SCI E&I

Question 1

how do the abdominals help with inspiration

Answer 1

they indirectly support the diaphragm by holding the abdominal contents preventing paradoxical breathing

Question 2

what muscles are most important in implication of paradoxical breathing

Answer 2

external intercostals

Question 3

normal chest expansion

Answer 3

2.5-3 inches

Question 4

talk about how vital capacity changes in tetraplegics. paraplegics?

Answer 4

VC is typically 5 L, but decreased 40% in tetras and 20% in paras

Question 5

what do you know about ventilatory reserve and how might it impact your treatment

Answer 5

VR is VC/TV so if its narrow then patients will not tolerate changes in oxygen demand readily

Question 6

FEV1 predicts ____

Answer 6

potential for effective cough

Question 7

other than numbers on the spirometer, how can we use it to measure breathing

Answer 7

ask the pt to count or recite the alphabet

Question 8

Answer 8

C

Question 9

therapist/caretaker assist for cough training happens at what level of injury? why?

Answer 9

C5 - doesn’t have enough GH IR force to do self heimlich

Question 10

what is the relationship between C1-3 patients and ventilators

Answer 10

pts require vent or phrenic nerve pacer

Question 11

what is the relationship between C4 patients and ventilators

Answer 11

can frequently wean from vents

Question 12

what is a helpful technique to assist in weaning pts from ventilators

Answer 12

biofeedback

Question 13

what is glossopharyngeal breathing

Answer 13

an air “gulping” technique for high tetras

Question 14

Answer 14

B

Question 15

what is pressure relief Rx

Answer 15

1 minute for every 15 minutes of sitting

Question 16

in a tilt-in-space/recline WC, what degree of tilt is needed for pressure relief

Answer 16

65 degrees

Question 17

what is mandatory during teaching pressure relief strategeis

Answer 17

must palpate the ITs

Question 18

what are effective strategies against orthostatic hypotension

Answer 18

midodrine, e-stim, and compression

Question 19

what is beevor’s sign

Answer 19

umbilicus displacement when a pt with a thoracic level injury is asked to curl up

Question 20

define the modified ashworth scale

Answer 20

0 = no increase in tone

1 = slight increase in tone (catch and release)

1+ = slight increase in tone (catch and resist)

2 = tone increase, but moves easily

3 = passive movement difficult

4 = rigid in flexion or extension

Question 21

what is the tardieu scale

Answer 21

R1 is the first catch and R2 is the available range

Question 22

what is the reflex scoring scale

Answer 22

0 = absent

1+ = hypo

2+ = normal

3+ = brisk

4+ = 1-3 beat clonus

5+ = sustained clonus

Question 23

what are the reflex locations of the UE

Answer 23

• biceps C5-6
• triceps C6-7

Question 24

what are the reflex locations for the LE

Answer 24

• patellar L2-4
• hams L5-S2
• achilles S1-2

Question 25

define spasticity

Answer 25

velocity dependent increase in resistance of a muscle or group to passive stretch (UMN)

Question 26

clasp knife phenomenon

Answer 26

a type of spasticity defined as increasing resistance followed by a sudden release of resistance (snapping into full ROM)

Question 27

baclofen

Answer 27

most common antispasmodic given orally or intrathecally via subdermal pump

Question 28

What are the ASIA UE motor exam points

Answer 28

* C5: elbow flexion * C6: wrist extension * C7: elbow extension * C8: DIP flexion * T1: pinky abduction

Question 29

what are the ASIA LE motor exam points

Answer 29

* L2: hip flexion * L3: knee extension * L4: ankle DF * L5: great toe ext * S1: ankle PF

Question 30

what are some muscle groups you will prioritize in MMT?

Answer 30

scapular stabilizers

Question 31

what is an EXCELLENT position to train/test scapular stretch

Answer 31

PoE

Question 32

what is a great combo activity for muscle re-education

Answer 32

FES and biofeedback

Question 33

what are three common findings during a sitting posture exam

Answer 33

* PPT (sacral sitting) to increase BoS and stability * T kyphosis and compensatory C lordosis * scoliosis

Question 34

describe functional mobility at the C7 level

Answer 34

pts may achieve independence though energy energy expenditure may be a concern

Question 35

describe functional mobility at the C6 level

Answer 35

pts MUCH LESS LIKELY to be independent (than C7) and will probably require assistance

Question 36

describe functional mobiilty at C5 and above

Answer 36

will require assistance

Question 37

rolling training ideas for C6 tetras (5)

Answer 37

* LE progression - 2 flexed, 1 flexed, legs crossed * cuff weight on wrist for momentum * head/neck to initiate roll * start 45 deg prop, 30 deg prop, etc * elbow flexion to pull on rail

Question 38

supine to sit ideas for C6 tetras (4)

Answer 38

* biceps with hands in pockets/under thighs * rolling effort with quick throw of UE behind (req high GHROM) * roll to side and walk elbows to pull with biceps * train the activity in reverse (long sit to supine)

Question 39

Answer 39

B