SCI Treatment Considerations Part 4 Flashcards
What nerves must be intact to contract muscles during functional activities?
peripheral NS
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.
False, ind. app. FES only used in the clinic and pts will be weaned off it.
Example of Independent Application of FES
FES over ant. tib. to improve foot drop during gait.
FES Dependent Application is used in what cases?
Hint: think neuroprosthesis
Also give an example.
Enable pt to perform functional activities.
Ex: FES on LE of patient w/ paraplegia while peddling on leg ergometer.
T/F: FES Dependent Application is used by the patient outside the clinic for ADLs.
True
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?
1 NM Strengthening (da biggest)
2 Transient spasticity management esp. when med tx not available
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
B
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?
1 LMN pathology
2 Pregnancy
3 Unctrlled autonomic dysreflexia
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?
Absent sensory: monitor skin for burns
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 ___.
1) quads, hamstrings
2) anterior tibialis
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+?
L300: foot drop
L300+: knee instability
T/F: Bioness L300, L300+ can be used for patients who have the potential to ambulate or patient who will not walk anymore.
False, ambulation only.
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
Quads: during St phases & 2nd half of swing phases
Hamstrings: during 1st half of swing
Anterior Tibialis: throughout swing phase
What can patients who are non-ambulatory use in combo w/ FES? How often (per week) do patients typically use this?
RT300 FES Bike
2-3x/week
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?
1 Maintain or incr. ROM
2 Improve muscle endurance with intact innervation
FES bike considerations for use include ___, difficult to predict outcome, and insufficient evident for duration & dosage of tx. Hint: important patient edu!
Risk of raising unrealistic expectations
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?
Upright Standing benefits: socialization, mood, resp./CV fxn, digestion, bone health, ROM, strengthening, skin integrity
What are some considerations for using the Lokomat that you will include in your patient edu? Hint: 4 considerations
1 realistic goals/expectations
2 hemodynamic stability
3 skin integrity
4 autonomic dysreflexia
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?
1 Unstable upright tolerance (cannot tolerance at least 30 mins of standing)
2 Fixed LE contractures
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.
ReWalk
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?
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
Bodyweight Supported Treadmill (BWST) Training is indicated for incomplete injuries, specifically patients who will ____ again.
Hint: think prognosis
ambulate/walk
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?
20-30 mins
4 days/week
8-12 wks
T/F: BWST are beneficial in acute/subacute phase, but there’s no evidence for use in the chronic phase.
True
