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Neuro Rehab 2 > SCI 5 - Rehab Considerations > Flashcards

SCI 5 - Rehab Considerations Flashcards

1
Q

how do PT exam priorities in an IRF vs hospital change

A

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

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2
Q

what are 4 primary goals with respiratory management

A

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

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3
Q

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

A

C5 and up

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4
Q

what is ileus and how does this impact respiratory function

A

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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5
Q

what is the significance of someone being unable to spontaneously sigh

A

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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6
Q

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

A

can cause dec chest expansion

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7
Q

what are considerations that contribute to lifelong respiratory management

A

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

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8
Q

what is the most effective training for respiratory strength training

A

hasn’t been established

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9
Q

what are 7 respiratory management strategies

A
  1. deep breathing exercises
  2. glossopharyngeal breathing
  3. forced expiratory strength exercises
  4. inspiratory strengthening exercises
  5. assisted cough
  6. ab support (ab binder)
  7. stretching ant ms/posture
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10
Q

what is glossopharyngeal breathing

A

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

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11
Q

what is the purpose of forced expiratory strengthening exercises

A

improve pulm function

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12
Q

what is the goal of inspiratory strengthening exercises

A

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

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13
Q

what are techniques for assisted coughing

A

either manual
or teach pt how to self assist

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14
Q

how does abdominal support like an ab binder help respiratory management

A

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

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15
Q

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

A

posture has huge impact on adequate chest expansion

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16
Q

what are secondary factors that predispose SCI for impaired skin integrity

A

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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17
Q

extrinsic factors for pressure sores (4)

A

friction
shear
moisture
pressure

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18
Q

intrinsic factors for pressure sores (7)

A

smoking
immobility
lack of sensation
nutrition
age
infection
incontinence

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19
Q

what are 8 spots that are important for daily skin inspection

A

elbow
hip
greater troch
knee
ankle
knee
groin
toes

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20
Q

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

A

skin breakdown and pressure sores can become fatal if infected

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21
Q

when is pressure mapping recommended

A

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

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22
Q

what are clinical implications of pressure mapping

A
  1. provides objective doc of peak pressures (mmHg)
  2. help determine cause of skin problem
  3. set positioning goals
  4. insurance justifications
  5. biofeedback to help w pt education w posture and pressure relief
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23
Q

what are limitations of pressure mapping

A
  1. doesn’t take place of regular skin inspection
  2. shouldn’t take place of clinical decision making
  3. if mat is taut, ineffective readings d/t hammocking effect
  4. cost of system dec accessibility across settings
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24
Q

timeline for a turning schedule

A

change position every 2 hrs

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25
Q

pressure relief schedule when OOB

A

pressure relief every 20-30min in sitting position

re-distribute pressure for at least 30sec in manual wc
- 5min in power wc

26
Q

what are 3 techniques for pressure relief from a seated position

A

wc depression
trunk flexion
lateral flex/rotation

27
Q

who is the wc depression pressure relief technique effective for

A

clients w low quadriplegia (C7) or paraplegia

28
Q

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

A

clients unable to effectively clear their buttocks during wc depression

29
Q

what does wc trunk flex relieve pressure of

A

effective in relieving back and sacral pressure

less effective for coccygeal pressure

30
Q

how often should ROM be performed

A

4-5x/wk

31
Q

what position should ROM be performed in

A

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

32
Q

what is an example of selective muscle length in the UE

A

shortening of long finger flexors

33
Q

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

A

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

34
Q

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

A

lengthened hamstrings and shortened low back ms

35
Q

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

A

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

36
Q

neck optimal ROM for SCI

A

normal
avoid FHP

37
Q

trunk optimal ROM for SCI

A

some tightness in low back

38
Q

shoulder optimal ROM for SCI

A

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

39
Q

elbow optimal ROM for SCI

A

full ext

40
Q

wrist optimal ROM for SCI

A

90deg ext

41
Q

fingers (C6 and above) optimal ROM for SCI

A

maintain some tightness in fingers and thumb webspace

42
Q

hips optimal ROM for SCI

A

110deg flex/SLR

43
Q

knees optimal ROM for SCI

A

normal

44
Q

ankles optimal ROM for SCI

A

neutral DF

45
Q

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

A

avoid stress to fx sites

46
Q

why is there an emphasis on BUE activities

A

avoid asymmetric, rotational stresses on spine

47
Q

what is contemporary practice for strength training in SCI

A

early involvement in functional activity re-training

48
Q

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

A

serratus ant
lats
pec major
RC ms
triceps

important for independent transfers

49
Q

frequency of strengthening exercises

A

strengthen all innervated muscles daily in early rehab

then 2-4x/wk performing 2-3sets of 8-12reps at 60-80% of 1RM

50
Q

what is the emphasis on for regaining postural control and why

A

regaining postural control by substituting upper body control and vision

d/t loss of proprioception and trunk/core ms

51
Q

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

A

relearning center of balance and limit of stability

52
Q

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

A

mat programs

53
Q

what purposes are mat programs used for

A

retraining function as well as for strengthening and ROM

54
Q

what is the sequence of exercise progressions for mat programs

A

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

55
Q

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

A

(B) and symmetrical

progression to weight-shifting and mvmt w/i posture

56
Q

what is there a gradual emphasis placed on in mat programs

A

timing and speed
- want to work on motor control

57
Q

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

A

brainstem in CNX and S2-4

secretes acetylcholine and referred to as cholinergic

58
Q

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

A

thoracolumbar area
originates in cell bodies of gray matter of cord

secretes norepinephrine
referred to as adrenaline producing

59
Q

what are sx of autonomic dysreflexia

A

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

60
Q

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

A

lesions above T6
- sympathetic lives in tspine

61
Q

when is autonomic dysreflexia most likely to present

A

several months post SCI

62
Q

what does noxious stim result in for autonomic dysreflexia

A

exaggerated sympathetic response –> vasoconstriction and inc BP

Neuro Rehab 2 (48 decks)

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