SCI Medical Management and Rehab Flashcards
What is the potential for recovery with SCI?
Greater recovery with incomplete lesions
70% of patients with cervical lesions recover 1 level below level of injury
At 4 months, what is one thing that is associated with a good prognosis for motor recovery at 1 year?
Preservation of pin prick
At what time after injury does motor function generally plateau?
12-18 months
When is surgical stabilization required?
Unstable fracture site
Gross malalignment
Cord compression
Deteriorating neurological status
What is minerva?
Cervical orthosis that effectively limits motion in all planes
What are primary goals of PT in the acute stage following and SCI?
Prevent secondary complications
Provide patient education
Begin early mobilization when medical clearance received
What are some respiratory factors you want to evaluate?
Observe strength of diaphragm Respiratory rate Chest excursion Vital capacity Cough Function
What are some ways you can encourage diaphragmatic breathing?
Can use light pressure just below sternum to facilitate inspiration and expiration
Use mirror for feedback
What is Glossopharyngeal Breathing?
Utilizae lips, pharyngeal muscles, and tongue to inhale air
Used with high cervical lesions
How can you help assist with respiration?
Abdominal binder Manual stretching (chest wall muscles)
What’s the most effective management of skin?
Prevention!!! Positioning Pressure relief Skin inspection Education
When in bed, how often does a patient need to be re-positioned?
At least every 2 hours
How often should a patient perform pressure relief in a wheelchair?
Every 15 minutes
must be maintained for 2 minutes to be effective
Name some pressure relief techniques for a patient in a wheelchair.
Push-up
Leaning forward (>45 degrees)
Leaning to side
Tilt feature (at least 65 degrees)
How often should ROM be completed in the acute stage?
Daily
What are the precautions if a patient has an injury to the lumbar spine?
Straight leg raise
What are the precautions if the cervical spine is injured?
Motion of head and neck contraindicated and caution when stretching shoulders (flexion and abduction
Why is selective stretching important?
Some joints and muscles benefit from tightness to enhance function
(Tetraplegia = tightness of lower trunk may improve sitting posture)
How much hamstring length is required for functional activities such as long sitting and dressing?
100 degrees
What do you want to make sure of before any upright activities?
Fracture site is stable and patient is cleared
How can you test aerobic capacity/endurance?
6-minute arm test
10-30 watts tetraplegia
30-60 watts paraplegia
How many people who experience a traumatic SCI may also experience a TBI
60%
True/False: Abnormal tone and spasms can cause involuntary muscle contractions or make it appear that a muscle moved or is stronger than it really is.
True
What do you want to be careful of with MMT?
Watch out for substitution (supinate forearm to extend wrist)
How can you assess self-care?
FIM
Spinal cord injury independence measure (SCIM) = reliable, vald, and may be more responsive than FIM
Quadriplegia index of function (QIF)
Capabilities of Upper Extremity Instrument (CUE)
What factors affect functional outcomes?
Motor level Age Concurrent injuries Secondary complications Body type Psychosocial Support
What are some key muscles innervated by C1, C2, C3, C4?
Face and neck muscles
Cranial nerve innervation
Diaphragm (Partial at C3 and C4)
What are some available movements at C1, C2, C3, C4?
Talking Mastication Sipping Blowing Scapular elevation
What are some key muscles innervated by C5?
Biceps Brachialis Brachioradialis Deltoid Infraspinatus Rhomboid Supinator
What are some available movements with C5?
Elbow flexion and supination
Shoulder ER
Shoulder abd and flexion to 90 degrees
What are some available movements with C6?
Shoulder flexion, extension, IR and add
Scapular abduction, protraction, and upward rotation
Forearm pronation
Wrist extension
What are some available movements with C7?
Elbow extension
Wrist flexion
Finger extension
What movements do you gain with C8?
Finger flexion
