SCI Flashcards
most common cause of SCI in the philippines
falls
general goals for acute and subacute rehab
prevent secodnary complications
neurorecovery
maximizing function
general goals for chronic rehab
compensatory or assistive approaches
what are the usual secondary complications
contractures
atrophy
bed sores
orthostatic HTN
unstable BP
objectives for SCI rehab
improve indep in ADLs
help accept new lifestyle - sexua;, recreational and housing
aid in societal reintegration
when should SCI rehab start
once medically stable and able to tolerate rehab
strength for starting SCI rehab once medically stable and able to tolerate rehab
weak
newly acquired SCI should be managed by _____
multidisciplinary team
PT + specialized ICU unit
strength for newly acquired SCI should be managed by PT + specialized ICU unit
strong
_____ management is crucial in acute stage
respiratory management
quiet inspiration
diaphragm and external intercostals
forced inspiration
scalenes
SCM
pectorals
upper traps
quiet expiration
passive elasticity or recoil of lung
muscles are relaxed
forced expiration
rectus abdominis and internal intercostals
respiratory damage in cervical SCI
prob in inspiration and expiration - phrenic nerve damage
quadriplegia
respiratory damage in thoracic SCI
prob in expiration and coughing - long thoracic nerve of rectus abdominis damage
paraplegia
discuss assisted coughing
pushing in or out the rectus abdominis
inhale, hold, cough then press 2x
discuss deep breathing exercises
inhale sa nose and exhale sa mouth
provide tactile and verbal fback
discuss glossopharyngeal breathing
swallowing or gulp air to dec lung volume
mema evidence
air shift maneuver
direct air towards hypoventilated areas
apple pressure to area in chest and tell pt to imagine air flowing there
resistance exercises for diaphragm
pwd weights pero weird
usually sucking or blowing on breathing apparatus
discuss use of abdominal support in respiratory management
helps exhalation by maintaining alignment of abdominal organs and diaphragm
stretching of chest muscles for respiratory management
pectorals - chest expansion
pwd din neck msucles
strength for respiratory muscle training
weak
strength for using abdominal binders to improve lung volume
weak
strength for targeted postural drainage and assisted coughinh
strong
strength for deep breathing and air stacking
weak
initial precautions for UE PROM
shoulder flexion and abd should not go beyond 90°
can influence movement of cervical spine in acute cases
use of UE ROM in chronic stage
pwede may lengthened or shortened
shoulder, elbow and wrist hyperext - supported sitting
shortened long finger flexors - tenodesis effect
contracture flexion of fingers - hook grasp
UE PROM should be what type of movement
bilat symmetric
assym can cause spine to move assym
initial precautions for paraplegia LE PROM
unitl 60° SLR
until 90° hip flex with knee bent
until cleared bawal pa
once cleared motions need to be developed for paraplegia LE PROM
hyperext of hips - jack knife and tripod for BAC
ER of hips - reach feet
pflexor tightness - avoid as it hinders gait
slight back ext tightness - stab in sitting
discuss selective stretching
hams - 110-120°; bed mob and transfers
hip IR - reach feet, dressing of LE garments
discuss selective shortening
finger flexors - tenodesis
back ext - postural in sitting
strength of long duration stretch and pos stretch
weak pero pwede padin daw long duration
strength of PROM, AAROM, passive standing, splinting in treating and preventing loss of ROM
weak
complications and contraindications of PROM
assoc unstable fx
DVT
HO
osteporosis
strength training is applicable to
innervated or partial innervated
NMES is for
partially innervated muscles and muscle strengthening or reeduc
ES is for
retard atrophy pero later on no effect na
significance of endurance training
dapat kaya ni pt yung transfers or functions ng paulit ulit
principles of strength training
overload
SAID
reversibility
relate spasticity and strength training
pt educ about antagonist spasticity- kase ma ffeel nya pag mag spastic
strengthening will not inc spasticity
discuss muscle substitution
reversed origin-insertion: lats at trunk stab via pelvic hiking
orthosis - pag wala muscle to sub; anke bracing to faci DF
surgical - re attach or transfer muscle OI
effects of alcohol abuse in exercise
muscle weakness kasi it inhibits calcium binding = panget contraction
effects of steroids in exercise
chronic use leads to atrophy of type 2 fibers
effects of anti spasticity meds in exercise
baclofena diazetab - acts on SC and not muscle
dantrolene sodium - acts on muscle hence it weakens
effects of length changes in muscle
lengthend/shortened = weak
strength of FES to improve hand and UE in acute to subacute cervical SCI
low and weak
strength of strength training to improve non-paralyzed and partially innervated muscles
weak
integumentary considerations in acute stage
confined to bed and cant feel or move
common in sacrum, heels and elbow
proper pos and pwede glove with water on LE
strats for functional training
- build foundation: motor control muna
- breaking down: part practice
- making task easier: mod to be easy
- learning skill in reverse: if mahirap supine to prone baka pwede prone to supine
substitution by agonists
weak gmeds use higher innervated like TFL
substitution by using gravity
diff UE pos can pos forearm in pronation or supination
substitution by using tension of passive structures
tightness of long finger flexors using tenodesis
substitution by using fixation of distal ex
hand on buttocks can help supine to sitting by using biceps to pull up
substitution by using msucle pulls differently
weak triceps - use ant delotid to pull humerus to straigthen elbow
discuss angular momentum
summation - use head and neck not just UE for more momentum
velocity - dapat mabilis
mass - adding weights can help roll
moment arm - more extended has more bwelo
discuss head and hips rela
opposite lagi sila
EBP guidelines fot cardiorespi fitness
20 mins of mod to vigorous aerobic for 2x a wk
EBP guidelines fot strength training
3 sets for msucle group for 2x a wk
EBP guidelines fot cardiometabolic health benefits
30 mins of mod to vigours aerobic for 3 x a wk
T2 and up
nonambulators
T3-11
physiologic standing
T12-L2
household amb
L3-down and ocassionally T12-L2
communit amb
can put braces indep
walk 100 yards non stop
stair neg
indep in ADLs c braces
pre-requisites for walking
able to move whatever can move
sitting/standing tolerance and balance
mx for sitting balance and tolerance
braces to supp spine
mx for orthostatic hypotension
compressive stockings
mx for standing tolerance
tilt table in acute c collar
standing frame for 10-15 mins
strength for not adding additional training in unsupp sitting aside from current tx
low and weak
strength in binders should be provided to improve postural hypotension
strong
add sa stockings
sequence of gait training
// bars muna
tolerance to balance
train pt c BAC if candidate
bodyweight supp training - treadmill
overground walking
strength for using bodyweight supp training - treadmill in addition to overground walking
low and weak
paraplegics give up training d/t
high energy cost
slow speed
diff donning/doffing of braces
insecurity
madali and safe mag w.c
osteoporosis
contractures
traumatic vs nerve root pain
traumatic - injury or fx
nerve root pain - irritation, shooting
SC dysesthesias, overuse
strength for TENS to reduce pain
weak
strength for educ to avoid shoulder overuse and trauma
strong
strength for lengthening vulnerable shoulder muscles
strong
strength for shoulder exercises
strong
strength for pROM to prevent/treat shoulder pain
no recommendations - can aggravate
