SCI Treatment Considerations: Part I Flashcards
Goals for ALL levels of SCI
- 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
What are the considerations for compensation vs restoration based on the ASIA levels?
A+B: Compensation
C: mix of compensation and restoration
D: Restoration
General Recommendations for Strength Training
- 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
What are the key muscles to strengthen related to the shoulder?
- Serratus Anterior
- Latissimus Dorsi
- Pec Major
- Rotator Cuff
- Triceps
Supine Position Benefits + Consideration
- 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
Side Lying Benefits + Considerations
- 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
Prone Benefits + Considerations
- 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
Quadraped Benefits + Considerations
- FUNCTIONAL
- Challenging - AD use
- Proximal muscle challenge
- Neck extension strengthening
High Kneeling Benefits and Considerations
- Trunk muscles/balance
- Works glutes, pelvis, low back stabiliers
- Ensure hips in neutral
Sitting Benefits + Considerations
- Core stabilization
- Closed chain UE exercises
- Dual-task balance
Assisted Standing Benefits + Considerations
- FUNCTIONAL
- Challenging - AD use
- Proximal muscles
- Neck extension strengthening
What are the recommended parameters for cardiorespiratory training and SCI?
20 min mod-to-vigourous intensity exercise, 2x/week
Progress to 30 min, 3x/week
What are the parameters of strength training and SCI?
Major muscle groups 2x/week
What are some precautions and contraindications to exercise post-SCI?
- Autonomic dysreflexia
- Severe or infected skin on WBing surfaces
- Symptomatic hypotension
- UTI
- Unstable fractures
- Uncontrolled hot/humid environments
- Insufficient ROM to perform exercise task
What are some of the major prevention strategies available for ROM?
- Daily ROM
- Proper positioning
- WBing activities
- Spasticity management
- Splinting
What are some of the major management options when contractures form?
- Serial casting
- Medication
- Surgical Interventions
T/F A patient with spasticity can be treated with serial casting.
True - as long as there is no clonus
Describe Surgical Interventions to manage contractures
- joint manipulaiton under anesthesia
- Rotational osteotomy
What UE muscles are prone to contractures?
- Elbow flexors
- Rotator cuff
- Scapular muscles
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.
- Hip flexors
- Hamstrings
- PFs
When is adaptive shortening of muscles appropriate in this patient population?
- Tenodesis grip
- Short/Long sitting with lengthened hamstrings + adaptive shortening of back extensors
What level can utilise a tenodesis grip? What is it?
Level C6 - wrist extension preserved; useful for tenodesis grasp
Level C6/7 must avoid overstretching their finger flexors
Why is lengthened hamstrings and adaptive shortening of back extensors helpful in SCI?
Provide balance + stability in short- and long-sitting positions.
What is an important consideration when trying to achieve adaptiven lengthening of the hamstrings?
Maintain 110º - 120º SLR without overstretching back muscles.
What are the three different ways that a patient with tetraplegia can maintain sitting balance, and how do they differ in difficulty level?
Posterior, Lateral, Anterior Prop, increasing in difficulty
What range of motion is needed for a tetraplegic to assume a prop position?
Shoulder EXT, ABD, ER
What are considerations for prop sitting with a C6/7 SCI?
C6 - must have anterior deltoid and shoulder ER.
C6/7: protect finger flexion in WBing
How do we teach reactionary techniques to someone with tetraplegia?
Small perturbations: head/neck, upper shoulder + upper trunk muscles
Large perturbations: difficult to be successful
Dynamic Balance Considerations for Paraplegic Injuries
- Dynamic balance = trunk control/strength + UE strength
- Quick reactionary strategies
- Higher paraplegia may benefit from head/neck reactionary techniques for smaller LOB.
What are the major therapeutic positions, and what are some functional tasks that benefit from their positioning?
- Long-sitting
- Short-sitting
- Ring sitting
- Prone on elbowa
