SCI (+DOC & NDD) - Treatment

Question 1

Pressure injury management (4)

Answer 1

Positioning, moving in bed and wheelchair -> Pressure relief techniques.
Education on self examination (caregiver), report redness to nurse/doctor.
Bumps and other small injures should also be reported.
Education about air cushions.

Question 2

Verticalization - benefits (4), Risk (1)

Answer 2

Either on a table that can be angled or patient standing up themselves/with assistance.
Improves gastrointestinal function (gravity doing it’s job).
Facilitates respiratory function.
Stimulates cardiovascular system (increases venous return).
Psychological benefits.
Watch out for orthostatic hypotension (dizziness, nausea, blurred vision, syncope).

Question 3

Spasticity management (4) and prevention (6)

Answer 3

Need to assess benefit vs risk ratio.
Preventing triggers such as fatigue, inactivity, infections, pressure ulcers, stress, pain.
Stretching, active exercises, electrical stimulation -> short term effect.
Medication: baclofen, botulinum toxin -> long term effect.

Question 4

Passive/Active Mobilization - Effect (3)

Answer 4

ROM maintenance and increase.
Prevention of MSK complications (contractures) and DVT.
Motor capacity maintenance (active)

Question 5

Stretching - Effect (3)

Answer 5

Contractures decrease (equina varus - fixed DF+inv).
ROM increase.
Spasticity management.

Question 6

PNF

Answer 6

Proprioceptive Neuromuscular Facilitation.
Increase strength and mobility. Diagonal pattern, facilitated by proprioceptive, cutaneous and auditory inputs to stimulate highest amount of muscle fibers.
Passive/Assisted/Active/Resistive
Shoulder and Trunk.

Question 7

Strengthening - Purpose, which muscles and which techniques

Answer 7

To increase independence and autonomy.
UL, trunk, abs and lat. dorsi.
Using MSK techniques, push up handles.

Question 8

Balance

Answer 8

Sitting vs standing
Dynamic vs static
Intrinsic vs extrinsic perturbation

Question 9

Wheelchair Manipulation - Prerequisites, which skills and which methods?

Answer 9

Needs to have UL strength, trunk control, sitting balance + control.
Going forwards, backwards, through tight spaces, up and down ramps, stairs, curbs, around obstacles.
Trained in all conditions and obstacles.

Question 10

DOC

Answer 10

Stimulation.
Sensory stimulating the patient to release neurotrophic factors to restore central synapses.

Question 11

NDD

Answer 11

Use ABI/SCI techniques and add approximation and cueing.
Aerobic exercise (increases endurance -> decreases fatigue. Strength. Yoga+stretching (spasticity in MS - Risk vs benefit). Will slow down progression, improve secondary symptoms, reconditioning.