SCI Goals & treatment Flashcards
Preventive goals
- 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)
Pressure injury management
-> 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
What are the goals of verticalizations?
-> Preventive goals
- impr. gastro-intestinal function
- facilitate respiratory function
- stimulate CVS
- psychological benefis
Spasticity management & prevention
-> 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++)
Passive/Active mobilisation
-> 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)
Stretching
-> 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..
PNF
= proprioceptive neuromuscular facilitation
- incr. strength & mobility
- facilitated by proprioceptive, cutaneous & auditory inputs
=> Diagonal patterns mvt D1 & D2
PNF D1
START
- Shoulder : Flexion/ABD/ER
- Forearm : supination
- wrist : ext
- fingers : ext
END
- Shoulder : Ext/ADD/IR
- Forearm : Pronation
- Wrist : Flexion
- Fingers : Flexion
PNF D2
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)
PNF techniques
- Rythmic initiation : ROM/strength
- Repeated contraction : strength/endurance
- Slow reversal : ROM/agonist-antagonist balance
- Slow reversal hold :strength
- Rhytmic stabilization : strength/endurance
Adaptative goals
- 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
Rehabilitative goal
- Maximize function, prioritizing independence
- Dvlp progressive strategies for transfers
- Educate caregivers about patient’s need & expectations
- promote gait
Strengthening aims
- move
- use strength for transfers
-> incr. strength => incr. body functions
Strengthening regions
- UL
- Latissimus dorsi
- abdominals
Strengthening methods
- task oriented training
- push up handles
- resistance training
Balance training : goal parameters
- specific position + parameter + perturbation
- position : sitted/standing
- parameter : dynamic/static
- perturbation : intrisic/extrinsic
What is important to train balance?
- Trunk control ++ <=>
1. Strength (abdominals, erector spinae, back muscles)
2. Mobility
3. Proprioception (pelvis/LL/trunk)
Transfers - how to help the patient?
assist -> educate -> train
-> active transfers require good balance & strength of UL/back/abs
- chair to floor & floor to chair transfert
Define sitting static balance
Sitting, when trunk is not moving, arm should not rest on bed or legs
Define sitting dynamic balance
Sitted, when trunk is moving
Define standing static balance
Standing, UL moving but not walking
Define standing dynamic balance
Standing & walking
If we want to work on balance on a complete SCI injury, what should we focus on?
Proprioception & strengthening abose the nli
WC manipulation : What are the prerequisites?
- UL strength (elbow extension, elbow flexion, hand grip, shoulder external rotators)
- Trunk control
