SCI treatment pt 1 Flashcards
list the 6 major components of SCI rehab
- skin integrity
- respiratory function
- ROM management
- Strengthening
- Upright tolerance
- balance and therapeutic positions
list goals for all levels of SCI
- upright tolerance → 10-12 hours/day
- utilize appropriate seating position and/or mobility devices to support posture and max function
- maintain skin integrity
- independent for all direction of care as needed
- caregiver becomes independent with all aspects of care as needed
- maintain healthy habits, minimize body habitus
- MAXIMIZE INDEPENDENCE
maintaining skin integrity after an SCI
- Pressure relief schedule
- wheelchair
- frequency = every 15-20 min
- duration = 2-3 min
- Bed
- rolling schedule = every 2 hours
- wheelchair
- Skin checks
- full body skin exam daily
- may require adaptive equipment like long-handled mirror
what is included in a respiratory examination for an SCI pt?
- respiratory rate, breathing pattern, chest excursion
- cough
- posture
- breath support with speech
- may need pulmonary function testing
list the types of cough quality
- functional cough
- weak functional cough
- nonfunctional cough
describe a functional cough
- Sound
- loud and forceful
- Number of coughs possible per exhale
- two or more
- Functional Significance
- independent in respiratory secretion clearance
describe a weak functional cough
- Sound
- soft, less forceful
- Number of coughs possible per exhale
- one per exhale
- Functional significance
- independent for clearing throat and small amount of secretions
- assistance needed for clearing large amount of secretions
describe a nonfunctional cough
- Sound
- sigh or throat clearing
- Number of coughs possible per exhale
- no true coughs
- cough attempt has no expulsive cough
- Functional significance
- assistance needed for airway clearance
List respiratory interventions for SCI pts
- Respiratory strength and endurance training
- Eccentric control of exhalation
- chest wall mobility
- posture considerations
- Glossopharyngeal breathing (tetra)
- abdominal breathing (tetra)
- Assisted cough techniques
- Self-cough technique
- Vent weaning (tetra)
what may be used during respiratory strength and endurance training?
- diaphragmatic breathing
- upper chest strengthening
- resistive inspiratory muscle trainers
describe diaphragmatic breathing
ideal for quiet breathing
“belly breathing”
instructing the pt to sniff can encourage diaphragmatic response
what is the purpose of upper chest strengthening?
increased inspired air to enhance coughing, improve breath support for speech, or during increased activity
how to perform upper chest strengthening for SCI pts
- PT places hands on upper chest and asks pts to push against them while breathing deeply
- quick stretch to SCM, Pec Major, and Scalenes by pushing the upper chest in and caudally just before asking the pt to inhale
what is the effect of resistive inspiratory muscle trainers?
- shown to improve strength and endurace in muscles of ventilation
- improved PFT results
- encourages slower and deeper breathing
- reduces use of accessory muscles
- increases activity tolerance
what is eccentric control of exhaltion?
- pt inhales maximally and then counts or says “ah” for as long as possible before taking another breath
- goal = 10-12 seconds
- can further promote by +manual vibration or resistance
way to target chest wall mobility
- deep breathing exercises
- passive stretching
- joint mobilizations
- intermittent positive pressure breathing
posture considerations pertaining to respiratory interventions with SCI pts
- ideal posture for enhanced respiration:
- anterior pelvic tilt
- erect trunk
- adducted scapulae
- neutral head and back alignment
what is glossopharyngeal breathing?
- Use of tongue and pharyngeal muscles
- forces air in lungs through a series of gulps
- can also help with chest wall mobility
use of abdominal binders during respiratory rehab in SCI pts
- can also be used with higher paraplegic injuries
- mainly for tetra
- used to contain abdominal contents in sitting and better position diaphragm
- increased VC, TV, MEP, and blood oxygenation
T/F: assisted cough techniques help improve coughing but have no effect on preventing other complications
FALSE
crucial in preventing things like pneumonia
describe the technique for assisted cough techniques
2 coughs per 1 breath out
describe the self-cough technique
- breath in as deeply as possible
- if possible, combine with trunk and neck extension as well as shoulder flexion or scapular adduction
- can use glossopharyngeal breathing to augment inhalation as needed
- hold breath briefly
- cough
- if possible combine with crunching everything down
- or even fall into folded position if not able to control
- if adequate UE strength and balance, can self-apply heimlich-maneuver to stomach
describe vent weaning
usually for tetraplegia
- C3 or lower can usually regain capacity to breathe independently
- even if unable to completely wean from vent, can still make goal towards developing capacity to breath independently for brief periods of time
- gradual reduction of pts dependence on ventilator
factors that may reduce potential for C3 and lower to wean from vent
- respiratory or other medical complications
- pre-exisiting respiratory conditions
- >50 years old
- VC <1000
- max negative inspiratory pressure < 30 cm H20
- hx smoking