SCI Treatment Considerations Part III Flashcards
What is the primary goal of wheelchair prescription with the SCI population?
lightest possible w/c
What makes K0005 chairs different than standard wheelchairs?
Titanium or carbon fiber frames (ultra-lightweight)
Benefits of Titanium frame
- Strong + lightweight
- ↑ fatigue life
- Corrosion resistant
- Dampening vibration
Carbon Fiber Benefits + Cons
- Lightweight
- Corrosion resistant
- Difficult to make
- Less impact resistant
- EXPENSIVE
What are the common wheelchair frames utilized in K5 chairs?
- Box
- Cantilver
- Folding
In order of most rigid to least (most lightweight to least)
What is the main consideration when choosing a w/c cushion?
Stability + skin protection
Air Cushion Considerations
- Highest skin protection
- Low-, mid-, high-grade
- High maintenance, can pop
- More disruptive posture (↓ stability)
Gel Cushion Considerations
- less skin protection (better than foam)
- Less maintenance than air
Hybrid Cushion Considerations
- Combo Air, Gel, Foam
- Additional stability over post. thighs
- Good balance of stability (gel/foam) and skin protection (air)
- Lacks full coverage skin protection
If your patient has a history of skin breakdown or an increased risk of skin breakdown, what cushion must you order?
Air
Add stability elsewhere on the chair
Backrest
Low Back Considerations
- Least supportive
- Allows for full upper trunk movement
- Least likely to get in way of propulsion
Backrest
Mid-back Considerations
- Extends to just below inferior angle of scapula
- Can block scapular movements
Backrest
High Back Considerations
- most supportive
- Restrictive to scapular movements and certain shoulder movements
Each heigh option for backrests also comes with different options for depth. What is the pros/cons to lateral vs depth?
Lateral: min lateral support to trunk = more freedom
Deep: more lateral support = more restrictive
Armrests
None - Considerations
- Advanced w/c users
- More freedom of movement, loose benefits of armrest (stability/push-up surface
Common for lumbar
Armrests
Swing Away Considerations
- Easiest to operate, do not need wrist/hand
- Unable to attach trough or table if needed
Armrests
Flip-Back
- Req. adquate hand/finger use
- More versatile (trough or table)
Foot/Leg rests
Rigid Considerations
- less maintenance
- Extra thing to maneuver around during transfers
Foot/Leg Rests
Swing-Away
- Ideal for individuals participating in gait trials
- Req. adequate hand/wrist function to operate
Wheels
Rubber Considerations
- Heavier option
- Way less maintenance
Wheels
Air Considerations
- Lighter option
- Smoother ride
- Maintenance, can pop
Wheels
Push-Rims Considerations
- Easier propulsion, build up to compensate for weaker grip
- Make chair wider - more difficult to negotiate tight spaces
Caster Considerations
- Smaller = lightweight
- Larger = outdoors/rough terrain
Power Wheel Chair Drive Systems
- Front-wheel
- Rear-wheel
- Mid-wheel
Front-wheel Drive
- Larger turning radius than mid-wheel but less than rear-wheel
- Helpful negotiating rough terrain
Rear-wheel Drive
- Largest 360-circumference and turning radius
- Fastest chair
Mid-wheel drive
- Most maneuverable, excellent indoor chairs
- Fair maneuverability outdoors
Standard Joystick Drive Control
- Requires grasp control
Football post joystick
Requires shoulder (placement), forearm, +/- elbow control
Chin Control and Low-Resistance-Tongue Joystick
- Decreased ability to talk/drink, etc while opperating chair
- Very fatiguing
- Increased TMJ issues
Sip and Puff Drive Control
- Pulmonary control req.
- Responds to different lengths/strengths of pulmonary functions
Head Array Drive Control
- Most supportive
What is the number one consideration when choosing a power wheel chair drive control?
A. Patient preference
B. ASIA Level
C. Functional Impairments
D. The Assistive Technology Professional will decide
C. Functional Impairments
A high cervical (C1-4) General W/C Considerations
- Power w/c
- Head array, chin, tongue, or sip and puff controls
- Portable respiratory may be attached
C5 General W/C Considerations
- Can use MWC with propulsion airs, likely will need PWC for distance and energy conservation
- Sip and puff, chin, tongue, or football post controls
C6 General W/C Considerations
- May need PWC for longer distances, can start to consider MWC with friction surface hand rims
- Should progress to independent on smooth surfaces.
C7 General W/C Considerations
MWC with friction surface hand rims but increased propulsion ability
C8 and down
MWC with standard hand rims
What are the major benefits found with FES?
- Neuromuscular strenthening
- Improved motor efficiency
- Transient spasticity management
- Pain reduction
- CV Health
- Improved BF
- Bone density
- Psychological benefits
Two Main uses of FES
- Independent Application
- FES Dependent Application
Independent Application FES
Use of FES for a finite time period to mimize impairments and to encourage motor relearning
Ex: use during therapy
FES Dependent Application
Enables pt to perform functional activities that wouldn’t otherwise be possible in daily life. (“neuroprosthesis”)
Take home application
Indications for FES
-** Upper Motor Neuron Injury**
- Absent or diminished motor function in arms, trunk +/- legs
- Demo of active contraction when e-stim is provided over motor point of muscle belly
- Patient able to tolerate stimulus provided by FES (stim is strong)
Precautions for FES
- Absent sensory
- Severe spasticity
- Heterotrophic ossificans
- Severe osteoporosis
- Chronic pain syndrome
Contraindications for FES
- Lower motor neuron pathology
- Cardiac pacemaker
- Pregnancy
- Unhealed fracture in area
- Skin breakdown in the area
- Internal stimulator near area (ex: Phrenic n. or bladder stimulator)
- DVT in area
- Malignancy in area of treatment
- Uncontrolled autonomic dysreflexia
How does the Bioness L300 and L300 work?
- Sensor is placed in sole of shoe to detect when extremity is in stance phase.
- Stims muscle in response to normal physiological activation of targeted muscles throughout gait cycle.
When does FES stim the quads?
during stance and 2nd half of swing
When does FES stim the hamstrings?
First half of swing
When does FES stim the Anterior tib?
throughout swing
What are the indications of the Bioness L300 and L300+
L300: foot drop, poor foot clearance
L300+: knee instability, poor foot clearance
RT300 FES Bike Indications
- Relaxation of muscle spasms
- Prevention or reduction of disuse atrophy
- Increasing local blood circulation
- Maintaining or increasing ROM
- Improve muscle endurance w/intact innervation
Considerations for RT300 FES Bike
- Risk of unrealistic expectations
- Difficult to predict outcome
- Insufficient evidence for duration and dosage of treatment
Lokomat Benefits
Complete: upright benefits
Incomplete:
- Individually adjustable gait pattern and guidance
- Real-time biofeedback
- Neuroplasticity, CPGs
Lokomat Considerations
- Realistic Expectations/goals
- Hemodynamic stability
- Skin integrity
- Autonomic dysreflexia
Lokomat Contraindications
- Unstable upright tolerance
- Fixed LE Contractures
- Osteopenia/osteoporosis
- Bone instability: non-consolidate fractures, unstable spinal column, severe OP
- Sig. cardiac disease/compromise
- Behavioral concerns (uncooperative, aggressive behavior, agitation)
- Pregnancy
- > 300#, >6ft 1in.
ReWalk
Exoskeleton device that enables user to sit, stand, walk, turn, negotiate stairs.
Prerequisites for ReWalk Trials
- Hands and shoulders can support crutches or a walker
- Healthy bone density
- No unhealed fractures
- Adequate standing tolerance
- No cardiac, respiratory, autonomic co-morbidities of concern
- Height 160cm -190 cm (5’3” - 6’2”)
- Weight does not exceed 100 kg (220lbs)
When is the Bodyweight Supported Treadmill Training indicated?
Incomplete injuries (B, C, D)
Dosage for Bodyweight Supported Treadmill Training include:
20-30 min, 4 days/week, 8-12 weeks
Ramps are an important home mod, how should they be constructed?
1 foot in length for every 1” of height needed.
How should doorframe widths and doors be set up?
Width of w/c + 6”
Easier to pull door rather than push
What hallway considerations should be made?
- more width needed to allow for turning in/out of rooms.
- PWC: need to consider type of drive
