SCI Tx Considerations: Part 1 Flashcards
What is the goal for upright tolerance for all levels of SCI injury?
Upright tolerance for 10-12 hrs/day
SCI pts will require tx that involve compensation patterns and restoration of patterns. Determine the tx needed for ea. ASIA level.
ASI-A & B = compensation
ASI-C = compensation + restoration
ASI-D = restoration
When working on strengthening with a SCI pt, what should you monitor closely for?
HEMODYNAMIC RESPONSES
-Blunted responses w/ autonomic dysfunction
T/F: A combo of multi-joint exercises, closed and open chain, have been found to be beneficial for SCI pts.
True
if 3 or more/5 MMT, prioritize closed chain, functional activities
T/F: MMT beyond ASIA requirements do not need to be completed for intact Spinal N roots.
False
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?
STOMPS = Strengthening and Optimal Movements for Painful Shoulders
What are some key muscles to strengthen to decr. shld injury risk and what is a big focus of shld ergonomics in PT?
1: SA, lats, pec major, RCMs, triceps
2: WC Mobility
What’s some helpful equipment and when would you use it with this patient population?
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.
What are some considerations for performing exercises in supine as opposed to SL?
- easy to facilitate rest breaks
- position compromising for breathing/resp. May need to prop pt up.
- least fxnal position, hard to do close-chain
What are some considerations for performing exercises in SL as opposed to supine?
- 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)
Prone is great for ___ back, hips, and knees for a stretch. Also good for ___ relief and ____ ext strengthening.
1 extending
2 pressure
3 neck
Quadruped is also good for neck ext strengthening
Be aware of __ ROM in prone, as you may need to prop up chest & head to allow for comfy ___.
1 neck
2 breathing
What positioning, other than assisted standing, is great for fxnal, closed-chain UE/LE strengthening, & incorporates trunk/pelvic stabilizers?
Quadruped
consider assist/facilitation & equipment to allow even tetraplegics to achieve this position or standing
T/F: Prone is primarily used to target LE strengthening.
False
UE strengthening
What positioning is great for core and UE closed-chain exercise, and can incorporate dual-task balance activities?
sitting.
In this position, be cautious of inappropriate loading through knee/hip joints by ensuring the pelvis/hips are neutral.
high-kneeling
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.
1) 20 mins
2) 3 sets
3) 2x/week
For cardiometabolic health (HR, BP, etc), __ mins __/week of mod-vigorous aerobics is recommended.
30 mins, 3x/week
What MSK, resp., CV, & ANS changes seen with SCI pts should be considered in their POC?
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)
Precautions/CIs to Exercise testing/training in SCI includes….
ANS dysreflexia, skin esp. on WB surfaces, hypotension, UTI, unstable fx, unctrlled temp environments, ROM limitations
What are prevention strategies for contractures we do with every SCI patient?
1 daily ROM, proper positioning, WBing
2 adequate spasticity management
3 splinting (esp. when pt is at rest)
3 Interventions to manage contractures and their specific indications
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
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 __.
1 elbow flexors
2 RCMs and other scapular muscles
3 Hip flexors, hamstrings, and DFers
Adaptive shortening of certain muscles is recommended. Pts with __ or __ SCIs must avoid overstretching their ___ to maintain tenodesis capabilities.
1 C6 or C7
2 finger flexors
Combination of lengthened __ and adaptive shortening of ___ can provide stability and balance in short/long sitting positions.
1 hamstrings
2 back extensors
maintain 110-120 degr. SLR without overstretching back muscles
Achieve balance by ___. Maintain balance by __. Then go into reacting to LOB by ___.
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
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?
Easy ———-> Hard
Posterior, Lateral, Anterior
Mid-Low Level Tetraplegics (C-spine SCIs)
Triceps are important for closed-chain BUE support in sitting. If impaired, what muscles can function to achieve closed-chain BUE support?
Anterior deltoids and shld ERs
In order to protect tenodesis grasp, ______ is needed whenever WBing through UEs during sitting balance tasks.
C6/7 to maintain finger flexion
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?
Small: head/neck, upper shld, upper trunk muscles
Large: difficult to be successful.
What is the patients “sweet spot” concerning balance?
When their COM lands perfectly over their BOS and they can briefly hold balance w/out UE support DESPITE LIMITED TRUNK STRENGTH
For paraplegics, dynamic balance considerations include __, __, & __, with a focus on quickening ___ strategies.
1 dynamic balance, trunk ctrl, UE/core strength
2 reactionary
Higher paraplegics may benefit from ___/___ rxnary techniques for smaller LOBs.
head/neck
4 Key positions to promote strength, balance, and functional independence.
1 long sitting
2 sitting
3 W sitting
4 prone, prop on elbows
