SCI treatment pt 2 Flashcards
precautions to exercise
UTI
insufficient ROM to perform task
autonomic dysreflexia** if onsets, stop exercise and find trigger
contraindications to exercise
symptomatic hypotension
unstable fx
uncontrolled hot/humid environment
how to manage and progress upright tolerance if OH is very present?
slow transitions
compression garments
equipment like tilt in space chairs, standing frame, etc
what is the most effective thing to do to progress upright tolerance when a pt experiences OH
wear an abdominal binder
what can you consider while doing assisted standing
monitor vitals closely
use FES
goals are tolerance based
what can you incorporate when doing assisted standing
trunk or UE strengthening
isometric or small range LE strengthening
what is the #1 cause of death after SCI
pneumonia
diaphragmatic breathing is ideal for what
quiet breathing
“belly breathing”
strength and endurance
how is diaphragmatic breathing done
supine
place large, light object on abdomen and instruct pt to watch them breath – progress to active resistance on abdomen
upper chest strengthening
increased inspired air to enhance coughing, improve breath support for speech or during increased activity
how is upper chest strengthening performed
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
what are resistive inspiratory muscle trainers shown to do
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
eccentric control of exhalation
pt inhales maximally & then counts or says “ah” or “oh” for as long as possible before taking another breath
goal time for eccentric control of exhalation
10-12 seconds
how can you further promote eccentric control of exhalation
manual vibration or resistance
chest wall mobility
deep breathing exercises
passive stretching
joint mob
intermittent positive pressure breathing
what is ideal posture for enhanced respiration
anterior pelvic tilt
erect trunk
adducted scap
neutral head and neck alignment
glossopharyngeal breathing
good for tetra
use of tongue and pharyngeal muscles - force air in lungs through series of gulps
who would use abdominal binders
tetra but high paraplegic pt’s can also benefit
what is abdominal binder used for
used to contain abdominal contents in sitting and better position diaphragm
takes over for trunk control
what does an abdominal binder increase
vital capacity
tidal volume
MEP
blood oxygenation
assisted cough technique is good for what
crucial in preventing complications like pneumonia
what is the assisted cough technique
2 coughs per 1 breath out
PT is kinda pushing on stomach when pt is breathing out
to perform a self-cough technique what must the pt have
some degree of UE, trunk and core strength to be able to sit back up
how to perform the self-cough technique
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
what is another way to perform self-cough technique
if UE strength is present and balance, can self apply heimlich-like maneuver to stomach
factors that will reduce the possibility of weaning off the vent
respiratory or other medical complications
pre-existing respiratory conditions
>50 yrs old
VC <1000
max neg inspiratory pressure <30cm H2O
hx of smoking
