SCI Treatment Considerations: Part I

Question 1

Goals for ALL levels of SCI

Answer 1

• Upright tolerance 10-12H/day
• Appropriate seating position +/- mobility devices to support posture and maximize function
• Skin integrity
• Independent for all direction of care (as needed)
• Caregive becomes independent with all aspects of care as needed.
• Maintain healthy habits, minimize body habitus
• MAXIMIZE INDEPENDENCE

Question 2

What are the considerations for compensation vs restoration based on the ASIA levels?

Answer 2

A+B: Compensation
C: mix of compensation and restoration
D: Restoration

Question 3

General Recommendations for Strength Training

Answer 3

• Monitor VITALS - hemodynamic response (blunted with autonomic dysfunction T6 and above)
• Open-chain exercises prioritized if 3 or more with muscle testing (multi-joint)
• Closed-chain exercises (isolated movement)
• SHOULDER prevention - STOMPS Trial

Question 4

What are the key muscles to strengthen related to the shoulder?

Answer 4

• Serratus Anterior
• Latissimus Dorsi
• Pec Major
• Rotator Cuff
• Triceps

Question 5

Supine Position Benefits + Consideration

Answer 5

• Gravity-eliminated position for many UE/LE muscles
• Easy to facilitate rest breaks
• Resp. compromise - pillows/wedge
• Least functionally relevant position - hard to facilitate closed-chain

Question 6

Side Lying Benefits + Considerations

Answer 6

• Gravity eliminated position for UE/LE muscles
• Vertebral Fx - more comfortable
• DON’T over flex spine
• Difficult to incorporate LE closed-chain activities
• UE Tasks: sidelying –> elbow prop –> side lying push ups

Question 7

Prone Benefits + Considerations

Answer 7

• Great way to extend back, hip/knee flexors
• Allows for full pressure relief of butt
• Progress position (prone on elbows > prone on extended hands)
• Neck: extension strengthening, ROM for comfort/respiration, pillow/towel prop if needed
• 1º used to target UEs when considering strenghtening interventions

Question 8

Quadraped Benefits + Considerations

Answer 8

• FUNCTIONAL
• Challenging - AD use
• Proximal muscle challenge
• Neck extension strengthening

Question 9

High Kneeling Benefits and Considerations

Answer 9

• Trunk muscles/balance
• Works glutes, pelvis, low back stabiliers
• Ensure hips in neutral

Question 10

Sitting Benefits + Considerations

Answer 10

• Core stabilization
• Closed chain UE exercises
• Dual-task balance

Question 11

Assisted Standing Benefits + Considerations

Answer 11

• FUNCTIONAL
• Challenging - AD use
• Proximal muscles
• Neck extension strengthening

Question 12

What are the recommended parameters for cardiorespiratory training and SCI?

Answer 12

20 min mod-to-vigourous intensity exercise, 2x/week

Progress to 30 min, 3x/week

Question 13

What are the parameters of strength training and SCI?

Answer 13

Major muscle groups 2x/week

Question 14

What are some precautions and contraindications to exercise post-SCI?

Answer 14

• Autonomic dysreflexia
• Severe or infected skin on WBing surfaces
• Symptomatic hypotension
• UTI
• Unstable fractures
• Uncontrolled hot/humid environments
• Insufficient ROM to perform exercise task

Question 16

What are some of the major prevention strategies available for ROM?

Answer 16

• Daily ROM
• Proper positioning
• WBing activities
• Spasticity management
• Splinting

Question 17

What are some of the major management options when contractures form?

Answer 17

• Serial casting
• Medication
• Surgical Interventions

Question 18

T/F A patient with spasticity can be treated with serial casting.

Answer 18

True - as long as there is no clonus

Question 19

Describe Surgical Interventions to manage contractures

Answer 19

• joint manipulaiton under anesthesia
• Rotational osteotomy

Question 20

What UE muscles are prone to contractures?

Answer 20

• Elbow flexors
• Rotator cuff
• Scapular muscles

Question 21

What LE muscles in incomplete tetraplegia or complete/incomplete paraplegia are prone to contracture formation? It is important to actively prevent this for ambulation purposes.

Answer 21

• Hip flexors
• Hamstrings
• PFs

Question 22

When is adaptive shortening of muscles appropriate in this patient population?

Answer 22

• Tenodesis grip
• Short/Long sitting with lengthened hamstrings + adaptive shortening of back extensors

Question 23

What level can utilise a tenodesis grip? What is it?

Answer 23

Level C6 - wrist extension preserved; useful for tenodesis grasp

Level C6/7 must avoid overstretching their finger flexors

Question 24

Why is lengthened hamstrings and adaptive shortening of back extensors helpful in SCI?

Answer 24

Provide balance + stability in short- and long-sitting positions.

Question 25

What is an important consideration when trying to achieve adaptiven lengthening of the hamstrings?

Answer 25

Maintain 110º - 120º SLR without overstretching back muscles.

Question 26

What are the three different ways that a patient with tetraplegia can maintain sitting balance, and how do they differ in difficulty level?

Answer 26

Posterior, Lateral, Anterior Prop, increasing in difficulty

Question 27

What range of motion is needed for a tetraplegic to assume a prop position?

Answer 27

Shoulder EXT, ABD, ER

Question 28

What are considerations for prop sitting with a C6/7 SCI?

Answer 28

C6 - must have anterior deltoid and shoulder ER.
C6/7: protect finger flexion in WBing

Question 29

How do we teach reactionary techniques to someone with tetraplegia?

Answer 29

Small perturbations: head/neck, upper shoulder + upper trunk muscles
Large perturbations: difficult to be successful

Question 30

Dynamic Balance Considerations for Paraplegic Injuries

Answer 30

• Dynamic balance = trunk control/strength + UE strength
• Quick reactionary strategies
• Higher paraplegia may benefit from head/neck reactionary techniques for smaller LOB.

Question 31

What are the major therapeutic positions, and what are some functional tasks that benefit from their positioning?

Answer 31

• Long-sitting
• Short-sitting
• Ring sitting
• Prone on elbowa