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
Cushion type: Better pressure distribution, minimize shear forces, prevents heat buildup; Heavy, moisture buildup, reduced sitting stability, chance of leakage
Gel
26
Cushion type: Best pressure distribution, waterproof; Easily punctured, transfers more difficult, more expensive, high maintenance
Air | - Rojo
27
Cushion type: Made of open cells; Better pressure distribution, very lightweight, keeps skin cooler, washable
Urethane honeycomb
28
What types of W/C would you expect a pt with different levels of SCI?
- 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
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
push rim activated power assist wheelchairs | - beneficial for C5/C6
30
W/C type: Smoother ride, Weighs more, Easier to get into a vehicle,Less energy efficient
folding frame
31
W/C type: Rougher ride, Lightweight, Must be taken apart to get into a vehicle, More energy efficient, More durable/high performance
Rigid frame
32
What are the benefits of having the rear wheel Axel forward?
1. Decreased roll resistance 2. Handrim contact increased 3. Propulsion with less muscle effort, smoother patterns, and lower stroke frequency - helps shoulder problems!