spinal cord injury - rehab, management of impairments + exercise prescription Flashcards
what is a major cause of morbidity and mortality in SCI?
-respiratory complications such as hypoventilation, atelectasis, secretion retention and pneumonia
why can respiratory complications happen with spinal cord patients?
-resp muscle fatigue or paralysis
-prolonged bed rest
-pain + sedation
-aspiration
-resp injuries
what are the levels of intervention for the diaphragm muscle?
C3-C5
what are examples of respiratory treatment options for SCI patients?
-exercise training of upper and lower limbs
-inspiratory muscle training
-pharmacological interventions
-assistive devices eg cough asst
-secretion removal eg suctioning
what effect does exercise for upper and lower limbs for resp management?
-might improve resting and exercising respiratory function can be improved
-functional electrical stimulated induced cycling ergometry increases peak 02 uptake, CO2 production and pulmonary ventilation
-training intensity must be relatively high 70-80% max HR and performed 3x per week for at least 6 weeks
what effect can IMT have on respiratory function for SCI?
-improves respiratory muscle strength and endurance in people with SCI
-might decrease SOB and RTI
what are examples of assisted devices for resp management of SCI patients?
-mechanical ventilation
-NIV
-intermittent positive pressure breathing
-phrenic nerve pacing for high cervical SCI injuries
-abdominal binder - like corsets, can help with BP and can help with diaphragm sometimes - but long term effects have not been established
what effect does strength training in the non paralysed muscles of an SCI patient have?
-improves strength, function and QOL in people with SCI
-same principle as any healthy muscles - 60-80% 1RM, 8-12 reps 2-3 sets
describe the evidence for strength training off partially paralysed muscles
-evidence is less certain
-may improve strength with recovery over time
-doesn’t usually increase spasticity in partially paralysed muscles
how are contractures managed in SCI patients?
-stretching and passive movements are standard practice
-2-10 mins of passive mvts and stretch to affected joint
-standing helps with contractures but takes time
in what % of SCI patients is spasticity present
80%
can both help and interfere with ADLs
in what instances do we need to allow tightness to happen?
-allowing the finger flexors to tighten to help with grip for C6/C7 SCI
what are examples of reasons for mechanical or nociceptive pain after SCI?
-back or neck pain associated with the injury
-persistent back or neck pain
-shoulder pain in patient with tetraplegia
-upper and lower limb MSK pain due to functional demands
what are the training guidelines for CVS fitness for SCI patients?
-20 minutes of moderate to vigorous intensity aerobic exercise 2 times per week
-3 sets of strength training for each major functioning muscle group 2 times per week
what are examples of options for CVS training?
-body weight supported treadmill training
-aerobic arm cycling of moderate intensity 20-60 mins per day at least 3 days per week
-FES training may help with muscle endurance, exercise tolerance etc
if you have total paralysis of LL, what aids can be used?
-AFO
-dictus splint
-FES
-hip- knee - ankle - foot- orthosis
-knee-ankle-foot-orthosis
what are examples of some outcome measures for walking?
-6MWT
-10 metre walk test
-Berg balance test
-TUG
-walking index for spinal cord injury
-SCI functional ambulation inventory
what outcome measures can be used for hand function for SCI patients?
-handheld dynamometry
-9 hole peg test
-box and blocks
-action research arm test
according to the cervical level, how is hand function managed?
what are some treatment options for hand function?
-task specific training
-splinting
-orthoses
-taping
-strengthening
-mobilisation techniques
what are examples of long term problems in SCI patients ?
-pressure sores
-kyphosis
-scoliosis
-restricted neck flexion
-shoulder pain
-osteoporosis
