SCI Tx Consideration: Part 2

Question 1

Wheel Chair pressure relief schedule freq/duration

Answer 1

Freq: Every 15-20 mins
Duration: 2-4 mins holding pressure relief position
For pushup method, only hold for 30-90 secs

Question 2

Bed Rolling pressure relief schedule

Answer 2

Rolling every 2 hours

Question 3

T/F: Skin checks should be done daily and may require adaptive equipment like a long-handled mirror.

Answer 3

True

Question 4

What’s a very common problem in acute stages with upright tolerance? What are the S&S of this problem?

Answer 4

Orthostatic Hypotension
S&S: hypotension + tachycardia, dizzy, pale, diaphoresis, slurred speech, foggy, blurred vision, N/V
check BP every 2 mins

Question 5

3 Strategies to manage/progress upright tolerance

Answer 5

1 Slow transitions
2 Compression garments (stockings, abd binders, ACE wrap)
3 Equipment (tilt n’space, tilt table, ERIGO, standing frame)

Question 6

Assisted standing has many benefits for these pts. What are some assisted standing devices and frequency of standing for this pt population?

Answer 6

1) Tilt table, stand-in table, BWS, standing frames, ERIGO
2) 2-3x/week in acute care, 1x/week in OP

Question 7

Which of the following is not a consideration for assisted standing?
A) incorporate trunk/UE strengthening (AROM, TB, DB, Ball tosses, fine motor)
B) LE isometrics/small range strengthening
C) use of FES
D) Monitor vitals closely ESP. BP
E) all of these are considerations

Answer 7

E

Question 7

Goals for standing are typically ___-based, but can incorporate ___ LE goals as well.

Answer 7

1 tolerance based
2 LE strengthening

Question 8

Respiratory examination should be done throughout care. Exam includes: (5)

Answer 8

1 RR, breathing pattern, chest excursion
2 cough
3 posture
4 breath support w/ speech
5 may need Pulmonary Function Testing

Question 9

A Functional cough is loud and forceful, and consists of ___ or more coughs per exhalation. What is the functional significance?

Answer 9

1) 2 or more
2) Ind. w/ resp. secretion clearance

Question 10

A weak functional cough is soft and less forceful, and consists of __ cough(s) per exhalation. What is the functional significance?

Answer 10

1) 1 cough
2) Ind. for clearing throat & small amts of secretions. Assistance needed for clearing large amts of secretions

Question 11

A nonfunctional cough is a sigh or throat clearing, and consists of ___ cough(s) per exhalation. What is the functional significance?

Answer 11

1) NO TRUE COUGHS
2) Assistance needed for airway clearance

Question 12

T/F: Pneumonia is the most common sequelae cause of death for pts with SCI.

Answer 12

True

Question 13

___ breathing aka “__ breathing” is ideal for quiet breathing. Place the pt in supine and place a light obj (box of tissue) on abdomen and instruct pt to watch themselves breathe. Instructing the pt to ___ can encourage diaphragmatic response.

Answer 13

1 Diaphragmatic breathing
2 belly breathing
3 sniff
add resistance to abdomen to progress exercise

Question 14

T/F: The diaphragm is innervated by the thoracic spine.

Answer 14

False, C3-C5 keeps the patient alive!
below T10 = normal ventilatory & resp. fxn

Question 15

Upper chest strengthening increases ___ air to enhance coughing, improve breath support for speech, or during increased activity.

Answer 15

inspired air

Question 16

Upper Chest Strengthening: Place your hands on pts upper chest and ask pt to push against them while breathing deeply. You can also apply a quick stretch to ___, __, & __ by pushing upper chest caudally just (before/after) asking the patient to inhale.

Answer 16

1) SCM, Pec major, Scalenes
2) before

Question 17

________ is a useful alternative to diaphragmatic breathing & upper chest strengthening for resp. strength/endurance training. Its shown to improve strengthen/endurance in ventilation, encourages slower/deeper breathing, reduces use of ___ muscles, and increases activity tolerance.

Answer 17

1) Resistive Inspiratory Muscle Trainers
2) accessory muscles
Can make these more functional by placing pt in diff positions (prone, supine, etc)

Question 18

Practice eccentric ctrl of exhalation by having pt inhale and say __ or __ for ____ before taking another breath. The goal is ____ seconds.

Answer 18

1) “ah” or “oh”
2) as long as possible
3) 10-12 seconds
can progress w/ vibration or resistance

Question 19

What are some interventions you can do to improve the patient’s chest wall mobility? (4)

Answer 19

1 deep breathing exercises
2 passive stretching
3 joint mobs
4 intermittent positive-pressure breathing
glossopharyngeal breathing can help w/ this too

Question 20

What is the ideal posture for enhance respiration?

Answer 20

APT, erect trunk, scapulae ADD, neutral head and neck alignment

Question 21

Glossopharyngeal breathing is the use of ___ and ___ to force air into lungs via a series of ___.

Answer 21

1) tongue and pharyngeal muscles
2) “gulps”
esp. used for patients if other resp. muscles are not intact

Question 22

____ __ are used for tetraplegics and higher paraplegics (more severe cases). It’s used to better contain contents in sitting and better position the diaphragm, leading to increased __, __, __, and blood oxygenation.

Answer 22

1) Abdominal Binders
2) VC (vital capacity), TV (tidal vol), MEP (max expiratory pressure)

Question 23

______ techniques are crucial in preventing complications like ___. The technique consists of __ coughs per 1 exhalation.

Answer 23

1) Assisted coughing
2) pneumonia
3) 2 coughs

Question 24

The self-cough technique procedures: Have patient inhale as deep as possible in combo with _____ as well as shld ___ or scapular ___. Then have pt hold breath in briefly, then cough. If possible combine cough with ____ as well as shld ___ or scapular __. It pt can ctrl it, have them fall into a ___ position. *can self-apply Helmlich-like Maneuver to stomach if adequate UE strength & balance*

Answer 24

1 trunk and neck extension 2 flexion 3 adduction 4 trunk and neck flexion 5 extension 6 abduction 7 folded

Question 25

At what SCI levels can patients usually regain capacity to breathe independently? What are some factors that reduce this potential?

Answer 25

1) C3 or lower 2) Resp. or other med. complications, pre-existing resp. conditions, >50 y/o, VC <1000, max negative inspiratory pressure <30 cm H2O, smoking *tetraplegics usually are on vents*

Question 26

T/F: If patient is unable to completely wean from vent, there is no need to make a goal towards developing capacity to breathe independently.

Answer 26

FALSE, can still make goals for ind. breathing for brief periods of time

Question 27

What are the benefits of developing a goal toward developing capacity to breathe independently for patients unable to wean from the vent?

Answer 27

1) reduces safety concerns from electronic failure 2) can help ease of transfers, bathing, or trachea care *gradual reduction of pt's dependence on ventilator: Progressive Ventilator-Free Breathing*