SCI Treatment Considerations Part 4

Question 1

What nerves must be intact to contract muscles during functional activities?

Answer 1

peripheral NS

Question 2

FES has 2 main uses. One is Independent Application. This is when the patient uses FES to minimize impairments to encourage motor relearning.
T/F: These patients are expected to be lifelong users of FES.

Answer 2

False, ind. app. FES only used in the clinic and pts will be weaned off it.

Question 3

Example of Independent Application of FES

Answer 3

FES over ant. tib. to improve foot drop during gait.

Question 4

FES Dependent Application is used in what cases?
Hint: think neuroprosthesis
Also give an example.

Answer 4

Enable pt to perform functional activities.
Ex: FES on LE of patient w/ paraplegia while peddling on leg ergometer.

Question 5

T/F: FES Dependent Application is used by the patient outside the clinic for ADLs.

Answer 5

True

Question 6

Benefits for FES include pain reduction, CV health, improved blood flow, psychological benefits and improved motor efficiency. What are 2 more benefits for the use of FES?

Answer 6

1 NM Strengthening (da biggest)
2 Transient spasticity management esp. when med tx not available

Question 7

What is NOT an indication of FES?
A: UMN injury
B: Present normal motor function in arms, trunk, and/or legs
C: Demonstration of active contraction when FES applied to muscle belly
D: Pt can tolerate FES

Answer 7

B

Question 8

Absolute CIs for FES include DVT in area, malignancy in area, internal stimulator near area, presence of a pacemaker, & unhealed fx in area. What are 3 more CIs for FES usage?

Answer 8

1 LMN pathology
2 Pregnancy
3 Unctrlled autonomic dysreflexia

Question 9

Precautions for FES include severe spasticity or osteoporosis in area, heterotopic ossificans, & chronic pain syndrome. What is one more precaution and a PT implication for this precaution?

Answer 9

Absent sensory: monitor skin for burns

Question 10

FES can be used with the Bioness L300 & L300+. If using a thigh cuff, the targeted muscles are ___ and ___. If using a calf cuff the target muscle is ___.

Answer 10

1) quads, hamstrings
2) anterior tibialis

Question 11

Indications for L300 and L300+ are poor foot clearance. What is an indication for L300+ that is NOT an indication of L300? What about one for L300 and NOT for L300+?

Answer 11

L300: foot drop
L300+: knee instability

Question 12

T/F: Bioness L300, L300+ can be used for patients who have the potential to ambulate or patient who will not walk anymore.

Answer 12

False, ambulation only.

Question 13

Bioness uses a sensor placed in the sole of the shoe to detect when LE is in St phase of gait. What phases of gait will FES stimulate the quads, hamstrings, and anterior tibialis? Hint: they all activate in diff phases of gait

Answer 13

Quads: during St phases & 2nd half of swing phases
Hamstrings: during 1st half of swing
Anterior Tibialis: throughout swing phase

Question 14

What can patients who are non-ambulatory use in combo w/ FES? How often (per week) do patients typically use this?

Answer 14

RT300 FES Bike
2-3x/week

Question 15

Indications for the FES Bike include prevention/reduction of disuse atrophy, relaxing muscle spasms, and incr. local blood circulation. What are 2 more indications for the FES bike?

Answer 15

1 Maintain or incr. ROM
2 Improve muscle endurance with intact innervation

Question 16

FES bike considerations for use include ___, difficult to predict outcome, and insufficient evident for duration & dosage of tx. Hint: important patient edu!

Answer 16

Risk of raising unrealistic expectations

Question 17

The Lokomat is a robotic assisted treadmill that can be used for complete or incomplete SCI (ASI-A-D). Benefits for incomplete SCIs are adjustable gait pattern & guidance, real-time biofeedback, and neuroplasticity/CPGs. What are the benefits for use by patients w/ a complete SCI?

Answer 17

Upright Standing benefits: socialization, mood, resp./CV fxn, digestion, bone health, ROM, strengthening, skin integrity

Question 18

What are some considerations for using the Lokomat that you will include in your patient edu? Hint: 4 considerations

Answer 18

1 realistic goals/expectations
2 hemodynamic stability
3 skin integrity
4 autonomic dysreflexia

Question 19

Some CIs for Lokomat training include pregnancy, >300lb or >6ft 1in, behaviors concerns, significant cardiac disease/compromise, bone instability (OP, unstable SC, decr. bone density). What are 2 more CIs for Lokomat training?

Answer 19

1 Unstable upright tolerance (cannot tolerance at least 30 mins of standing)
2 Fixed LE contractures

Question 20

What is an exoskeleton device that enables patients to independently sit, stand, walk, turn, & stair ambulation with no muscle activation needed?
Hint: less common, expensive, and has prerequisites for usage.

Answer 20

ReWalk

Question 21

Prerequisites for ReWalk trials include height b/w 5’3 & 6’2, weight =/<220lbs, no cardiac/resp./autonomic comorbidities, and healthy bone density / no unhealed fx. What are 2 more prerequisites for ReWalk?

Answer 21

1 Need full UE strength to support crutches/walker
2 Adequate standing tolerance (w/ good trunk ctrl)
max support only goes up to waist
can be used for ASI-As

Question 22

Bodyweight Supported Treadmill (BWST) Training is indicated for incomplete injuries, specifically patients who will ____ again.
Hint: think prognosis

Answer 22

ambulate/walk

Question 23

BWST promotes SC learning/activation. During early training, PTs manually assist with foot placement. What dosage would you give a patient using BWST (freq. & duration?

Answer 23

20-30 mins
4 days/week
8-12 wks

Question 24

T/F: BWST are beneficial in acute/subacute phase, but there’s no evidence for use in the chronic phase.

Answer 24

True

Question 25

Most patients who have the ability to walk will need an orthotic. What are 4 types of orthotics used and what should you consider when prescribing one to your patient?
Hint: 2 considerations

Answer 25

1) HKAFO, RGO (reciprocating gait orthosis), KAFO, AFO
2) ambulation goals; weight of orthosis

Question 26

Which orthotic is similar to the ReWalk but has a higher energy cost?

Answer 26

RGOs

Question 27

Home modification for ramps is…
A: 2ft for every 1in of height
B: 0.5ft for every 1in of height
C: 1ft for every 1in of height
D: 10in for every 1in of height

Answer 27

C

Question 28

Home modification for doorframe width is…
A: 10in + width of WC seat
B: 4in + width of WC seat
C: 8in + width of WC seat
D: 6in + width of WC seat

Answer 28

D

Question 29

Is it easier for patients to push or pull doors?

Answer 29

pull

Question 30

Consider patient’s ___ function when prescribing a door handle.

Answer 30

hand

Question 31

Consider the power WC’s type of ___ when looking at patient’s hallway (the ___ placement). More width is required to allow for turning.

Answer 31

drive;
wheel

Question 32

Which of the following is NOT a consideration when looking to modify pt’s home.
A: Surface - hardwood vs carpet
B: Countertop type/height & location/type of appliances in the kitchen
C: Thresholds that require patient to step over them
D: Bathrooms - toilet/sink height, tub vs stall, tub bench vs chair
E: all of these are considerations

Answer 32

E

Question 33

12% of SCI pts are employed at __ year(s) & 33% of SCI pts are employed at __ year(s).

Answer 33

12% - 1 year
33% - 20 years
ADA 1990 protection against discrimination

Question 34

CARF requires rehabs to have academic programs. What legal obligations do public schools have w/ respect to patients returning to school?

Answer 34

they’re required to provide assist

Question 35

T/F: There are not a lot of adaptive sports programs for post-SCI patients.

Answer 35

false, it’s plenty