SCI 8 - Neuromotor Recovery Flashcards
what is a critical part when dc a patient from inpatient rehab
community re-integration
- accessible housing, nutrition, transportation, finances, employment, fitness
where is a pt dc if they meet their LTG in inpatient rehab
home
where is a pt dc if they don’t meet their LTG in inpatient rehab
SNF
what is a helpful mindset to encourage SCI patients to have as they recover
“yes you can”
- think ab what you can do
- not what you can’t do
what are considerations to individualize the program transitioning to outpatient programs
BSF
activity
participation
pt/caregiver goals
resources
accessibility
what does the ACSM recommend for CV training in SCI
endurance training 3-5 days/wk
20-60min/day
at 50-80% of peak HR
what are examples of CV training
UE ergometry
wc propulsion
swimming
BWSTT
HIT
FES induced walking, cycling
what type of training will improve the aerobic fitness in the SCI population
endurance training
what is FES
functional electrical stim
stims ms contraction to facilitate functional mvmts
what are the benefits to using FES
maintain ms viability / ms mass
promotes CV health
mental health - rewarding
counteracts secondary complications
what are uses for FES
shoulder subluxation
functional rowing
bicycle ergometry
what is the SCI rehab machine Erigo
combines gradual verticalization w robotic mvmt therapy
- allows intense training safely in very early stage of rehab
what is the trend of ASIA classifications w regard to potential for gait w/o physical (A) but use of ADs
increases
- lowest w ASIA A and highest potential w ASIA D
what are nonfunctional ambulator benefits to gait training
bone density
CV
mental health
what are considerations for determining if SCI pt is appropriate for gait training
ROM:
>10deg hip ext
~110 SLR
full knee ext
adequate lumbar ext
minimum of 5deg DF
UE strength
tolerance to upright
MSK integrity
endurance/cardiac condition
time since injury/acuity
why is it important for good lumbar ext and DF in SCI pts for gait training
pts often hang on y ligs
what is the NeuroRecovery Network (NRN)
network of rehab centers charged w developing and providing therapies that promote functional recovery and improve health of people living w paralysis
- founded thru Christopher Reeve Foundation
how does locomotor training work neurophysiologically speaking in SCI
tapping into neuroplasticity to restore locomotion
enhancing afferent input to SC
activates CPGs embedded in lumbosacral SC
- CPGs associated w reciprocal pattern of walking
where are plastic changes induced w locomotor training
SC level
sensory motor cortex via intensive locomotor training, ONLY in incomplete SCI
what are principles of neuroplasticity
use it or lose it
use it and improve it
specificity
repetition matters
intensity matters
time matters
salience matters
age matters
transference or generalization
interference
what does BWST locomotor training target
relearning of nervous system motor patterns associated w walking
- kicks into CPGs w reciprocality of walking
what does BWST locomotor training enable
early initiation of gait training (& standing)
integration of WBing activities
stepping and balance using task-specific approach
symmetrical gait pattern
what provides sensory input for SCI during locomotor training and where is this input set
sensory info from:
- actual stepping
- manual contacts of PT
- contact of foot on ground
sensory info from legs and trunk repetitively sent to SC to CPGs
what is a progression of BWST locomotor training
overground walking training
community ambulation
how can maximal afferent input into LE be ensured during BWST locomotor training
LE maximally loaded for WB
- minimizing or eliminating loading of UEs
what manual cues is the therapist providing during BWST locomotor training
bring LE into enough hip ext to trigger hip flex to take a step
- provide cues consistent w walking, facilitating flex/ext ms activation
what component of BWST locomotor training is important to tap into neuro-motor recovery
inc speed as quickly and safely as possible
- HIT type of exercise
what are the 2 main types of robotic assisted devices
move on their own regardless of what client is doing
augment or assist the active mvmts of the client
