SCI treatment pt 2

Question 1

precautions to exercise

Answer 1

UTI
insufficient ROM to perform task
autonomic dysreflexia** if onsets, stop exercise and find trigger

Question 2

contraindications to exercise

Answer 2

symptomatic hypotension
unstable fx
uncontrolled hot/humid environment

Question 3

how to manage and progress upright tolerance if OH is very present?

Answer 3

slow transitions
compression garments
equipment like tilt in space chairs, standing frame, etc

Question 4

what is the most effective thing to do to progress upright tolerance when a pt experiences OH

Answer 4

wear an abdominal binder

Question 5

what can you consider while doing assisted standing

Answer 5

monitor vitals closely
use FES
goals are tolerance based

Question 6

what can you incorporate when doing assisted standing

Answer 6

trunk or UE strengthening
isometric or small range LE strengthening

Question 7

what is the #1 cause of death after SCI

Answer 7

pneumonia

Question 8

diaphragmatic breathing is ideal for what

Answer 8

quiet breathing
“belly breathing”
strength and endurance

Question 9

how is diaphragmatic breathing done

Answer 9

supine
place large, light object on abdomen and instruct pt to watch them breath – progress to active resistance on abdomen

Question 10

upper chest strengthening

Answer 10

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

Question 11

how is upper chest strengthening performed

Answer 11

therapist place hands on upper chest and asks pt to push against them while breathing deep

quick stretch to SCM, pec major, scalenes by pushing upper chest in and caudally just before asking pt to inhale

Question 12

what are resistive inspiratory muscle trainers shown to do

Answer 12

improve strength and endurance in muscles of ventilation, improve PFT results, encourages slower and deeper breathing, reduces use of accessory muscles and increases activity tolerance

Question 13

eccentric control of exhalation

Answer 13

pt inhales maximally & then counts or says “ah” or “oh” for as long as possible before taking another breath

Question 14

goal time for eccentric control of exhalation

Answer 14

10-12 seconds

Question 15

how can you further promote eccentric control of exhalation

Answer 15

manual vibration or resistance

Question 16

chest wall mobility

Answer 16

deep breathing exercises
passive stretching
joint mob
intermittent positive pressure breathing

Question 17

what is ideal posture for enhanced respiration

Answer 17

anterior pelvic tilt
erect trunk
adducted scap
neutral head and neck alignment

Question 18

glossopharyngeal breathing

Answer 18

good for tetra

use of tongue and pharyngeal muscles - force air in lungs through series of gulps

Question 19

who would use abdominal binders

Answer 19

tetra but high paraplegic pt’s can also benefit

Question 20

what is abdominal binder used for

Answer 20

used to contain abdominal contents in sitting and better position diaphragm

takes over for trunk control

Question 21

what does an abdominal binder increase

Answer 21

vital capacity
tidal volume
MEP
blood oxygenation

Question 22

assisted cough technique is good for what

Answer 22

crucial in preventing complications like pneumonia

Question 23

what is the assisted cough technique

Answer 23

2 coughs per 1 breath out

PT is kinda pushing on stomach when pt is breathing out

Question 24

to perform a self-cough technique what must the pt have

Answer 24

some degree of UE, trunk and core strength to be able to sit back up

Question 25

how to perform the self-cough technique

Answer 25

breathe in as deeply as possible - combine trunk & neck extension with shoulder flexion or scap adduction

hold breath

cough - combine forced exhalation with trunk & neck flexion as well as shoulder extension or scap abduction

Question 26

what is another way to perform self-cough technique

Answer 26

if UE strength is present and balance, can self apply heimlich-like maneuver to stomach

Question 27

factors that will reduce the possibility of weaning off the vent

Answer 27

respiratory or other medical complications
pre-existing respiratory conditions
>50 yrs old
VC <1000
max neg inspiratory pressure <30cm H2O
hx of smoking