SCI E&I Flashcards
how do the abdominals help with inspiration
they indirectly support the diaphragm by holding the abdominal contents preventing paradoxical breathing
what muscles are most important in implication of paradoxical breathing
external intercostals
normal chest expansion
2.5-3 inches
talk about how vital capacity changes in tetraplegics. paraplegics?
VC is typically 5 L, but decreased 40% in tetras and 20% in paras
what do you know about ventilatory reserve and how might it impact your treatment
VR is VC/TV so if its narrow then patients will not tolerate changes in oxygen demand readily
FEV1 predicts ____
potential for effective cough
other than numbers on the spirometer, how can we use it to measure breathing
ask the pt to count or recite the alphabet
C
therapist/caretaker assist for cough training happens at what level of injury? why?
C5 - doesn’t have enough GH IR force to do self heimlich
what is the relationship between C1-3 patients and ventilators
pts require vent or phrenic nerve pacer
what is the relationship between C4 patients and ventilators
can frequently wean from vents
what is a helpful technique to assist in weaning pts from ventilators
biofeedback
what is glossopharyngeal breathing
an air “gulping” technique for high tetras
B
what is pressure relief Rx
1 minute for every 15 minutes of sitting
in a tilt-in-space/recline WC, what degree of tilt is needed for pressure relief
65 degrees
what is mandatory during teaching pressure relief strategeis
must palpate the ITs
what are effective strategies against orthostatic hypotension
midodrine, e-stim, and compression
what is beevor’s sign
umbilicus displacement when a pt with a thoracic level injury is asked to curl up
define the modified ashworth scale
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
what is the tardieu scale
R1 is the first catch and R2 is the available range
what is the reflex scoring scale
0 = absent
1+ = hypo
2+ = normal
3+ = brisk
4+ = 1-3 beat clonus
5+ = sustained clonus
what are the reflex locations of the UE
- biceps C5-6
- triceps C6-7
what are the reflex locations for the LE
- patellar L2-4
- hams L5-S2
- achilles S1-2
define spasticity
velocity dependent increase in resistance of a muscle or group to passive stretch (UMN)
clasp knife phenomenon
a type of spasticity defined as increasing resistance followed by a sudden release of resistance (snapping into full ROM)
baclofen
most common antispasmodic given orally or intrathecally via subdermal pump
What are the ASIA UE motor exam points
- C5: elbow flexion
- C6: wrist extension
- C7: elbow extension
- C8: DIP flexion
- T1: pinky abduction
what are the ASIA LE motor exam points
- L2: hip flexion
- L3: knee extension
- L4: ankle DF
- L5: great toe ext
- S1: ankle PF
what are some muscle groups you will prioritize in MMT?
scapular stabilizers
what is an EXCELLENT position to train/test scapular stretch
PoE
what is a great combo activity for muscle re-education
FES and biofeedback
what are three common findings during a sitting posture exam
- PPT (sacral sitting) to increase BoS and stability
- T kyphosis and compensatory C lordosis
- scoliosis
describe functional mobility at the C7 level
pts may achieve independence though energy energy expenditure may be a concern
describe functional mobility at the C6 level
pts MUCH LESS LIKELY to be independent (than C7) and will probably require assistance
describe functional mobiilty at C5 and above
will require assistance
rolling training ideas for C6 tetras (5)
- 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
supine to sit ideas for C6 tetras (4)
- 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)
B
