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Neuro II > SCI Treatment Considerations Part II > Flashcards

SCI Treatment Considerations Part II Flashcards

1
Q

What are the two locations at most risk of skin breakdown?

A
  • Coccyx
  • Ischial Tuberosities
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2
Q

What are four major ways a patient can relieve pressure in a manual wheelchair?

A
  1. Side lying
  2. Cross leffed
  3. Pancake
  4. Push-up
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3
Q

In general, what muscles are required for side-lying pressure relief?

A
  • UE
  • Core
  • Head
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4
Q

In general, what muscles are required for Cross-legged pressure relief?

A

Core

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5
Q

In general, what muscles are required for pancake pressure relief?

A

Have to be able to use UE to get back up

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6
Q

In general, what muscles are required for pushup pressure relief?

A

Triceps, UE

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7
Q

How often should pressure relief strategies be implemented?

W/c and bed mobility

A

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

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8
Q

Why should wheelchair push-ups not be considered a primary pressure relief strategy?

A

↑ shoulder strain

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9
Q

How else can we maintain skin integrity while the patient is in their wheelchair?

A
  • Positioning
  • Cushions
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10
Q

Why is upright tolerance such a high priority post-SCI?

A

b/c orthostatic hypotension is VERY COMMON problem in acute stages.

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10
Q

What is the purpose of skin checks, and how often should they be performed?

A

Full body skin exam DAILY

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11
Q

What signs and symptoms should you be looking for as it relates to orthostatic
hypotension?

A
  • Hypotension + Tachycardia
  • Dizziness
  • Pale skin
  • Sweating
  • Slurred speech
  • Fogginess
  • Blurred Vision
  • N/V
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12
Q

What strategies are available to manage and progress upright tolerance?

A
  • Slow transitions
  • Compression garments (Abd binders, TED stocking, ACE Wraps)
  • Equipment (TIS, tilt table, ERIGO, active standing frame)
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13
Q

What additional benefits exist from integrating standing programs into your SCI plan of care?

A
  • Socialization
  • Mood
  • Respiratory + Cardiovascular function
  • Aids in digestion
  • Bone health
  • ROM maintenance
  • Strengthening
  • Skin integrity
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14
Q

What additional activities can be integrated into standing programs?

A
  • AROM, TheraBand, Dumbell exercises
  • Ball tosses
  • Boxin activities
  • Fine motor tasks
  • Isometrics or small range LE strengthening
  • FES
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15
Q

How are goals written for upright tolerance?

A

Focused on tolerance based

16
Q

What components of a basic respiratory examination should be performed on patients with an SCI?

A
  • respiratory rate, breathing pattern, chest excursion
  • Cough
  • Posture
  • Breath support with speech
  • May need pulmonary function test
17
Q

Functional Cough
* Sound
* # coughs/exhalation
* Functional significance

A
  • Sound: loud and forceful
  • # coughs/exhalation: 2 or more
  • Functional significance: independent in resp. secretion clearance
18
Q

Weak Functional Cough
* Sound
* # coughs/exhalation
* Functional significance

A
  • 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.
19
Q

Non-Functional Cough
* Sound
* # coughs/exhalation
* Functional significance

A
  • Sound: sigh or throat clearing
  • # coughs/exhalation: no true coughs; attemp but no expulsive cough
  • Functional significance: assistance needed for airway clearance
20
Q

How can we coach a patient into diaphragmatic breathing, and what are this intervention’s benefits?

A

Supine: place large, light object on abdomen and instruct patient to watch themselves breathe

Progression: active resistance on abdomen

21
Q

What is a cue that can help encourage diaphragmatic response when teaching diaphragmatic breathing?

A

Instructing them to sniff

21
Q

Upper chest strengthening is important for

A

increasing inspired air to enhance coughing, improve breathing support for speech or during increased activity

22
Q

How is upper chest strengthening performed?

A

Therapist places hands on upper chest and ask patient to push against them while breathing deeply

23
Q

What are resistive inspiratory muscle trainers?

A

alternative to upper respiratory strengthening, handheld device that strengthens inspiration

23
Q

What does pushing against the chest for upper chest strengthening accomplish?

A

A quick stretch to SCM, Pec major, scalene

24
Q

What have inspiratory muscle trainers been shown to improve?

A
  • strength + endurance of ventilation
  • Improved PFT results
  • slower/deeper breathing
  • Reduces use of accessory muscles
  • Increases activity tolerance
25
Q

What is the functional relevance of eccentric exhalation control, and how can it be improved?

A

Cough control? Improved with manual vibration or resistance

26
Q

Why are chest wall mobility and postural considerations essential for respiratory function?

A

Enhanced respiration

27
Q

Explain the function of glossopharyngeal breathing

A

Use of tongue and pharyngeal muscles to force air in lungs through a series of “gulps”

28
Q

Why is glossopharyngeal breathing a vital skill for higher injuries to master?

A

Helpful for transfers if vent pops off or transfers, or loss of power - pt has a way to get some air into lungs.

29
Q

How can an abdominal binder help with respiratory function?

A

Contains abdominal contents in sitting and better positions diaphragm (loss of truncal tone)

30
Q

What are the benefits of an effective assisted or independent cough technique?

A

Preventing complications lead to pneumonia

31
Q

What patient’s need an assissted cough technique?

A

Those with weak or non-functional cough

32
Q

How many coughs per breath should be completed with assited cough techniques?

A

2 coughs per 1 breath out

33
Q

How do you teach a self-cough technique?

A
  • Breathe in as deeply as possible (open up)
  • Hold breath briefly
  • Cough (close down)
34
Q

What level can typically regain the capacity to breathe independently (aka vent wean)

A

C4 or lower

35
Q

What factors reduce the potential to vent wean?

A
  • Respiratory/medical complications
  • Pre-existing resp. conditions
  • > 50Y
  • VC <1000
  • Max negative inspiratory pressure <30 cm H2O
  • Hx of smoking
36
Q

Even if a patient is unable to vent wean, wht is an important goal?

A

Developing capacity to breath independently for brief period of time

Neuro II (17 decks)

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