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PHTH 529 - Neuro > SCI - Interventions > Flashcards

SCI - Interventions Flashcards

1
Q

phase 1

A

rolling
supine to sit
scooting
supine to prone
sitting balance and tolerance

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2
Q

phase 2 - joint stability and transfers

A

w/c set up
body and w/c positioning
weight shifting
assisted transfers
independent transfers

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3
Q

phase 3 - strengthening

A

strength and stretching program
UE strengthening
LE stretching

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4
Q
A
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5
Q

phase 4 coordination

A

balancing @ a higher level
community integration
functional activities
standing activities
coordination

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6
Q

phase 5 - gait

A

start upright in parallel bars or AD
treadmill training
orthotics

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7
Q

overarching outcomes in SCI

A

pathology - decrease pressure sores and education

body structure - muscle performance/flexibility, aerobic capacity/cough, joint mobility

posture - assisted or independent in sitting, assume sitting posture

bed mobiity, transfers, overall mobility (w/c and reintegration into community)

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8
Q

ortho/stress at fx site

precautions/prevention

A

orthotic use after surgery
heterotopic ossification

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9
Q

skin monitor

precautions/prevention

A

pressure relief
equipment
shrearing forces

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10
Q

cardiovascular

precautions/prevention

A

orthostatic hypotension (gradual increase)
DVT

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11
Q

autonomic dysreflexia

precautions/prevention

A

headache
flushing of skin
high BP

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12
Q

respiratory

precautions/prevention

A

cough
diaphragmatic and intercostal

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13
Q

overuse syndrome

precautions/prevention

A

shoulders
overstretching of low back and hands

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14
Q

five activities that SCI pts need to perform

A

rolling
mobilizing from supine to long sitting
unsupported sitting
lifting vertically
transfer from variety or surfaces

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15
Q

C7 SCI for balance on plinth

A

need long hamstring length in long sit
- sitting balance with primarily shoulder and c-spine musculature
- shoulder ext rotation for improved postural control with weak triceps
- tenodesis in finger flexors
- use of wrist extensors for moving lower extremities

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16
Q

sitting balance activities

A
  1. first find alignment and always start with static activities
  2. scooting activities on the mat (depression activities)
  3. use of UE poles, devices: static strategies gaining balance
  4. dynamic activiities: ex. ball toss and catching
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17
Q
A
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18
Q

C6-8 SCI sitting activities

A

need immense practice for various sitting
can practice long and short sit

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19
Q

t1-6 SCI sitting activities

A

short sit at edge of bed or mat
may need UE for dynamic balance

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20
Q

whole body vibration and SCI

A

WBV allows to elicit EMG activities with complete SCI in sitting and passive standing
- specific amp and freq = 45 Hz and 1.2 cm
- variety of postures dont change EMG

21
Q

process of transfers from w/c

A

position the w/c and pt
hands foward of the pelvis
feet position midway between mat and chair
WB thru base of hand
principles of head-torsion/trunk
- rotation of trunk with head toward the mat
- lifting the butt = no possibility of shearing

22
Q

Assisted cough for cervical and high t-spine

process

A

place heel of one hand on pt abdomen (just above navel) then place other hand on top of first hand

pt takes a deep breath and holds

pt coughs + provider pushes upward and under rib cage

23
Q

starting level aerobic activity guidelines

A

20 minutes
2x a week
mod-vigorous intensity

24
Q

advanced level aerobic activity guideliens

A

30 mins
3x a week
mod-vigorous intensity

25
aerobic activities
arm ergometer swimming W/C locomotion resistance activities circuit resistive training
26
aerobic exercise guidelines
vigorous-intensity 70% of HR max monitor: - RR - O2 saturation
27
suspending or no initiation of aerobic activities
RR: > 30 SaO2: < 90% Unwarranted accessory breathing Increased rise in HR (20 beats) in resting HR Complaints of headache
28
aerobic ex/cardiovascular fitness above t4
loss of central command of sympathetic nervous system above t4 lack effective orthostatic regulation because of sympathetic function resting hypotension with decrease in activity and blood flow = loss of pumping efficiency - L ventricular atrophy: diminished chamber size
29
aerobic activity/cardiac below t6
higher resting HR or nearly normal slightly elevated BP with depressed stroke volume circulatory hypokinesis = less regulation of blood flow --> increased risk of thrombosis
30
hamstring streching in cervical injuries
need special attention at least 120 deg
31
32
flexibility
pt's with SCI do not need full ROM in all joints some joints benefit from allowing tightness to develop in certain musles to enhance function
33
extensibility in c6-7 quad
long sitting needs tightness in the lumbar extensors and length in hamstrngs to keep upright sitting with quadriplegia = tightness of the lower trunk musculature improves sitting posture - when transfering = increased trunk stability
34
tenodesis grasp and release
biomechanical occurance letting some opening and closing of the fingers by wrist extension after SCI @ C6 or C7 = use of wrist extension to promite a biomechanical grasp
35
tenodesis transfers and sitting
teach pt to WB on balms of the hands and not overstretch the finger flexors - use tenodesis to grasp objects
36
SCI muscular disuse
chronic disuse = slow, fatigue resistance --> fast, fatigable muscles extensive decline in fatigue resistance is seen due to decreased capillary density of muscles e-stim reduce the normal post-SCI deteruiration of muscle
37
Regular pressure relief
individuals with SCI should perform pressure relief maneuvers (weight shifts, leaning forward, etc.) every 15-30 mins with each shift lasting 1-2 minutes
38
39
skin inspection
daily visual inspection of the skin (specific in areas of high risk) to see for any pressure sores
40
skin protection
by distributing weight across the seating surface decrease shear promite heat exchange and airflow
41
causes of skin wounds
moisture (sweat or urine) bigger people = warmer and may need more airflow in their cushions
42
skin protection and w/c pushups
NO LONGER RECOMMENDED because of the impact on shoulder integrity equal benefits of bending forward and leaning to the side for decrease pressure + more blood flow + oxygenation
43
pressure relief leaning forward
at least 45deg (elbows on knees position) lateral trunk leaning to 15deg reduces pressure and increases blood flow + tissue oxygenation important to be be able to return back normal sitting position
44
cervical or high t-spine level pressure relief
between 25-65 deg = give pressure relief 15 deg or less does not provide proper pressure relief
45
UE theraband and weights
scapular retraction shoulder ER diagonal extension (adduction) serratus anterior
46
UE theraband and weights guidelines
3 sets for each functioning muscle groups mod intensity 2x per week
46
function of standing activities
SCI causes rapid bone demineralization after one year - slows bone decay with supported standing - improved bladder and renal function - decreased spasticity - also functions as a stretching program
47
standing activities
all pt with SCI should be assessed for potential benefits of standing according to level and type of injury - should be assessed once physiologically stable - should stand 3+ a week for 30-60 mins

PHTH 529 - Neuro (4 decks)

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