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Neuro 2 > SCI treatment pt 2 > Flashcards

SCI treatment pt 2 Flashcards

1
Q

benefits of physical activity and exercise in SCI pts

A
  1. increased strength, endurance, mobility, sleep, self-image, blood lipid profiles
  2. decreased risk of premature mortality
  3. decreased anxiety, loneliness, depression, stress, heart disease, BP, respiratory illness, DM, obesity, and other medical complications
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2
Q

methods for physical activity and exercise in SCI pts

A
  1. arm ergometry
  2. FES UE or LE cycle
  3. wheelchair propulsion
  4. adaptive rowing machines
  5. adaptive bicycling
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3
Q

what are the 2 primary guidelines for SCI physical activity?

A
  1. cardiovascular fitness and muscle strength
  2. cardiometabolic health benefits
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4
Q

specific parameters for cardiorespiratory fitness and muscle strength

A
  • 20 min moderate to vigorous intensity aerobic exercise 2x/week
  • 3 sets of strength exercises 2x/week for each major functioning muscle group
    • moderate to vigorous intensity
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5
Q

parameters for cardiometabolic health in SCI pts

A
  • 30 min 3x/week of moderate to vigorous intensity aerobic exercise
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6
Q

Considerations for Physical activity and Exercise in SCI pts

A
  1. be sure to take into consideration any MSK, respiratory, CV, and autonomic nervous system changes that can occur after SCI
    • MSK → decreased BMD
    • Respiratory → decreased pulmonary reserve
    • CV → OH
    • Autonomic NS → temp regulation, impaired sweat glands
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7
Q

exercise response in tetraplegic and high paraplegic SCI pts

A

blunted HR response to activity, low VO2 peak

vascular support (TED stockings, abdominal binder) may be warranted

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8
Q

at what level of SCI should we consider autonomic nervous system impairments?

A

T6 and above

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9
Q

Contraindications to exercise testing and training in SCI

A
  1. Autonomic dysreflexia
  2. Severe or infected skin on weight bearing surfaces
  3. Symptomatic hypotension
  4. UTI
  5. Unstable fractures
  6. Uncontrolled hot/humid environments
  7. Insufficient ROM to perform exercise tasks
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10
Q

Manual WC considerations when picking out a wheelchair

A
  1. what material is used in fabricating the WC frame
  2. what shape or design of the frame is chosen
  3. what components are included
  4. what adjustments are available
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11
Q

what is the primary goal of WC prescription?

A

finding the combo of parts that produces the lightest WC

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12
Q

list materials that can be used to make a WC as well as potential frames

A
  1. Materials
    • titanium
    • carbon fiber
  2. Frames
    • box frame
    • cantilever frame
    • folding frame
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13
Q

options for cushion

A
  1. Air
  2. Gel
  3. Hybrid
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14
Q

considerations for air cushions

A
  1. highest level of protection for skin
  2. comes in low, mid, and high grade
  3. high maintenance, can pop
  4. more disruptive to posture
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15
Q

considerations for gel cushions

A
  1. less protective of skin, but still highly superior to typical foam cushions
  2. less maintenance
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16
Q

considerations for hybrid cushions

A
  1. combo of air or gel and foam
  2. offers additional stability over posterior thighs
  3. good option for pts who need air but struggle with postural implications
    • but lose full coverage/protection
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17
Q

options for back rests on WC

A
  1. low back
  2. mid back
  3. high back
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18
Q

considerations for low back

A
  1. least supportive
  2. allows for full upper trunk movement
  3. least likely to get in way of propulsion
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19
Q

considerations for mid back WC

A
  1. extends to just below inferior angle of scapula
  2. may get in way of scapular movements
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20
Q

considerations for high back

A
  1. most supportive
  2. restrictive to scapular movement and certain shoulder movements
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21
Q

each height also comes with different options for depth, describe them

A
  1. Lateral
    • minimal lateral support to trunk
    • allows for more freedom for trunk movements
  2. Deep
    • offers much more lateral support
    • more restrictive
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22
Q

options for armrests on WC

A
  1. none
  2. swing-away
  3. flip-back
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23
Q

considerations to no arm-rests

A
  1. for more advanced WC users
  2. offers more freedom of movement, but lose benefits of armrest (stability, push up surface)
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24
Q

considerations of swing-away armrests

A
  1. easiest to operate, do not need wrist/hand
  2. unable to attach trough or table if needed
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25
Q

considerations to flip-back armrests

A
  1. need adequate hand and finger use
  2. more versatile - able to attach trough or table
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26
Q

options for foot rests/leg rests on WC

A
  1. rigid
    • less maintenance
    • extra thing to manever feet around during transfers
  2. swing-away
    • ideal for pts participating in gait trails
    • need adequate hand and wrist function to operate
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27
Q

options for wheels on WC

A
  1. rubber
  2. air
  3. push-rims
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28
Q

considerations for rubber wheels

A
  1. heavier option
  2. way less maintenance
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29
Q

considerations for air wheels

A
  1. lighter option
  2. smoother ride
  3. more maintenance, can pop
30
Q

considerations for push-rim wheels

A
  1. allows for easier propulsion, can build up to compensate for weaker grip
  2. make chair wider - more difficult to negotiate tight spaces
31
Q

considerations for casters

A
  1. smaller casters are more lightweight
  2. larger casters are beneficial when frequently negotiating outdoors/rough terrain
32
Q

what does choosing pt’s WC parts ultimately come down to?

A

the pts capabilities, limitations and preferences

33
Q

list two types of WC speciality tech

A
  1. push-assist technology
  2. power stand-up manual wheelchair
34
Q

Power WC considerations

A
  1. 3 primary drive systems
    • rear-wheel
    • mid-wheel
    • front-wheel
  2. primary considerations → maneuverability
    • 360-degree turning circumference
    • turning radius
35
Q

Rear-Wheel WC considerations

A
  1. Largest 360-degree circumference and turning radius
    • very difficult to navigate in tight spaces
  2. fastest chair
    • most stable when faster
36
Q

Mid-Wheel WC considerations

A
  1. most maneuverable, excellent indoor chair
  2. fair maneuverability over outdoor surfaces
  3. slower
  4. most stable on slopes since they have front and rear casters
37
Q

Front-Wheel PWC considerations

A
  1. larger turning radius than mid-wheel, but excellent at navigating tight corners
  2. helpful when negotiating rough terrain
  3. best for navigating outdoors
38
Q

options for driving a PWC

A
  1. Head array
  2. Sip and puff
  3. low-resistance joystick → tongue control
  4. chin control
  5. football post joystick
  6. standard joystick
39
Q

General WC considerations for SCI C5 and up (including high cervical C1-4)

A
  1. High cervical (C1-4)
    • power wheelchair
    • head array, chin, tongue, or sip and puff control
    • portable respiratory may be attached
  2. C5
    • can use a MWC with propulsion aids, but will likely need PWC for distance and energy conservation
    • sip and puff, chin, tongue or football posts control
40
Q

General WC considerations for SCI injuries C6 and down

A
  1. C6
    • MWC with friction surface hand rims
    • should progress to independent on smooth surfaces
  2. C7
    • MWC with friciton surface hand rims but increased propulsion ability
  3. C8 and down
    • MWC with standard hand rims
41
Q

what are the 2 main uses of FES in SCI pts?

A
  1. Independent application
  2. FES Dependent application
42
Q

what is independent application of FES?

A
  1. Use of FES for a finite time period to minimize impairments and to encourage motor relearning in context of function
    • expectation is that the pt will be weaned off FES
    • ex → FES over anterior tib to improve foot drop during ambulation
43
Q

what is dependent application of FES?

A
  1. this enables the pt to perform functional activities that wouldn’t be otherwise possible
    • neuroprosthesis
    • ex → FES on LE musculature of pt with paraplegia while peddling on leg ergometer
44
Q

Indications for the use of FES

A
  1. UMN injury
    • SCI, CVA, TBI, MS, CP, PD, etc
  2. Absent or diminished motor function in arms, trunk, and/or legs
    • focal or diffuse weakness
  3. demo of active contraction when e-stim is provided over motor point of muscle belly
  4. pt able to tolerate stimulus provided by FES
    • stim must be strong
45
Q

Indications for use of the RT300 FES bike

A
  1. relaxation of muscle spasms
  2. prevention or reduction of disuse atrophy
  3. increasing local blood circulation
  4. maintaining or increasing ROM
  5. improve muscle endurance with intact innervation
46
Q

considerations for the RT300 FES bike

A
  1. risk of raising unrealistic expectations
  2. difficult to predict outcome
  3. insufficient evidence for duration and dosage of treatment
47
Q

Contraindications for the use of FES

A
  1. LMN pathology
  2. Cardiac pacemaker
  3. Pregnancy
  4. Unhealed fracture in area
  5. Skin breakdown in area
  6. Internal stimulator near area
  7. DVT in area
  8. Malignancy in area of trx
  9. Uncontrolled autonomic dysreflexia
48
Q

relative contraindications for the use of FES

A
  1. absent sensory
  2. severe spasticity
  3. HO
  4. severe osteoporosis
  5. chronic pain syndrome
49
Q

what is Lokomat Training?

A

Robotic assisted treadmill

50
Q

benefits to Lokomat training?

A
  1. complete injuries
    • upright benefits discussed with standing all applicable here
  2. incomplete injuries
    • individually adjustable gait pattern and guidance
    • real-time biofeedback
    • neuroplasticity, CPGs
51
Q

considerations for Lokomat training

A
  1. realistic expectations/goals
  2. hemodynamic stability
  3. skin integrity
  4. autonomic dysreflexia
52
Q

Contraindications for Lokomat training

A
  1. Fixed Le contractures
  2. Considerably reduced BMD (osteopenia or osteoporosis)
  3. Bone instability
    • non-consolidate fractures
    • unstable spinal column
    • severe OP
  4. Sig cardiac disease/compromise
  5. Behavioral concerns
  6. Pregnancy
  7. >300 lbs, >6ft 1
53
Q

what is the ReWalk?

A

an exoskeleton device

ReWalk system enables the device user to sit, stand, walk, turn and has the ability to climb and descend stairs

ReWalk users are able to independently operate the systems

54
Q

Prerequisites for ReWalk Trials

A
  1. Hands and shoulders can support crutches or a walker
  2. Healthy BMD
  3. No unhealed fractures
  4. Adequate standing tolerance
  5. No cardiac, respiratory, autonomic comorbidities of concern
  6. Height is between 160 cm and 190 cm
  7. Weight does not exceed 100 kg
55
Q

indications for BWST

A
  1. incomplete injuries
    • ASIA B, C, or D
  2. this promotes spinal cord learning/activation of spinal locomotor pools
56
Q

Parameters for BWST in SCI pts

A
  1. Variable levels of loading from 35% decreasing to 10% to full loading
  2. during early training PT manually assist with foot placement
  3. high frequency (4 days/week)
  4. moderate duration (20-30 mins)
  5. typically for 8-12 weeks
57
Q

describe 2 different progressions that may be used with BWST

A
  1. decreased BWS, increase speed, eliminate manual assistance
  2. progress to over ground locomotor training for community ambulation
58
Q

SCI ambulation and orthotic options

A
  1. HKAFO (Hip-knee-ankle-foot orthosis)
  2. RGO (reciprocating gait orthosis)
  3. KAFO (knee-ankle-foot orthosis)
  4. AFO (ankle-foot orthosis)
59
Q

Home modification considerations for SCI

A
  1. ramps
  2. doorframe widths and doors
  3. door and appliance handles
  4. hallway considerations
  5. surface considerations
  6. bathroom modifications
  7. kitchen modifications
60
Q

Community reintegration considerations for SCI

A
  1. returning to work
    • 60% of pts with traumatic SCI were employed at time of accident
      • 12% employed at 1 yr
      • 33% employed at 20 yrs
    • ADA 1990 protection against discrimination
  2. returning to school
    • CARF requires rehabs to have academic programs
    • public schools have legal obligations to provide assist
  3. return to leisure
    • TONS of options for adaptive sports
61
Q

Outcome measures commonly used in SCI populations

A
  1. MPI-SCI
  2. Satisfaction With Life Scale
  3. RNL
  4. Penn Spam Frequency Index
  5. Capabilities of UE Functioning Instrument
  6. SCIM
  7. Wheelchair skills test
  8. WISCI-II
  9. SCI-FAI
    10.
62
Q

what is the MPI-SCI?

A

Multidimensional Pain Inventory - SCI version

  1. cog-behavioral conceptualization of chronic pain
  2. 3 sections (12 subscales total)
  3. Validity → moderate to high
    • high correlation with brief pain inventory
    • mod correlation with beck depression inventory
    • mod correlation with FIM
63
Q

list the 3 sections in the MPI-SCI

A
  1. Pain impact
  2. Response by significant others
  3. General activities

generally takes ~20 min to complete

scored on 0-6 Likert scale with final score = mean score

64
Q

describe the satisfaction with life scale

A
  1. assess satisfaction with pt’s life as a whole
  2. quick, easy self-report
  3. excellent validity with other scale assessing well-being
    • recommended to complement other scales that focus on emotional well-being
65
Q

what is the RNL?

A

Reintegration into Normal Living

11 items (1-10 scale)

score/110 * 100

66
Q

what is the Penn Spasm Frequency Index?

A
  1. Self report measure that assesses a pt’s perception of spasticity and severity following SCI
  2. best to use alongside MAS
67
Q

what is the capabilities of UE functioning instrument?

A
  1. measures UE functional limitations in individuals with tetraplegia
    • 32-item questionnaire (7 domains, scored 1-7)
    • total score = 224
68
Q

what is the SCIM?

A

Spinal Cord Independence Measure

SCI equivalent to the FIM

3 domains

69
Q

what are the 3 domains of the SCIM?

A
  1. self-care
  2. respriation and sphincter management
  3. mobility
70
Q

what is the Wheelchair Skills Test?

A
  1. Comprehensive, objective WC mobility assessment
  2. Manual or power versions
  3. >80% = advanced WC skills
71
Q

what is the WISCI-II?

A

Walking Index for SCI

  1. rank orders ability of pt to walk 10m after SCI from most to least severe impairment
  2. considerations:
    • amount of assistance
    • AD
    • braces
72
Q

what is the SCI-FAI?

A

SCI Functional Ambulation Inventory

  1. Observational gait assessment
    • 3 subscales
      • gait parameters (20 pts)
      • AD (14 pts)
        • device
        • orthotics
      • Temporal distance (5 pts)
        • community vs home frequency
        • 2-min walk test

Neuro 2 (29 decks)

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