - Resistive, grading tasks Functional task with adaptive equipment - Environmental controls - High tech and low tech

Answer 4

External breathing full time (some short time without) Require suctioning and great deal of medical care At risk for ulcers, UTI Teaching them to: - Direct their own care - Use a mouth stick - Total assist for ADL - Head, chin or sip and puff chair - Environmental controls

Answer 5

Usually need external breathing initially, but as diaphragm strengthens, they become independent Require suctioning and great deal of medical care At risk for ulcers, UTI Teaching them to: - Direct their own care - Use a mouth stick - Total assist for ADL - Head, chin or sip and puff chair - Environmental controls

Answer 6

Deltoids and biceps work May use a mobile are support or ball bearing feeder (if less than 3+) If greater than 3+, can go without support and use a universal cuff Can feed themselves, shave, answer phone, write, and drive electric chair or knobby manual chair Still have poor trunk control below the shoulders Usually dependent for dressing and bathing Known to return to work

Answer 7

Tenodesis action May need a splint They get rotator cuff, biceps They can: - Roll in bed - Still may use a universal cuff Level of independence with modifications Have the potential to be independent with all ADL’s, transfers, and can drive with modification Work on trunk control (will never be 100%), strengthening, transfers, adaptive equipment, endurance

Answer 8

Tenodesis action May need a splint They get rotator cuff, biceps, and triceps They can: - Roll in bed - Still may use a universal cuff - Reach above head - Easily push a standard manual chair Work on trunk control (will never be 100%), strengthening, transfers, adaptive equipment, endurance Level of independence with modifications Have the potential to be independent with all ADL’s, transfers, and can drive with modification

Answer 9

Extrinsic flexors and extensors and thumb musculature (still don’t have intrinsic) - They present with Claw hand or intrinsic minus hand

Answer 10

They have full hand use Independent with all ADL’s and transfers without modification Drive with hand controls

Answer 11

They have full hand use Independent with all ADL’s and transfers without modification Drive with hand controls Independent with wheelchair Some degree of standing in frame or braces but not functional

Answer 12

Ambulation with forearm crutches

Answer 13

Functional and independent with KAFO or AFO, crutches, or as needed

Answer 14

Outpatient rehab Job retraining Education Home adaptations - May mean moving Community groups - Almost like a minority group Aging and spinal cords - Importance of ergonomics