SCI Goals & treatment

Question 1

Preventive goals

Answer 1

• respiratory management
• prevention of dermatological, MSK & vascular complications
• facilitation of active mvt in available musculature
• orientation to the vertical position
• pain management
• spasticity management
• management of MSK complications
• Education of patient (stretching, bladder control, complications)

Question 2

Pressure injury management

Answer 2

-> Preventive goal
- positioning
- moving in bed & WC -> PI relief techniques
- report redness; reports injuries (bumps..) <=> educate on self examination
- educate about air cushions
- instruct patient on checking & reporting their bumps/small injuries until healed

Question 3

What are the goals of verticalizations?

Answer 3

-> Preventive goals
- impr. gastro-intestinal function
- facilitate respiratory function
- stimulate CVS
- psychological benefis

Question 4

Spasticity management & prevention

Answer 4

-> Preventive goal
- Spasticity is negative only if it’s painful or restrict the ROM
- Otherwise +
- Preventive triggers (fatigue, inactivity, infections, pressure ulcers..)
- PT treatment : stretching, active ex -> short time effect
- Pharmacological treatment :baclofen or botulinum toxin (side effects++)

Question 5

Passive/Active mobilisation

Answer 5

-> Preventive goal
- ROM maintainance & incr. (joint such as hip & shoulder for ADL such as dressing & transferts)
- Prevention of MSK complications + DVT
- Motor capacity maintainance (active)

Question 6

Stretching

Answer 6

-> Preventive goals
- Contracture decr.
- ROM incr.
- Spasticity management

=> Education of patient about doing those on their own => incr. independance by not depending on caregivers & physio..

Question 7

PNF

Answer 7

= proprioceptive neuromuscular facilitation
- incr. strength & mobility
- facilitated by proprioceptive, cutaneous & auditory inputs
=> Diagonal patterns mvt D1 & D2

Question 8

PNF D1

Answer 8

START
- Shoulder : Flexion/ABD/ER
- Forearm : supination
- wrist : ext
- fingers : ext
END
- Shoulder : Ext/ADD/IR
- Forearm : Pronation
- Wrist : Flexion
- Fingers : Flexion

Question 9

PNF D2

Answer 9

START :
Shoulder : EXT/ABD/ER
Forearm : Supination
Wrist : Ext
Fingers : Ext
(elbow extension)

END :
Shoulder : Flex/ADD/IR
Forearm : Pronation
Wrist : Flex
Fingers : flex
(elbow flexed)

Question 10

PNF techniques

Answer 10

• Rythmic initiation : ROM/strength
• Repeated contraction : strength/endurance
• Slow reversal : ROM/agonist-antagonist balance
• Slow reversal hold :strength
• Rhytmic stabilization : strength/endurance

Question 11

Adaptative goals

Answer 11

• UL, back & abs strength training, depending on ASIA & NLI level
  -Maintaining sitting mobility
• Dvlp & education about compensatory strategies
• Learning about use of WC & other mobility aids
• Sports adaptation

Question 12

Rehabilitative goal

Answer 12

• Maximize function, prioritizing independence
• Dvlp progressive strategies for transfers
• Educate caregivers about patient’s need & expectations
• promote gait

Question 13

Strengthening aims

Answer 13

• move
• use strength for transfers
  -> incr. strength => incr. body functions

Question 14

Strengthening regions

Answer 14

• UL
• Latissimus dorsi
• abdominals

Question 15

Strengthening methods

Answer 15

• task oriented training
• push up handles
• resistance training

Question 16

Balance training : goal parameters

Answer 16

• specific position + parameter + perturbation
• position : sitted/standing
• parameter : dynamic/static
• perturbation : intrisic/extrinsic

Question 17

What is important to train balance?

Answer 17

• Trunk control ++ <=>
  1. Strength (abdominals, erector spinae, back muscles)
  2. Mobility
  3. Proprioception (pelvis/LL/trunk)

Question 18

Transfers - how to help the patient?

Answer 18

assist -> educate -> train
-> active transfers require good balance & strength of UL/back/abs
- chair to floor & floor to chair transfert

Question 19

Define sitting static balance

Answer 19

Sitting, when trunk is not moving, arm should not rest on bed or legs

Question 20

Define sitting dynamic balance

Answer 20

Sitted, when trunk is moving

Question 21

Define standing static balance

Answer 21

Standing, UL moving but not walking

Question 22

Define standing dynamic balance

Answer 22

Standing & walking

Question 23

If we want to work on balance on a complete SCI injury, what should we focus on?

Answer 23

Proprioception & strengthening abose the nli

Question 24

WC manipulation : What are the prerequisites?

Answer 24

• UL strength (elbow extension, elbow flexion, hand grip, shoulder external rotators)
• Trunk control

Question 25

WC manipulation : Which skills should a patient learn?

Answer 25

• turn
• acc & decelerate
• go up (gap & obstacles)
• how to fold WC

Question 26

WC manipulation : How to learn?

Answer 26

• Education of patient (on how to do it)
• Training (Obstacle course)

Question 27

Which devices can help a patient to return to walking?

Answer 27

• walking aids, assistive devices
• orthosis (eg: Knee ankle foot braces)
• Devices like Exoskeleton & Lokomat (stimulate recovery of motor function through assisted gait)

Question 28

Which patients should do sports adapatation? What are the benefits?

Answer 28

For any patient, not only yound & athletes
- Incr. cardiovascular & respiratory health
- Incr. strength
- Incr. balance
- Incr. mental health
- Reduce isolation by incr. social interaction

Question 29

What is the overall purpose of rehabilitation in SCI?

Answer 29

Incr. quality of life by increasing independance