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Neuro II > SCI Treatment Considerations Part III > Flashcards

SCI Treatment Considerations Part III Flashcards

1
Q

What is the primary goal of wheelchair prescription with the SCI population?

A

lightest possible w/c

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2
Q

What makes K0005 chairs different than standard wheelchairs?

A

Titanium or carbon fiber frames (ultra-lightweight)

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3
Q

Benefits of Titanium frame

A
  • Strong + lightweight
  • ↑ fatigue life
  • Corrosion resistant
  • Dampening vibration
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4
Q

Carbon Fiber Benefits + Cons

A
  • Lightweight
  • Corrosion resistant
  • Difficult to make
  • Less impact resistant
  • EXPENSIVE
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5
Q

What are the common wheelchair frames utilized in K5 chairs?

A
  • Box
  • Cantilver
  • Folding

In order of most rigid to least (most lightweight to least)

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6
Q

What is the main consideration when choosing a w/c cushion?

A

Stability + skin protection

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7
Q

Air Cushion Considerations

A
  • Highest skin protection
  • Low-, mid-, high-grade
  • High maintenance, can pop
  • More disruptive posture (↓ stability)
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8
Q

Gel Cushion Considerations

A
  • less skin protection (better than foam)
  • Less maintenance than air
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9
Q

Hybrid Cushion Considerations

A
  • Combo Air, Gel, Foam
  • Additional stability over post. thighs
  • Good balance of stability (gel/foam) and skin protection (air)
  • Lacks full coverage skin protection
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10
Q

If your patient has a history of skin breakdown or an increased risk of skin breakdown, what cushion must you order?

A

Air

Add stability elsewhere on the chair

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11
Q

Backrest

Low Back Considerations

A
  • Least supportive
  • Allows for full upper trunk movement
  • Least likely to get in way of propulsion
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12
Q

Backrest

Mid-back Considerations

A
  • Extends to just below inferior angle of scapula
  • Can block scapular movements
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13
Q

Backrest

High Back Considerations

A
  • most supportive
  • Restrictive to scapular movements and certain shoulder movements
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14
Q

Each heigh option for backrests also comes with different options for depth. What is the pros/cons to lateral vs depth?

A

Lateral: min lateral support to trunk = more freedom
Deep: more lateral support = more restrictive

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15
Q

Armrests

None - Considerations

A
  • Advanced w/c users
  • More freedom of movement, loose benefits of armrest (stability/push-up surface

Common for lumbar

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16
Q

Armrests

Swing Away Considerations

A
  • Easiest to operate, do not need wrist/hand
  • Unable to attach trough or table if needed
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17
Q

Armrests

Flip-Back

A
  • Req. adquate hand/finger use
  • More versatile (trough or table)
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18
Q

Foot/Leg rests

Rigid Considerations

A
  • less maintenance
  • Extra thing to maneuver around during transfers
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19
Q

Foot/Leg Rests

Swing-Away

A
  • Ideal for individuals participating in gait trials
  • Req. adequate hand/wrist function to operate
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20
Q

Wheels

Rubber Considerations

A
  • Heavier option
  • Way less maintenance
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21
Q

Wheels

Air Considerations

A
  • Lighter option
  • Smoother ride
  • Maintenance, can pop
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22
Q

Wheels

Push-Rims Considerations

A
  • Easier propulsion, build up to compensate for weaker grip
  • Make chair wider - more difficult to negotiate tight spaces
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23
Q

Caster Considerations

A
  • Smaller = lightweight
  • Larger = outdoors/rough terrain
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24
Q

Power Wheel Chair Drive Systems

A
  1. Front-wheel
  2. Rear-wheel
  3. Mid-wheel
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25
Q

Front-wheel Drive

A
  • Larger turning radius than mid-wheel but less than rear-wheel
  • Helpful negotiating rough terrain
26
Q

Rear-wheel Drive

A
  • Largest 360-circumference and turning radius
  • Fastest chair
27
Q

Mid-wheel drive

A
  • Most maneuverable, excellent indoor chairs
  • Fair maneuverability outdoors
28
Q

Standard Joystick Drive Control

A
  • Requires grasp control
29
Q

Football post joystick

A

Requires shoulder (placement), forearm, +/- elbow control

30
Q

Chin Control and Low-Resistance-Tongue Joystick

A
  • Decreased ability to talk/drink, etc while opperating chair
  • Very fatiguing
  • Increased TMJ issues
31
Q

Sip and Puff Drive Control

A
  • Pulmonary control req.
  • Responds to different lengths/strengths of pulmonary functions
32
Q

Head Array Drive Control

A
  • Most supportive
33
Q

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

A

C. Functional Impairments

34
Q

A high cervical (C1-4) General W/C Considerations

A
  • Power w/c
  • Head array, chin, tongue, or sip and puff controls
  • Portable respiratory may be attached
35
Q

C5 General W/C Considerations

A
  • Can use MWC with propulsion airs, likely will need PWC for distance and energy conservation
  • Sip and puff, chin, tongue, or football post controls
36
Q

C6 General W/C Considerations

A
  • May need PWC for longer distances, can start to consider MWC with friction surface hand rims
  • Should progress to independent on smooth surfaces.
37
Q

C7 General W/C Considerations

A

MWC with friction surface hand rims but increased propulsion ability

38
Q

C8 and down

A

MWC with standard hand rims

39
Q

What are the major benefits found with FES?

A
  • Neuromuscular strenthening
  • Improved motor efficiency
  • Transient spasticity management
  • Pain reduction
  • CV Health
  • Improved BF
  • Bone density
  • Psychological benefits
40
Q

Two Main uses of FES

A
  • Independent Application
  • FES Dependent Application
41
Q

Independent Application FES

A

Use of FES for a finite time period to mimize impairments and to encourage motor relearning

Ex: use during therapy

42
Q

FES Dependent Application

A

Enables pt to perform functional activities that wouldn’t otherwise be possible in daily life. (“neuroprosthesis”)

Take home application

43
Q

Indications for FES

A

-** 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)

44
Q

Precautions for FES

A
  • Absent sensory
  • Severe spasticity
  • Heterotrophic ossificans
  • Severe osteoporosis
  • Chronic pain syndrome
45
Q

Contraindications for FES

A
  • 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
46
Q

How does the Bioness L300 and L300 work?

A
  • 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.
47
Q

When does FES stim the quads?

A

during stance and 2nd half of swing

48
Q

When does FES stim the hamstrings?

A

First half of swing

49
Q

When does FES stim the Anterior tib?

A

throughout swing

50
Q

What are the indications of the Bioness L300 and L300+

A

L300: foot drop, poor foot clearance
L300+: knee instability, poor foot clearance

51
Q

RT300 FES Bike Indications

A
  • Relaxation of muscle spasms
  • Prevention or reduction of disuse atrophy
  • Increasing local blood circulation
  • Maintaining or increasing ROM
  • Improve muscle endurance w/intact innervation
52
Q

Considerations for RT300 FES Bike

A
  • Risk of unrealistic expectations
  • Difficult to predict outcome
  • Insufficient evidence for duration and dosage of treatment
53
Q

Lokomat Benefits

A

Complete: upright benefits
Incomplete:
- Individually adjustable gait pattern and guidance
- Real-time biofeedback
- Neuroplasticity, CPGs

54
Q

Lokomat Considerations

A
  • Realistic Expectations/goals
  • Hemodynamic stability
  • Skin integrity
  • Autonomic dysreflexia
55
Q

Lokomat Contraindications

A
  • 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.
56
Q

ReWalk

A

Exoskeleton device that enables user to sit, stand, walk, turn, negotiate stairs.

57
Q

Prerequisites for ReWalk Trials

A
  • 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)
58
Q

When is the Bodyweight Supported Treadmill Training indicated?

A

Incomplete injuries (B, C, D)

59
Q

Dosage for Bodyweight Supported Treadmill Training include:

A

20-30 min, 4 days/week, 8-12 weeks

60
Q

Ramps are an important home mod, how should they be constructed?

A

1 foot in length for every 1” of height needed.

61
Q

How should doorframe widths and doors be set up?

A

Width of w/c + 6”
Easier to pull door rather than push

62
Q

What hallway considerations should be made?

A
  • more width needed to allow for turning in/out of rooms.
  • PWC: need to consider type of drive

Neuro II (17 decks)

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