SCI 5 - Rehab Considerations Flashcards
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
what are 4 primary goals with respiratory management
improving ventilation
effective cough
dec ineffective breathing pattern substitutes
prevent chest tightness
what SCI are expiratory ms weakness an important consideration with respiratory care
C5 and up
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
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
how could associated rib fx or thoraco-abdominal surgery be considerations for respiratory care
can cause dec chest expansion
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
what is the most effective training for respiratory strength training
hasn’t been established
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
what is glossopharyngeal breathing
(+) pressure breathing technique that uses ms of mouth and pharynx to propel small volumes of air (“gulps”) into lungs
what is the purpose of forced expiratory strengthening exercises
improve pulm function
what is the goal of inspiratory strengthening exercises
“threshold training”
inc threshold/load on ms to facilitate inspiration
what are techniques for assisted coughing
either manual
or teach pt how to self assist
how does abdominal support like an ab binder help respiratory management
inc intra abdominal pressure and elevate diaphragm to improve biomechanical position for breathing
why is stretching anterior musculature and correcting posture part of respiratory management
posture has huge impact on adequate chest expansion
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
extrinsic factors for pressure sores (4)
friction
shear
moisture
pressure
intrinsic factors for pressure sores (7)
smoking
immobility
lack of sensation
nutrition
age
infection
incontinence
what are 8 spots that are important for daily skin inspection
elbow
hip
greater troch
knee
ankle
knee
groin
toes
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
when is pressure mapping recommended
w/i first 3 days of admission at an acute inpatient rehab on a specialty cushion
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
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
timeline for a turning schedule
change position every 2 hrs
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
