Spinal Cord Injury II: Function Expectations and Respiration

Question 1

Look at chart on 91-92.

Answer 1

Do it a lot. I’ll ask some questions here but I may not cover everything that you need to know.

Question 2

At what level does one usually become independent with power w/c?

Answer 2

C5

Question 3

At what level does one be able to drive at all?

Answer 3

C5

Question 4

At what level does one become indep. with skin inspection?

Answer 4

C6

Question 5

At what level does one expect to sometimes be able to stand in parallel bars?

Answer 5

C7

Question 6

At what level does one expect to have FULL UE function?

Answer 6

T2

Question 7

At what level does one gain finger flexion?

Answer 7

C8

Question 8

At what level does one gain Serratus Ant.?

Answer 8

C6

Question 9

At what level does one become independent driving?

Answer 9

C7

Question 10

At what minimal level does one expect to become fully indep. with w/c, ADL’s, mobility AND pressure relief?

Answer 10

C7

Question 11

At what level does one expect to gain pelvis control?

Answer 11

L1-2

Question 12

At what level does one expect to gain functional ambulation with KAFO’s?

Answer 12

L1-2

Question 13

What is the most common cause of death in patients with SCI?

Answer 13

Respiratory complications (particularly pneumonia because of lack of coughing resulting in infection).

Question 14

What are the 3 steps of inhalation in normal breathing?

Answer 14

1. Diaphragm pulls caudally (cephalocaudal expansion)
2. Upper ribs elevated by intercostals and scalenes, SCM, etc. (AP expansion)
3. Descent of diaphragm exerts pressure on abdominal viscera, causing protrusion, then continued contraction elevates lower ribs. (lateral expansion)

Question 15

How do the abdominal muscles and intercostals contribute to forced exhalation?

Answer 15

Abdominals are 1° muscles. They push abdominal viscera up into diaphragm forcing air out of lungs, along with flexing trunk which aids in upward movement of viscera and diaphragm and stabilizing 12th ribs allowing intercostals to function. Intercostals draw ribs together, depressing them on stabilized 12th ribs, decreasing chest cavity volume.

Question 16

1. Coughing requires coordination of what 2 things?

2. What are the 4 stages of coughing?

Answer 16

1. glottis and muscles of respiration
2. a. Max inspiration b. glottis closure c. contraction of forced experation muscles d. glottis opening with continued forceful experation.

Question 17

At what level does one usually gain indep. breathing but needs airway assist for clearance?

Answer 17

C4

Question 18

At what level does one usually gain ability for indep. airway clearance (with teaching)?

Answer 18

T1

Question 19

Why is breathing easier in supine then sitting with patients with absense of abdominal musculature?

Answer 19

1. Upright the abdominal viscera are allowed to protrude 2° to abdominal paralysis, causing diaphragm to descend and flatten, placing it in mechanical disadvantage
2. In supine, gravity pushes viscera & diaphragm back.

Question 20

What are the 3 main reasons for respiration return in SCI patients?

Answer 20

1. Decrease in diaschisis = increased tone in respiratory muscles.
2. motor return
3. increased stiffness of the joints of the rib cage.

Question 21

Why do patients not requiring ventilation deteriorate in the first few days? in the long term?

Answer 21

First few days: ascending lesions, accumulation of secretions, fatigued muscles of ventilation.
Long term: Aging, inactivity, obesity, reduced compliance of lungs/chest wall.

Question 22

Describe IPPV. How is it typically delivered?

Answer 22

Intermittent Positive Pressure Ventilator delivers set volume or set pressure during inspiration, passive exhalation. Delivered by tracheostomy or ideally oral, nasal, or oral-nasal.

Question 23

How can one teach diaphragmatic breathing patterns?

Answer 23

Supine with light/large object on abdomen. Cue to make them raise it with inspiration.

Question 24

How can one teach upper chest breathing?

Answer 24

Place hands on upper chest while asking patient to “push against my hands as you take a deep breath”.

Question 25

What are ways to increase strength and endurace of respiratory muscles?

Answer 25

Diaphragmatic breathing against resistance (manual or weights (cuff weights) but MUST NOT demonstrate decreased elevation of the epigastric area) and inspiratory muscle trainers.

Question 26

How does PT teach patient to develop eccentric control of exhalation? Why is this important

Answer 26

Max inhale then say “ah” for as long as possible before next breath. This is important for normal speech (10-12 s is good goal for normal speech patterns).

Question 27

Can PT’s treat glossopharyngeal breathing?

Answer 27

no, unless you have special training to help high-level injured patients with this.

Question 28

1. At what level and below do most patients eventually wean off a ventilator?
2. What are some factors that complicate weaning?

Answer 28

1. C3 and below.

2. respiratory illness, preexisting conditions, older age, VC <1000, smoking hx.

Question 29

What are the 3 most commonly seen results of accumulation of secretions?

Answer 29

1. Atelectasis (collapse of lung by bronchus filled with fluid causing distal portion to collapse)
2. Pneumonia
3. Respiratory insufficiency

Question 30

What are some techniques for clearing secretions (more on page 98-99 of notes)?

Answer 30

1. Postural drainage with percussion and vibration of chest wall.
2. IPPB
3. Tracheal and bronchial suctioning
4. Manually assisted coughing
5. Mechanical insufflation-exsufflation
6. Self-cough (self Heimlich)
7. Frequent position changes
8. Strengthening (of respiratory muscles)
9. Patient education on complications, signs/symptoms, techniques, equipment use, etc.