SCI 5 - Rehab Considerations Flashcards by Jenn Cantilli

how do PT exam priorities in an IRF vs hospital change

in IRF more into:
- mobility and balance assessment
- DME needs
- resources at home
- pt/caregiver needs/ed

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what are 4 primary goals with respiratory management

improving ventilation
effective cough
dec ineffective breathing pattern substitutes
prevent chest tightness

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what SCI are expiratory ms weakness an important consideration with respiratory care

C5 and up

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what is ileus and how does this impact respiratory function

dec in GI propulsion and intestinal peristalsis
- don’t have same mvmt of content in bowel –> buildup of contents can cause dec respiratory excursion –> respiratory failure

can be noxious stim

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what is the significance of someone being unable to spontaneously sigh

regulated by brainstem, spontaneous sighs happens throughout the day and essential to health
-> failure means might not be exhaling all air out of lungs leading to unhealthy lung status

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how could associated rib fx or thoraco-abdominal surgery be considerations for respiratory care

can cause dec chest expansion

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what are considerations that contribute to lifelong respiratory management

expiratory ms weakness
ileus
failure to spontaneous sigh
bronchial mucus hypersecretion
associated rib fx & TA surg
dysphagia and aspiration

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what is the most effective training for respiratory strength training

hasn’t been established

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what are 7 respiratory management strategies

deep breathing exercises
glossopharyngeal breathing
forced expiratory strength exercises
inspiratory strengthening exercises
assisted cough
ab support (ab binder)
stretching ant ms/posture

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what is glossopharyngeal breathing

(+) pressure breathing technique that uses ms of mouth and pharynx to propel small volumes of air (“gulps”) into lungs

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what is the purpose of forced expiratory strengthening exercises

improve pulm function

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what is the goal of inspiratory strengthening exercises

“threshold training”
inc threshold/load on ms to facilitate inspiration

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what are techniques for assisted coughing

either manual
or teach pt how to self assist

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how does abdominal support like an ab binder help respiratory management

inc intra abdominal pressure and elevate diaphragm to improve biomechanical position for breathing

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why is stretching anterior musculature and correcting posture part of respiratory management

posture has huge impact on adequate chest expansion

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what are secondary factors that predispose SCI for impaired skin integrity

paralysis (can’t shift wt)
incontinence
obesity
edema
spasticity
- drives bony prominences into surface, creating shearing forces
joint contractures
poor nutrition

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extrinsic factors for pressure sores (4)

friction
shear
moisture
pressure

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intrinsic factors for pressure sores (7)

smoking
immobility
lack of sensation
nutrition
age
infection
incontinence

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what are 8 spots that are important for daily skin inspection

elbow
hip
greater troch
knee
ankle
knee
groin
toes

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why is it important for skin inspection checks to become part of patient’s daily routine

skin breakdown and pressure sores can become fatal if infected

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when is pressure mapping recommended

w/i first 3 days of admission at an acute inpatient rehab on a specialty cushion

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what are clinical implications of pressure mapping

provides objective doc of peak pressures (mmHg)
help determine cause of skin problem
set positioning goals
insurance justifications
biofeedback to help w pt education w posture and pressure relief

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what are limitations of pressure mapping

doesn’t take place of regular skin inspection
shouldn’t take place of clinical decision making
if mat is taut, ineffective readings d/t hammocking effect
cost of system dec accessibility across settings

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timeline for a turning schedule

change position every 2 hrs

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pressure relief schedule when OOB

pressure relief every 20-30min in sitting position re-distribute pressure for at least 30sec in manual wc - 5min in power wc

what are 3 techniques for pressure relief from a seated position

wc depression trunk flexion lateral flex/rotation

who is the wc depression pressure relief technique effective for

clients w low quadriplegia (C7) or paraplegia

who is wc lateral flex/rotation pressure relief technique effective for

clients unable to effectively clear their buttocks during wc depression

what does wc trunk flex relieve pressure of

effective in relieving back and sacral pressure less effective for coccygeal pressure

how often should ROM be performed

4-5x/wk

what position should ROM be performed in

supine or prone unless unstable fx and/or respiratory compromise in these positions

what is an example of selective muscle length in the UE

shortening of long finger flexors

shortened long finger flexors: pt pop, why, appropriate ROM

NLI C6-8 provides functional grasp via tenodesis - pt uses active wrist ext to achieve passive thumb ADD against 1st MT and passive finger flex DONT perform PROM into wrist ext w fingers ext - only stretch finger joints in wrist flex position

what is an example of selective ms length in the lower body

lengthened hamstrings and shortened low back ms

lengthen HS and shorten low back ms: pt pop, why, ROM needed

NLI above T12 (no core ms) stability enhanced in long sitting - hang on tendons w/o flopping forward bc don't have core ms HS need to achieve 100-120deg hip flex w full knee ext

neck optimal ROM for SCI

normal avoid FHP

trunk optimal ROM for SCI

some tightness in low back

shoulder optimal ROM for SCI

90 deg ext and ER - want to encourage excessive mvmt to give more power for wc propulsion & dec risk of injury w motion during transfers/mobility

elbow optimal ROM for SCI

full ext

wrist optimal ROM for SCI

90deg ext

fingers (C6 and above) optimal ROM for SCI

maintain some tightness in fingers and thumb webspace

hips optimal ROM for SCI

110deg flex/SLR

knees optimal ROM for SCI

normal

ankles optimal ROM for SCI

neutral DF

why may the application of resistance be contraindicated early in the rehab process

avoid stress to fx sites

why is there an emphasis on BUE activities

avoid asymmetric, rotational stresses on spine

what is contemporary practice for strength training in SCI

early involvement in functional activity re-training

what are the key UE ms to strengthen (5) and why

serratus ant lats pec major RC ms triceps important for independent transfers

frequency of strengthening exercises

strengthen all innervated muscles daily in early rehab then 2-4x/wk performing 2-3sets of 8-12reps at 60-80% of 1RM

what is the emphasis on for regaining postural control and why

regaining postural control by substituting upper body control and vision d/t loss of proprioception and trunk/core ms

what is a SCI pt relearning w regard to postural control/balance early on

relearning center of balance and limit of stability

what is a major component of SCI intervention during the rehab phase

mat programs

what purposes are mat programs used for

retraining function as well as for strengthening and ROM

what is the sequence of exercise progressions for mat programs

sequence progresses from achievement of Stability w/i posture --> advances thru Controlled Mobility --> to Skill in Functional Use

what should early activities be in mat programs and how should they progress

(B) and symmetrical progression to weight-shifting and mvmt w/i posture

what is there a gradual emphasis placed on in mat programs

timing and speed - want to work on motor control

where does the parasympathetic nervous system live anatomically and what does it secrete/referred to as

brainstem in CNX and S2-4 secretes acetylcholine and referred to as cholinergic

where does the sympathetic nervous system live anatomically and what does it secrete/referred to as

thoracolumbar area originates in cell bodies of gray matter of cord secretes norepinephrine referred to as adrenaline producing

what are sx of autonomic dysreflexia

inc SBP/DBP >20mmHg flushing, nasal congestion sweating above level of lesion pounding HA bradycardia

what SCI levels is autonomic dysreflexia most commonly seen in and why

lesions above T6 - sympathetic lives in tspine

when is autonomic dysreflexia most likely to present

several months post SCI

what does noxious stim result in for autonomic dysreflexia

exaggerated sympathetic response --> vasoconstriction and inc BP