SCI Treatment Considerations Part II Flashcards
What are the two locations at most risk of skin breakdown?
- Coccyx
- Ischial Tuberosities
What are four major ways a patient can relieve pressure in a manual wheelchair?
- Side lying
- Cross leffed
- Pancake
- Push-up
In general, what muscles are required for side-lying pressure relief?
- UE
- Core
- Head
In general, what muscles are required for Cross-legged pressure relief?
Core
In general, what muscles are required for pancake pressure relief?
Have to be able to use UE to get back up
In general, what muscles are required for pushup pressure relief?
Triceps, UE
How often should pressure relief strategies be implemented?
W/c and bed mobility
W/c: q 15-20min for 2-4 min
Bed Mobility: rolling q 2 hours
Pushup only 30-60 seconds
*For at least 1 year post injury
Why should wheelchair push-ups not be considered a primary pressure relief strategy?
↑ shoulder strain
How else can we maintain skin integrity while the patient is in their wheelchair?
- Positioning
- Cushions
Why is upright tolerance such a high priority post-SCI?
b/c orthostatic hypotension is VERY COMMON problem in acute stages.
What is the purpose of skin checks, and how often should they be performed?
Full body skin exam DAILY
What signs and symptoms should you be looking for as it relates to orthostatic
hypotension?
- Hypotension + Tachycardia
- Dizziness
- Pale skin
- Sweating
- Slurred speech
- Fogginess
- Blurred Vision
- N/V
What strategies are available to manage and progress upright tolerance?
- Slow transitions
- Compression garments (Abd binders, TED stocking, ACE Wraps)
- Equipment (TIS, tilt table, ERIGO, active standing frame)
What additional benefits exist from integrating standing programs into your SCI plan of care?
- Socialization
- Mood
- Respiratory + Cardiovascular function
- Aids in digestion
- Bone health
- ROM maintenance
- Strengthening
- Skin integrity
What additional activities can be integrated into standing programs?
- AROM, TheraBand, Dumbell exercises
- Ball tosses
- Boxin activities
- Fine motor tasks
- Isometrics or small range LE strengthening
- FES
How are goals written for upright tolerance?
Focused on tolerance based
What components of a basic respiratory examination should be performed on patients with an SCI?
- respiratory rate, breathing pattern, chest excursion
- Cough
- Posture
- Breath support with speech
- May need pulmonary function test
Functional Cough
* Sound
* # coughs/exhalation
* Functional significance
- Sound: loud and forceful
- # coughs/exhalation: 2 or more
- Functional significance: independent in resp. secretion clearance
Weak Functional Cough
* Sound
* # coughs/exhalation
* Functional significance
- Sound: soft, less forceful
- # coughs/exhalation: one per exhalation
- Functional significance: independent for clearing throat and small amount of secretions. Assistance needed for clearing large amount of secretions.
Non-Functional Cough
* Sound
* # coughs/exhalation
* Functional significance
- Sound: sigh or throat clearing
- # coughs/exhalation: no true coughs; attemp but no expulsive cough
- Functional significance: assistance needed for airway clearance
How can we coach a patient into diaphragmatic breathing, and what are this intervention’s benefits?
Supine: place large, light object on abdomen and instruct patient to watch themselves breathe
Progression: active resistance on abdomen
What is a cue that can help encourage diaphragmatic response when teaching diaphragmatic breathing?
Instructing them to sniff
Upper chest strengthening is important for
increasing inspired air to enhance coughing, improve breathing support for speech or during increased activity
How is upper chest strengthening performed?
Therapist places hands on upper chest and ask patient to push against them while breathing deeply
What are resistive inspiratory muscle trainers?
alternative to upper respiratory strengthening, handheld device that strengthens inspiration
What does pushing against the chest for upper chest strengthening accomplish?
A quick stretch to SCM, Pec major, scalene
What have inspiratory muscle trainers been shown to improve?
- strength + endurance of ventilation
- Improved PFT results
- slower/deeper breathing
- Reduces use of accessory muscles
- Increases activity tolerance
What is the functional relevance of eccentric exhalation control, and how can it be improved?
Cough control? Improved with manual vibration or resistance
Why are chest wall mobility and postural considerations essential for respiratory function?
Enhanced respiration
Explain the function of glossopharyngeal breathing
Use of tongue and pharyngeal muscles to force air in lungs through a series of “gulps”
Why is glossopharyngeal breathing a vital skill for higher injuries to master?
Helpful for transfers if vent pops off or transfers, or loss of power - pt has a way to get some air into lungs.
How can an abdominal binder help with respiratory function?
Contains abdominal contents in sitting and better positions diaphragm (loss of truncal tone)
What are the benefits of an effective assisted or independent cough technique?
Preventing complications lead to pneumonia
What patient’s need an assissted cough technique?
Those with weak or non-functional cough
How many coughs per breath should be completed with assited cough techniques?
2 coughs per 1 breath out
How do you teach a self-cough technique?
- Breathe in as deeply as possible (open up)
- Hold breath briefly
- Cough (close down)
What level can typically regain the capacity to breathe independently (aka vent wean)
C4 or lower
What factors reduce the potential to vent wean?
- Respiratory/medical complications
- Pre-existing resp. conditions
- > 50Y
- VC <1000
- Max negative inspiratory pressure <30 cm H2O
- Hx of smoking
Even if a patient is unable to vent wean, wht is an important goal?
Developing capacity to breath independently for brief period of time
