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Neuro 2 > SCI treatment pt 1 > Flashcards

SCI treatment pt 1 Flashcards

1
Q

list the 6 major components of SCI rehab

A
  1. skin integrity
  2. respiratory function
  3. ROM management
  4. Strengthening
  5. Upright tolerance
  6. balance and therapeutic positions
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2
Q

list goals for all levels of SCI

A
  1. upright tolerance → 10-12 hours/day
  2. utilize appropriate seating position and/or mobility devices to support posture and max function
  3. maintain skin integrity
  4. independent for all direction of care as needed
  5. caregiver becomes independent with all aspects of care as needed
  6. maintain healthy habits, minimize body habitus
  7. MAXIMIZE INDEPENDENCE
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3
Q

maintaining skin integrity after an SCI (frequency of pressure relief wheelchair and bed; how often skin checks should occur)

A
  1. Pressure relief schedule
    • wheelchair
      • frequency = every 15-20 min
      • duration = 2-4 min
    • Bed
      • rolling schedule = every 2 hours
  2. Skin checks
    • full body skin exam daily
    • may require adaptive equipment like long-handled mirror
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4
Q

what is included in a respiratory examination for an SCI pt? (5)

A
  1. respiratory rate, breathing pattern, chest excursion
  2. cough
  3. posture
  4. breath support with speech
  5. may need pulmonary function testing
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5
Q

list the types of cough quality

A
  1. functional cough
  2. weak functional cough
  3. nonfunctional cough
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6
Q

describe a functional cough

A
  1. Sound
    • loud and forceful
  2. Number of coughs possible per exhale
    • two or more
  3. Functional Significance
    • independent in respiratory secretion clearance
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7
Q

describe a weak functional cough

A
  1. Sound
    • soft, less forceful
  2. Number of coughs possible per exhale
    • one per exhale
  3. Functional significance
    • independent for clearing throat and small amount of secretions
    • assistance needed for clearing large amount of secretions
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8
Q

describe a nonfunctional cough

A
  1. Sound
    • sigh or throat clearing
  2. Number of coughs possible per exhale
    • no true coughs
    • cough attempt has no expulsive cough
  3. Functional significance
    • assistance needed for airway clearance
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9
Q

List respiratory interventions for SCI pts (9)

A
  1. Respiratory strength and endurance training
  2. Eccentric control of exhalation
  3. chest wall mobility
  4. posture considerations
  5. Glossopharyngeal breathing (tetra)
  6. abdominal breathing (tetra)
  7. Assisted cough techniques
  8. Self-cough technique
  9. Vent weaning (tetra)
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10
Q

what may be used for respiratory strength and endurance training? (3)

A
  1. diaphragmatic breathing
  2. upper chest strengthening
  3. resistive inspiratory muscle trainers
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11
Q

describe diaphragmatic breathing

A

ideal for quiet breathing

“belly breathing”

instructing the pt to sniff can encourage diaphragmatic response

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12
Q

what is the purpose of upper chest strengthening?

A

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

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13
Q

how to perform upper chest strengthening for SCI pts, what does this cause?

A
  1. PT places hands on upper chest and asks pts to push against them while breathing deeply
  2. quick stretch to SCM, Pec Major, and Scalenes by pushing the upper chest in and caudally just before asking the pt to inhale
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14
Q

what is the effect of resistive inspiratory muscle trainers? (5)

A
  1. shown to improve strength and endurace in muscles of ventilation
  2. improved PFT results
  3. encourages slower and deeper breathing
  4. reduces use of accessory muscles
  5. increases activity tolerance
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15
Q

what is eccentric control of exhaltion?

A
  1. pt inhales maximally and then counts or says “ah” for as long as possible before taking another breath
    • goal = 10-12 seconds
  2. can further promote by +manual vibration or resistance
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16
Q

way to target chest wall mobility (4)

A
  1. deep breathing exercises
  2. passive stretching
  3. joint mobilizations
  4. intermittent positive pressure breathing
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17
Q

posture considerations pertaining to respiratory interventions with SCI pts (ie. what is the ideal posture for enhanced respiration)

A
  • anterior pelvic tilt
  • erect trunk
  • adducted scapulae
  • neutral head and back alignment
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18
Q

what is glossopharyngeal breathing?

A
  1. Use of tongue and pharyngeal muscles
    • forces air in lungs through a series of gulps
    • can also help with chest wall mobility
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19
Q

use of abdominal binders during respiratory rehab in SCI pts

what does this provide an increase in?

A
  1. can also be used with higher paraplegic injuries
    • mainly for tetra
  2. used to contain abdominal contents in sitting and better position diaphragm
    • increased VC, TV, MEP, and blood oxygenation
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20
Q

T/F: assisted cough techniques help improve coughing but have no effect on preventing other complications

A

FALSE

crucial in preventing things like pneumonia

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21
Q

describe the technique for assisted cough techniques

A

2 coughs per 1 breath out

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22
Q

describe the self-cough technique

A
  1. 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
  2. hold breath briefly
  3. 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
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23
Q

describe vent weaning

A

usually for tetraplegia

  1. C3 or lower can usually regain capacity to breathe independently
  2. even if unable to completely wean from vent, can still make goal towards developing capacity to breath independently for brief periods of time
  3. gradual reduction of pts dependence on ventilator
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24
Q

factors that may reduce potential for C3 and lower to wean from vent

A
  1. respiratory or other medical complications
  2. pre-exisiting respiratory conditions
  3. >50 years old
  4. VC <1000
  5. max negative inspiratory pressure < 30 cm H20
  6. hx smoking
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25
Q

prevention strategies for preventing ROM impairments and soft tissue contractures (5)

A
  1. Daily ROM exercises
  2. proper positioning
  3. WBing activities
  4. Adequate spasticity management
  5. Splinting
26
Q

list some methods for managing contractures (3)

A
  1. Serial casting
    • can be used both prevention and management
  2. Medication
    • baclofen
    • botox injection
  3. Surgical interventions
    • joint manip under anesthesia
    • arthroscopic vs open release
    • rotational osteotomy
27
Q

Prevention of muscle shortening

Particular considerations

A
  1. with weakened or paralyzed elbow extensors, shortening of elbow flexors is a common problem
  2. rotator cuff and other scapular muscles should be monitored closely for contractures
  3. patient with incomplete tetra or complete/incomplete paraplegia who are walking candidates requrie normal ROM throughout the entire LE
28
Q

adaptive shortening in SCI pts

A
  1. with intact innervation of C6 = wrist extension preserved
    • can use wrist extension to acheive tenodesis which will create a grasp
  2. pts with C6 or C7 SCIs must avoid overstretching their finger flexors during activities and functional tasks to maintain tenodesis capabilities
29
Q

adaptive lengthening in SCI pts

A
  1. combination of lengthened hamstrings + adaptive shortening of back extensors can provide stability and balance in short and long sitting positions
    • need to maintain 110-130 SLR without overstretching back muscles
30
Q

strengthening considerations for SCI pts (8)

A
  1. further MMT should be completed for all intact spinal nerve roots
  2. monitor pt closely for hemodynamic response when initiating new strengthening activities
  3. combo of multi-joint exercises as well as isolated movements
  4. both open and closed chain are helpful
  5. injury prevention is key
  6. focus on strengthening key muscles and teach strategies to minimize UE use
  7. big focus on shoulder ergonomics (wheelchair mobility)
  8. core strengthening!
31
Q

how do you know when to attempt closed chain activities with an SCI pt?

A

if strength is >/= 3/5 go for it

32
Q

where is common source of injury in SCI pts?

A

shoulder

remember that UEs become the primary mode for locomotion which increases the load at the shoulder

33
Q

list some helpful equipment that may be used in SCI pts during rehab

A
  1. powder board
  2. skates
  3. air splints
  4. inclined board
  5. mobile arm support
  6. thera-band
34
Q

what are the benefits for the supine position in SCI pts?

A
  1. gravity-eliminated position for many UE/LE muscles
  2. easy to facilitate rest breaks
35
Q

considerations for supine position in SCI pts

A
  1. totally flat can be compromising for many respiratory muscles
  2. may need to consider propping pt on wedge or several pillows to improve respiratory fxn during exercise
  3. least functionally relevant position, harder to facilitate CC activities
36
Q

benefits to side-lying position in SCI pts

A
  1. gravity eliminated position for some UE/LE muscles
  2. can be more comfortable position than supine if vertebral fracture presents
37
Q

considerations for side-lying position in SCI pts

A
  1. need to be aware of not over-flexing trunk, can compromise respiration
  2. difficult to incorporate LE CC activities
  3. more so able to implement some function-based UE tasks
    • side lying > elbow prop, side lying push ups
38
Q

benefits to the prone position in SCI pts

A
  1. great way to extend back, hip flexors, even knee flexors
  2. allows for full pressure relief of the butt
  3. can progress position in variety of ways
    • prone on elbows
    • prone with elbow extended
  4. can allow for neck extension strengthening
39
Q

considerations for prone position in SCI pts

A
  1. be cognizant of neck ROM
    • head/neck need to be able to move freely to allow for comfort of breathing
  2. if neck ROM limitations may consider use of towel rolls to prop chest and head
  3. primarily a position used to target UEs when considering strengthening interventions
40
Q

benefits of quadruped position in SCI pts

A
  1. great functional position, CC UE/LE
  2. challenges proximal muscles
  3. incorporates trunk muscles and pelvic stabilizers
  4. can allow for neck extension strengthening
41
Q

considerations for quadruped positioning in SCI pts

A
  1. challenging position
    • but variety of ways therapist can assist and facilitate to allow even pts with tetra to achieve this position
  2. consider use of equipment to help pt maintain quadruped position
42
Q

benefits of high-kneeling position in SCI pts

A
  1. if intact, great position for glutes, pelvic muscles, low back stabilizers
  2. if higher level, targets intact trunk muscles and can incorporate balance strategies
43
Q

considerations for high-kneeling position in SCI pts

A
  1. be careful of leg position
    • be sure pelvis, hips are neutral to avoid inappropriate load through hip and knee joint
44
Q

benefits of sitting in SCI pts

A
  1. core stabilization
  2. CC UE exercises
45
Q

considerations for sitting position in SCI pts

A
  1. great position to incorporate dual-task balance activity while strengthening targeted muscles
46
Q

benefits of (assisted) standing in SCI pts

A
  1. great functional positions, CC UE/LE
  2. Challenges proximal muscles
  3. incorporates trunk muscles and pelvic stabilizers
  4. can allow for neck extension strengthening
47
Q

considerations for (assisted) standing position in SCI pts

A
  1. challenging position but there are variety of ways the PT can assist and facilitate to allow even pts with tetra to achieve this position
  2. consider use of equipment to help pt maintain position
48
Q

T/F: OH is very common in SCI pts in acute stages?

A

TRUE

can make it difficult for pts to tolerate upright positions

49
Q

S/S of OH (8)

A
  1. hypotension + tachycardia
  2. dizziness
  3. pale skin
  4. sweating
  5. slurred speech
  6. fogginess
  7. blurred vision
  8. N/V
50
Q

list strategies to manage and progress upright tolerance in SCI pts

A
  1. slow transitions
  2. compression garments
    • abdominal binders
    • TED stockings
    • ACE wraps
  3. equipement
    • tilt’n space w/c
    • tilt table
    • ERIGO
    • active standing frame
51
Q

regardless of the level of injury or prognosis, incorporating standing in POC has a ton of benefits including:

A
  1. socialization
  2. mood
  3. respiratory and cardiovascular function
  4. aids in digestion
  5. bone health
  6. ROM maintenance
  7. strengthening
  8. skin integrity
52
Q

Assisted Standing considerations

A
  1. Monitor vitals closely during EACH session
  2. incorporate trunk or UE strengthening into session as tolerated
  3. incorporate isometric or small range LE strengthening as able and as device allows
  4. consider use of FES while standing
53
Q

how are goals structured for assisted standing using a device?

A

typcially tolerance-based

but can incorporate strengthening goals as well

54
Q

sitting balance considerations with tetraplegic injuries (3)

A
  1. achieve balance
    • transitioning to/from each available UE prop position
  2. maintain balance
    • strengthening of intact muscles to maintain UE prop position
    • compensatory techniques when key postural muscles are weak
  3. react to loss of balance
    • compensatory head/neck techniques to make up for loss of functional reaching response
55
Q

what are the 3 primary positions for UE support when in short or long sitting?

A
  1. posterior prop
  2. lateral prop
  3. anterior prop
56
Q

ROM requirements and goal setting for teta UE prop positions

A
  1. ROM
    • shoulder extension, ABD, and ER
  2. Goal for mid-low level tetraplegia
    • achieving independence with each position
    • improving transition into/out of each position
57
Q

compensation for weak triceps in a tetraplegic pt trying to perform static sitting

A
  1. triceps are important when relying on CC BUE support in sitting
    • if triceps are impaired (ie C6 injury) can still achieve CC UE support if anterior deltoid and shoulder ER are functiona l
    • teaching pt how to get in/out of this position is crucial for progressing sitting balance
58
Q

what out for _____ at the wrist in static sitting balance in tetraplegic pts

A

protecting tenodesis grasp

C6/7 need to maintain finger flexion whenever WBing through UEs during static sitting balance tasks

59
Q

reactionary techniques with the loss of trunk strength and variable UE strength

A

small perturbations: head/neck, upper shoulder and upper trunk muscles

large perturbations: difficult to be successful

60
Q

what is the “sweet spot” pertaining to balance?

A

every pt has one of these in which their COM lands perfectly over their BOS and they can briefly hold balance without UE support despite inadequate trunk strength

61
Q

dynamic balance considerations for paraplegic pts

A
  1. Dynamic balance + trunk control + UE and core strengthening
  2. focus on quickening reactionary strategies
  3. higher paraplegic may benefit from head/neck reactionary techniques for smaller LOB
62
Q

what are therapeutic positions?

A

key positions to promote strength, balance, and functional indpendence

  1. Long sit
  2. short sit
  3. ring sit
  4. prone

Neuro 2 (30 decks)

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