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Neuromotor II > SCI exam > Flashcards

SCI exam Flashcards

1
Q

What are the strategies for vertebral stabilization and immobilization after a SCI?

A
  1. Closed reduction - Traction by cervical tongs (not often used, temporary before halo or surgery) and/or halo brace (assures fixation)
  2. Open reduction - Surgical decompression and stabilization
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2
Q

Whta are the advantages of using a halo?

A
  1. Reduces time in bed - screwed into head
  2. Earlier progression to upright activities and rehabilitation
  3. Left in place until x-ray indicates fracture is stable – approx. 12 weeks
    - disadvantages: difficult for positioning in bed/ WC, unable to move head
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3
Q

What are the types of orthoses are used during SCI?

A
  1. Sterno-occipital-mandibular immobilizer (SOMI)
  2. Hard Collar
  3. TLSO
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4
Q

What should you look while performing a respiratory assessment?

A
  1. Function of respiratory muscles
  2. Respiratory rate
  3. Chest expansion - normal 2.5-3 inches
  4. Breathing patterns
  5. Ability to produce a productive cough
  6. Vital capacity - spirometer
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5
Q

What should you look while performing a skin assessment?

A
  1. Everyone’s responsibility
  2. Patient education
  3. Use of a mirror
  4. Proper cushion in W/C
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6
Q

What is emphasized in sensory testing?

A

pinprick and light touch

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7
Q

What are the functional assessments for SCI?

A
  1. Wheelchair Skills Test (Pg. 915) - Manual W/C skills
  2. Power Chair Test - Using various switches
  3. SCI Functional Ambulation Inventory (SCI-FAI) (Pg. 916) - Gait Parameters, Assistive Devices, Distance Measures
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8
Q

What is a participation assessments for SCI?

A

Craig Handicap Assessment and Reporting Technique (CHART)

  • Designed to provide an objective measure of the degree to which impairments and disabilities affect participation in the years after a SCI
  • 15 min interview consisting of 32 questions
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9
Q

What is respiratory management of someone with SCI?

A
  1. Glossopharyngeal breathing
  2. Diaphragmatic breathing
  3. Abdominal support
  4. Assisted coughing and teaching indep coughing techniques
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10
Q

What do you want to keep in mind when performing ROM and positioning with SCI?

A
  1. Fracture site healing
  2. Acutely ankle boots or splints for heel cords and to prevent pressure sores and external rotation of LE
  3. Selective stretching:
    - Need lordotic posture
    - C6 or C7 Preserve tenodesis – keep fingers flexed
    100 degrees ROM in hamstrings – but no more
    - Increase tolerance to prone position
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11
Q

What do you want to keep in mind when doing selective strengthening with SCI?

A
  • Avoid stress on fracture site
  • Emphasize bilaterally to avoid rotational stress on the spine
  • Quadriplegia emphasis on: Anterior deltoid, Shoulder extensors, Biceps and lower trapezius
  • Paraplegia in addition to above emphasis on: Shoulder depressors, Triceps, Latissimus dorsi
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12
Q

What are functional expectations pts with SCI need to responsible for?

A
  1. Skin inspection
  2. Pressure relief
  3. Bowel and bladder care
  4. Wheelchair management
  5. Orthotic management
  6. Leg management
  7. Coughing
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13
Q

What are functional expectations of someone with a SCI C4 or higher?

A
  1. Full time help required
  2. Max assist for transfers
  3. Mechanical lifts are used
  4. Power W/C with tilt is needed
  5. Unable to drive
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14
Q

What are functional expectations of someone with a SCI C5?

A
  1. Assistance for set up with bed skills and ADL’s
  2. Manual W/C with projections but more likely power W/C with joystick
  3. Transfers with assistance using slideboard
  4. Dependent skin inspection
  5. Tilt-in-space chair for independent pressure relief
  6. Driving with hand controls
  7. Part time help required
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15
Q

What are functional expectations of someone with a SCI C6?

A
  1. Independent bed skills and ADL’s
  2. Manual W/C with projections or friction surface hand rims but may need power W/C with joystick for longer distances
  3. Independent transfers with slideboard on level surfaces
  4. Independent skin inspection and pressure relief
  5. Driving with hand controls, usually requires assistance getting W/C into car
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16
Q

What are functional expectations of someone with a SCI C7?

A
  1. Manual W/C with friction surface hand rims
  2. Independent transfers without slideboard
  3. Driving with hand controls, able to get W/C in and out of car
17
Q

What are functional expectations of someone with a SCI C8-T1?

A
  1. Increased independence with less adaptive equipment
  2. Manual W/C with standard hand rims
  3. Independent transfers
  4. Driving with hand controls
18
Q

What are functional expectations of someone with a SCI T4-T6?

A

Physiological standing - not practical for functional ambulation

19
Q

What are functional expectations of someone with a SCI T9-T12?

A
  1. Household ambulation
  2. Bilateral HKAFO’s and crutches
  3. High energy consumption
  4. Wheelchair used for energy conservation
20
Q

What are functional expectations of someone with a SCI L2-L4?

A
  1. Functional community ambulation
  2. Bilateral KAFO’s and crutches
  3. Wheelchair for convenience and energy conservation
21
Q

What are functional expectations of someone with a SCI L4-L5?

A
  1. Functional community ambulation
  2. Bilateral KAFOs or AFOs and crutches
  3. Many patients still use wheelchair for convenience and energy conservation
22
Q

What are prognostic indicators for SCI?

A
  1. Level of injury
  2. 2Age
  3. Motivation
  4. Comorbidities
  5. Weight
  6. Baseline level of fitness/ endurance
  7. Support
23
Q

What are thing to consider in custom W/C prescription?

A
  1. Seat depth
  2. Floor to seat height (include cushion)
  3. Back height
  4. Seat width - consider coats during winter, stable weight (?)
  5. Heel loops (spasticity), pelvic belt, etc.
  6. Arm rests and foot rests
  7. Cushion type
  8. Power options - Tilt, Switches
24
Q

Cushion type: Lightweight, inexpensive; Least effective pressure distribution, cannot be washed, heat buildup, wears out faster

A

Contoured foam

- temporary, for someone not with SCI

25
Q

Cushion type: Better pressure distribution, minimize shear forces, prevents heat buildup; Heavy, moisture buildup, reduced sitting stability, chance of leakage

A

Gel

26
Q

Cushion type: Best pressure distribution, waterproof; Easily punctured, transfers more difficult, more expensive, high maintenance

A

Air

- Rojo

27
Q

Cushion type: Made of open cells; Better pressure distribution, very lightweight, keeps skin cooler, washable

A

Urethane honeycomb

28
Q

What types of W/C would you expect a pt with different levels of SCI?

A
  • C4 or higher rely on a power W/C
  • C5 or C6 may indep. propel a manual W/C but may not have endurance or strength for community W/C mobility
  • C7 or lower indep. propel a manual W/C
29
Q

Between power and manual
Manual W/C with power assist wheels; When force is applied to push rims the motor is activated, Requires less energy, less strokes, and less shoulder ROM

A

push rim activated power assist wheelchairs

- beneficial for C5/C6

30
Q

W/C type: Smoother ride, Weighs more, Easier to get into a vehicle,Less energy efficient

A

folding frame

31
Q

W/C type: Rougher ride, Lightweight, Must be taken apart to get into a vehicle, More energy efficient, More durable/high performance

A

Rigid frame

32
Q

What are the benefits of having the rear wheel Axel forward?

A
  1. Decreased roll resistance
  2. Handrim contact increased
  3. Propulsion with less muscle effort, smoother patterns, and lower stroke frequency
    - helps shoulder problems!

Neuromotor II (13 decks)

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