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Neuro Eval II > SCI Examination, Interventions, & Special Considerations > Flashcards

SCI Examination, Interventions, & Special Considerations Flashcards

1
Q

Strengthening Interventions

A
  • Strengthen functioning musculature with strength exercises and functional exercises
  • Gravity eliminated positions for weaker muscle groups (<3/5)
     STOMPS Strengthening and Optimal Movements for Painful Shoulders (Mulroy 2011)
     HEP prescription
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2
Q

UMN Sign

A

Decreased inhibition at level of spinal cord

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3
Q

What do we initially see post SCI?

A

Spinal Shock (hypotonic, areflexic)
Over a few days to weeks, tone starts to kick in

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4
Q

Flexor spasms:

A

hip flexion, knee flexion, ankle dorsiflexion, great toe extension

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5
Q

Extensor Spasms:

A
  • hip extension, knee extension, ankle plantar flexion
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6
Q

Negative impact of spasticity on mobility?

A

 impede mobility
 skin integrity
 pain
 disturbed sleep
 decreased ROM → contractures

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7
Q

Positive impact of spasticity on mobility?

A

 assist with mobility & stability
 prevents atrophy
 physiologic benefits(bone density, circulation)

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8
Q

PT Interventions for spasticity management

A
  • passive movement/stretching
  • active movement including FES
  • direct muscle electrical stimulation interventions based on afferent stimulation
  • interventions based on direct cord stimulation
  • repetitive TMS
    * Weak evidence, short term effects, lack of functional outcomes*
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9
Q

Special considerations of ROM for SCI?

A

“Normal” ROM is not always the goal, depending on the level of injury and impairment

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10
Q

What areas do we want decreased ROM?

A
  • Finger flexors
  • Thumb webspace
  • Back extensors
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11
Q

What areas do we want increased ROM?

A
  • Elbow flexors
  • Wrist flexors
  • Shoulder ER
  • Shoulder extension
  • Ankle DF
  • Knee ext w/ hip flex
  • Hip ER
  • Hip extension
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12
Q

Functional Tenodesis

A
  • Passive insufficiency of finger flexors, pulley system w/ forearm extensors
  • Wrist extension: grasp
  • Wrist flexion: release
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13
Q

2 ROM complications post SCI

A
  • Contractures from resting posture, lack of mobility, and spasticity
  • Heterotopic Ossification (commonly develops 1-4 months post)
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14
Q

Interventions for Heterotopic ossification

A

Gentle PROM, medication, surgery
- Will only operate when absolutely necessary bc recurrence rate is very high

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15
Q

PT intervention for ROM complications (ie contractures)

A

 Self stretching HEP
 Caregiver-assisted stretching HEP
 Positioning (bed & WC)  Orthotics - PRAFOs, AFOs, static progressive AFOs
 Used for stretching or maintaining muscle length

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16
Q

6 aspects of SCI activity examination

A
  • sitting balance
  • bed mobility
  • transfers
  • wheelchair mobility
  • standing balance
  • gait
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17
Q

What is the foundation of everything else you will do for non-ambulatory patients?

A

sitting balance

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18
Q

3 positions of sitting balance

A
  • long sitting
  • short sitting
  • ring sitting
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19
Q

Functional sitting positions and considerations

A
  • UE positioning: anterior prop, posterior prop, no UEs –> KEEP FINGERS CURLED WITH UE WBing TO PRESERVE TENODESIS
  • LE positioning: short sit, long sit, ring sit
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20
Q

Sitting Balance Strategies

A
  • External Rotation of shoulders to allow for stability without triceps
  • C Curve to utilize passive back extensor tightness for stability and create external trunk flexion moment
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21
Q

Movement/dynamic challenges for sitting balance interventions

A
  • transitions between prop positions
  • manual perturbations
  • directional reaching
  • lifting objects with weight
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22
Q

4 types of bed mobility

A
  • rolling
  • short sit to/from supine
  • long sit to/from supine
  • long sit to/from short sit
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23
Q

Bed mobility special considerations

A

 Level of impairment
 Fine motor control or not
 Flexibility
 Trunk control & balance
 Adaptive equipment (bed ladder, leg loops, Dycem gloves)

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24
Q

How to decrease the challenge of rolling

A

3/4 supine with wedge, flex hip/knee, cross legs, elevating HOB

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25
How to increase challenge of rolling
sheets, bed vs mat (softer surface), with or without shoes
26
Bed mobility strategies
Bed mobility strategies – scapular protraction, lead with head, momentum, ventilatory assist, break task down into parts (part to whole practice), mechanical advantage with large BOS (positioning UE far from trunk to prop for balance while maneuvering LEs)
27
Before transferring, what should you consider?
Upright tolerance
28
5 types of transfers
 WC<>bed  WC<>tub  WC<>toilet  WC<>car  WC<>floor
29
SCI Transfers Special Considerations
 Level of impairment  Body habitus  Fine motor control/grip – managing LEs  Trunk control & balance for seated transfers  Lower extremity function  Adaptive equipment  Skin integrity
30
Transfer strategies and principles
 Head hips relationship CRITICAL in this patient population  UE placement to facilitate force production & stability  Shoulder ER– biomechanics of passive elbow extension  Bring COM close to UE providing most propulsive force during lateral transfer
31
Basic Propulsion
 Propulsive and recovery phases  “10 and 2” grip & release
32
Advanced Wheelchair Skills
o Static wheelie (foundational) o Pop up wheelie o Sustained wheelie o Forward/backward/360 degrees in wheelie o Curbs, ramps, stairs o Sideslopes o Uneven terrain
33
Wheelchair Prescription for motor complete SCI C1-C3
 MWC tilt in space (dependent)  PWC w/ head array
34
Wheelchair Prescription for motor complete SCI C4
 MWC tilt in space (dependent)  PWC w/ head array or sip n puff
35
Wheelchair Prescription for motor complete SCI C5
 PWC w/ adapted joystick (goal post)
36
Wheelchair Prescription for motor complete SCI C6
 PWC w/ adapted joystick - community  MWC w/ adapted rims – household
37
Wheelchair Prescription for motor complete SCI C7
 MWC – may have adapted rims  Consider power assist for community
38
Wheelchair Prescription for motor complete SCI C8-L3
 MWC w/o adaptations  Consider power assist for community
39
What is one of the first and most important interventions to teach individuals with SCI?
Pressure relief!!
40
4 methods of pressure relief
 Lateral lean  Anterior lean  Tricep push up  Tilt in space (power or manual WC)
41
PT Role in Acute SCI
Assess perception of current situation & prep for community re-entry including transportation
42
PT Role in Acute and Chronic SCI
Ensure adequate referrals in place to allow for community re-entry  Vocational Rehab  Leisure/Recreation Driving
43
Environmental Factors
* Home accessibility - carpet vs hard wood, throw rugs, steps, lips * Home modifications – grab bars, walk in vs tub shower (may need bathroom reno), ramps
44
Personal Factors
* Previous life activity – occupation, recreation * Family support/dependents * Psychological well-being
45
Causes of autonomic dysfunction - Orthostatic Hypotension
decreased skeletal muscle pump action & altered sympathetic activity in injuries T6 & above (vasoconstriction) deconditioning/prolonged immobilization, dehydration
46
Signs of autonomic dysfunction - Orthostatic Hypotension
decreased BP, dizziness/lightheadedness, palor, sudden fatigue, nausea, loss of consciousness
47
PT Intervention for Orthostatic Hypotension
compression, fluids, slow position changes, lay patient supine and elevate legs, train upright tolerance
48
What is considered orthostatic hypotension
drop in 20 mmHg systolic or 10 mmHg diastolic
49
Causes of autonomic dysreflexia
noxious stimulus below injury level
50
signs of autonomic dysreflexia
elevated BP, headache, sweating, bradycardia, flushing, pounding in ears, nasal congestion
51
PT Intervention for Autonomic Dysreflexia
NOTIFY MD - Sit patient up - Remove compression - look for source *** commonly caused by pressure sores
52
Intervention for deconditioning
- Endurance training (MONITOR VITALS) - Circuit resistance training - 20-30 min mod-vigorous exercise, 2x/wk - Canadian SCI Physical Activity Guidelines
53
Deep Vein Thrombosis Intervention
Medication management and compression garments
54
Spinal precautions following SCI - Acute
– no prone, bending, lifting >10 lbs, twisting * Follow MD orders – often lifted 6-12 weeks post injury or stabilization surgery
55
Spinal Orthoses
* Thoracolumbar sacral orthosis (TLSO) * Sternal occipital mandibular immobilizer (SOMI) * Hard cervical collar (Aspen, Miami J) * HALO
56
Secondary musculoskeletal complications - shoulder pain interventions
STOMPS Strengthening and optimal movements for painful shoulders
57
Secondary musculoskeletal complications - Osteoporosis
o Bone density decreases w/ decreased forces acting on bone (Wolff ’s law) o Careful mobilizing chronic SCI – attn to position of joints & forces through bone o fractures common o Intervention: weightbearing as medically cleared, FES cycling
58
Why is there a high risk for pressure ulcer development post SCI
due to sensory deficit, mobility methods and impaired thermoregulation
59
common pressure points
sacrums, heels, trochanters, ischium, malleoli
60
Positioning/posture Interventions for pressure ulcers
o Turning schedules (2 hr) o HOB restrictions for sacral wounds (<30 deg) o Partial sidelying positions o Accommodate for postural deviations (scoliosis, pelvic obliquity) in WC
61
Mechanical pressure relief
- every 15-30 minutes for 30-90 seconds - Timers -PRAFOs
62
3 other types of interventions for pressure ulcers
- Wheelchair cushion 0 minimize shearing and friction forces during mobility training - education on effects of impaired thermoregulation on skin integrity - moisture can cause tissue maceration/damage
63
Respiratory system impacts of SCI
- reduced tidal volume and vital capacity - decreased forced expiration and inhalation
64
what is a common cause of death following SCI?
respiratory dysfunction secondary to secretion build up
65
PT interventions for respiratory dysfunction
cough assist, positioning to optimize ventilation
66
why does respiratory failure occur at lesions above C4?
- phrenic nerve involvement (C3-5 innervation) - medical interventions: artificial ventilation or phrenic nerve stimulators
67
At what level is voluntary control of bowel and bladder lose?
S2-S4
68
Following spinal shock, what occurs to the bladder?
➢ Following spinal shock, reflexive bladder (UMN) or flaccid bladder (LMN) develops ➢ Intermittent catheterization ➢ Indwelling foley catheter ➢ Manual emptying (pressure)
69
Bowel Programs
can greatly impact rehab success if unregulated ➢ suppositories ➢ digital stimulation ➢ stool softeners ➢ diet modification
70
Who primarily manages bowel/bladder programs?
OT and RN

Neuro Eval II (16 decks)

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