Spinal Cord Injury Flashcards
complications with SC injury
•autonomic dysreflexia cardiovascular impairment •including postural hypotension •impaired temp control •pulmonary impairment • bowel and bladder dysfunction
most common PI areas with SC patients
- ischium
- sacrum
- trochanter
- bony areas of feet
- heels
PI and SCI
- Decreased mobility, activity, sensation, spasticity B+B incontinence, nutritional deficiencies contribute to pressure injuries
- Patients should be checked with the Braden scale and palpation for increased skin temp due to hyperemia should be checked as well as areas under orthotic contact points. (p. 871)
- In bed patients should be re-positioned every 2 hours
- Patients should perform a pressure relief maneuver every 15 minutes in the wheelchair by doing a push up, leaning sideways or leaning forward
- All pressure relief maneuvers should be held for at least 2 minutes to be effective (p. 874-875)
Pressure relief maneuvers
- If using a forward lean pressure relief weight shift, the lean should be greater than 45 degrees
- Patients who cannot perform pressure relief may be assisted or wheelchair tilted back- if tilted back it should be at least 65 degrees to remove pressure from ischial tuberosities
Heterotopic ossification
- bone growth in soft tissues usually near the joints (esp. hips and knees) below the level of the lesion
- Factors associated with heterotopic ossification include: complete injury, trauma, severe spasticity, UTI, pressure injuries, and vigorous PROM that causes trauma.
- Early symptoms include swelling , joint and muscle pain, decreased ROM, erythema, and local warmth near the joint.
- Management includes: pharmacologic such as bisphosphonates and NSAIDS, PT- maintaining ROM, pulsed low- intensity electromagnetic field and surgical excision if there is resultant extreme limitations of activities.
SCI pt bone mineral and fx risk
- SCI patients experience rapid bone mineral loss in the first 4-6 months after injury and continues to decrease up to 3 years post injury
- Risk factors for fracture include: female, lower BMI, complete injury, paraplegia vs. tetraplegia, longer time since injury.
- Falls or a forced maneuver during transfer, ADL, such as dressing and stretching are common activities that precipitate fracture.
- Interventions: pharmacological- bisphosphonates, electrical stimulation, weight bearing activities with standing frame or orthotics and assistive devices.
Contracture prevention
•A consistent program of ROM exercise, positioning and splinting are important to maintain joint motion and prevent contracture (p. 867-868)
Contracture risk with SCI patients
Factors that place SCI patients at high risk for developing contractures: lack of active muscle function, eliminating the normal reciprocal stretching of a muscle group and surrounding structures, spasticity, positioning in a wheelchair for prolonged periods of time and abnormal muscle tone.
Early mobility interventions post SCI
- gradual return to vertical
- s/s of OH: dizziness, nausea, ringing in the ears, loss of vision or conciousness
- Use of abdominal binder and elastic stockings
- Patient should be brought to supine position or trunk reclined with LE’s elevated if any s/s of OH is experienced
- ROM and strengthening
Avoid stress on unstable site in the lumbar region
To avoid stress on an unstable site in the lumbar region, SLR may be restricted to no more than 60 degrees and hip flexion (during combined hip and knee flexion) limited to no greater than 90 degrees
With an unstable cervical spine motion may be limited
With an unstable cervical spine, motion of the head and neck may be contraindicated and shoulder flexion and abduction limited to no more than 90 degrees.
HS functional length
Some muscles require such as hamstrings eventually require a fully lengthened range for an SLR of 100 degrees for functional activities such as long sitting and LE dressing; but the hamstrings should not be overstretched as they provide pelvic stabilization in sitting -> selective stretching
Head-hips relationship
moving the head in one direction in order to cause the movement of hip sin the opposite direction
principles of compensatory strategies in mobility
- head-hips relationship
- momentum
- muscle substitution
- task modification
- working in and out of the task
SCI level requiring power w/c
SCI with C4 lesions and above require power w/c
SCI level that may elect to use a power w/c
SCI with C5 lesion may elect to use a power W/C esp. for community mobility
level of SCI able to propel a manual w/c
A SCI with a C5 or C6 level injury may be able to independently propel a manual W/C but may not have the strength or endurance for community W/C mobility.
SCI level can independently propel a manual w/c
A SCI with intact triceps (C7) can independently propel a manual wheelchair
two basic frames for manual w/c
1) Folding frame: for those who plan to transfer to a car because they can be folded for storage without having to remove as many parts and provide a smoother ride on uneven surfaces. Disadvantages= heavier and more movable parts causing it to be less energy efficient.
2) Rigid frame: lighter, more energy efficient, may have an adjustable seat to back angle and is more durable than a folding frame.
Disadvantages= More difficult to store in a car- both wheels must be removed.
Wheel locks
High mounted wheel locks are easier to access but can be an obstacle to transfers. Low mounted wheel locks are more difficult to access but are not in the way of transfers
Wheelies and GB
when patients are practicing wheelies, a GB should be looped through the frame of the w/c
other w/c skills SCI patients should learn
Other W/C skills SCI patients should learn include: falling from a W/C, picking up objects off the floor, opening and closing doors, negotiating obstacles, putting wheel locks on and off, removing and returning leg rests, folding the W/C, removing the cushion, moving armrests, and removing and putting the wheels back on
SCI and rolling
- Rolling (pgs 890-891) is a prerequisite skill for other bed mobility tasks- the patient learns to use the head, neck UE’S as well as momentum to move the trunk and/or LE’s
- It is usually easiest to begin rolling from the supine position
- If asymmetric involvement is present rolling should be initiated to the weaker side
- Flexion of the head and neck with rotation assists movement from supine to prone
- Extension of the head and neck with rotation is used to assist movement from prone to supine
- Crossing the ankles facilitates rolling- therapist should cross patients ankles so that the upper limb is in the direction of the roll, i.e. right ankle crossed over left to roll to the left
transfers and SCI
- The head-hips relationship is important . Moving the head and upper trunk in one direction cause the lower trunk and buttocks to move in the opposite direction
- Hand position is important. The hands should be positioned forward of the hips to form a tripod with the buttocks.
- Greater force is generated in the trailing UE (furthest from the surface transferring to.
- If one UE is weaker or more painful, it should be the lead UE.
- The lead UE should be farther from the trunk and buttocks and the trailing UE closer to the trunk/ buttocks
- Emphasis should be placed on lifting and shifting laterally instead of sliding/ scooting to the side to avoid shearing
SCI and pressure
- patients should be checked with the Braden scale and palpation for increased skin temp due to hyperemia should be checked as well as areas under orthotic contact
- in bed patients should be re-positioned every 2 hours
- patients should perform a pressure relief maneuver every 15 minutes in the w/c by doing a push up, leaning sideways, or leaning forwards.
- if using a forward lean then the lean should be >45°
- patients who cannot perform pressure relief may be assisted or w/c tilted back- if tilted back angle should be at least 65° or more to decrease pressure on ischial tuberosities
- all pressure relief maneuvers should be held for at least 2 minutes to be effective
- also check under Halos and orthotics
