SCI Tx Considerations: Part 1

Question 1

What is the goal for upright tolerance for all levels of SCI injury?

Answer 1

Upright tolerance for 10-12 hrs/day

Question 2

SCI pts will require tx that involve compensation patterns and restoration of patterns. Determine the tx needed for ea. ASIA level.

Answer 2

ASI-A & B = compensation
ASI-C = compensation + restoration
ASI-D = restoration

Question 3

When working on strengthening with a SCI pt, what should you monitor closely for?

Answer 3

HEMODYNAMIC RESPONSES
-Blunted responses w/ autonomic dysfunction

Question 4

T/F: A combo of multi-joint exercises, closed and open chain, have been found to be beneficial for SCI pts.

Answer 4

True
if 3 or more/5 MMT, prioritize closed chain, functional activities

Question 5

T/F: MMT beyond ASIA requirements do not need to be completed for intact Spinal N roots.

Answer 5

False

Question 6

D/T UEs being primary mode of locomotion, the shoulder is the #1 site for MSK pain and injury after SCI. What is the name of the trial that can help decr. shld pain and risk of injury?

Answer 6

STOMPS = Strengthening and Optimal Movements for Painful Shoulders

Question 7

What are some key muscles to strengthen to decr. shld injury risk and what is a big focus of shld ergonomics in PT?

Answer 7

1: SA, lats, pec major, RCMs, triceps
2: WC Mobility

Question 8

What’s some helpful equipment and when would you use it with this patient population?

Answer 8

1: powder board, air splints, mobile arm support, TB
2: For pts w/ severe weakness and to aid in locking out other joints while you are working with an adjacent joint.

Question 9

What are some considerations for performing exercises in supine as opposed to SL?

Answer 9

• easy to facilitate rest breaks
• position compromising for breathing/resp. May need to prop pt up.
• least fxnal position, hard to do close-chain

Question 10

What are some considerations for performing exercises in SL as opposed to supine?

Answer 10

• More comfy than supine if fx present
• Over-flex trunk compromise resp.
• hard to do close-chain
• can implement fxn-based tasks (SL>elbow prop>SL pushups)

Question 11

Prone is great for ___ back, hips, and knees for a stretch. Also good for ___ relief and ____ ext strengthening.

Answer 11

1 extending
2 pressure
3 neck
Quadruped is also good for neck ext strengthening

Question 12

Be aware of __ ROM in prone, as you may need to prop up chest & head to allow for comfy ___.

Answer 12

1 neck
2 breathing

Question 13

What positioning, other than assisted standing, is great for fxnal, closed-chain UE/LE strengthening, & incorporates trunk/pelvic stabilizers?

Answer 13

Quadruped
consider assist/facilitation & equipment to allow even tetraplegics to achieve this position or standing

Question 13

T/F: Prone is primarily used to target LE strengthening.

Answer 13

False
UE strengthening

Question 14

What positioning is great for core and UE closed-chain exercise, and can incorporate dual-task balance activities?

Answer 14

sitting.

Question 15

In this position, be cautious of inappropriate loading through knee/hip joints by ensuring the pelvis/hips are neutral.

Answer 15

high-kneeling

Question 16

For Cardioresp. fitness and strength, __ minutes of mod to vigorous aerobics and __sets of mod to vigorous strength for ea. major muscle group __/week is recommended.

Answer 16

1) 20 mins
2) 3 sets
3) 2x/week

Question 17

For cardiometabolic health (HR, BP, etc), __ mins __/week of mod-vigorous aerobics is recommended.

Answer 17

30 mins, 3x/week

Question 18

What MSK, resp., CV, & ANS changes seen with SCI pts should be considered in their POC?

Answer 18

MSK: decr. bone density
Resp: decr. pulmonary reserve
CV: orthostatic hypotension
ANS: temp regulation, sweat glands impaired
tetraplegics may require vascular support (stockings, abd binder)

Question 19

Precautions/CIs to Exercise testing/training in SCI includes….

Answer 19

ANS dysreflexia, skin esp. on WB surfaces, hypotension, UTI, unstable fx, unctrlled temp environments, ROM limitations

Question 20

What are prevention strategies for contractures we do with every SCI patient?

Answer 20

1 daily ROM, proper positioning, WBing
2 adequate spasticity management
3 splinting (esp. when pt is at rest)

Question 21

3 Interventions to manage contractures and their specific indications

Answer 21

1 Serial Casting (common at ankle): pts w/ spasticity WITHOUT CLONUS for prevention and tx of contractures
2 Medications: baclofen and botox, can be in combo w/ casting, best for flexor spasticity w/out fixed contractures
3 Surgical Interventions: for more severe cases, joint manips/arthroscopy/open releases, Rotational osteotomy at hip joint for severe hip contractures

Question 22

With weak/absent elbow extensors, shortening of ___ is a common issue. ___ and other ___ muscles should be monitored closely for contractures. Pts w/ tetraplegia or paraplegia who are walking require normal LE ROM, common trouble makers include __, __, and __.

Answer 22

1 elbow flexors
2 RCMs and other scapular muscles
3 Hip flexors, hamstrings, and DFers

Question 23

Adaptive shortening of certain muscles is recommended. Pts with __ or __ SCIs must avoid overstretching their ___ to maintain tenodesis capabilities.

Answer 23

1 C6 or C7
2 finger flexors

Question 24

Combination of lengthened __ and adaptive shortening of ___ can provide stability and balance in short/long sitting positions.

Answer 24

1 hamstrings
2 back extensors
maintain 110-120 degr. SLR without overstretching back muscles

Question 25

Achieve balance by ___. Maintain balance by __. Then go into reacting to LOB by ___.

Answer 25

1 transitioning to each. UE prop position
2 strengthening of muscle in UE prop position & compensation techniques when key postural muscles get weak
3 compensative head/neck techniques to make up for loss of functional reaching response

Question 26

Important ROM for all prop positions involve the shoulder (ext/abd/ER). What are 3 primary prop positions in order from easiest to hardest and what population have prop positioning as a part of their goals?

Answer 26

Easy ———-> Hard
Posterior, Lateral, Anterior
Mid-Low Level Tetraplegics (C-spine SCIs)

Question 27

Triceps are important for closed-chain BUE support in sitting. If impaired, what muscles can function to achieve closed-chain BUE support?

Answer 27

Anterior deltoids and shld ERs

Question 28

In order to protect tenodesis grasp, ______ is needed whenever WBing through UEs during sitting balance tasks.

Answer 28

C6/7 to maintain finger flexion

Question 29

Normally small perturbations involve the trunk/pelvic/hip muscles and large perturbations involve UE reaching. What are considered perturbations for Tetraplegics w/ loss of trunk & variable UE strength?

Answer 29

Small: head/neck, upper shld, upper trunk muscles
Large: difficult to be successful.

Question 30

What is the patients “sweet spot” concerning balance?

Answer 30

When their COM lands perfectly over their BOS and they can briefly hold balance w/out UE support DESPITE LIMITED TRUNK STRENGTH

Question 31

For paraplegics, dynamic balance considerations include __, __, & __, with a focus on quickening ___ strategies.

Answer 31

1 dynamic balance, trunk ctrl, UE/core strength
2 reactionary

Question 32

Higher paraplegics may benefit from ___/___ rxnary techniques for smaller LOBs.

Answer 32

head/neck

Question 33

4 Key positions to promote strength, balance, and functional independence.

Answer 33

1 long sitting
2 sitting
3 W sitting
4 prone, prop on elbows