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Neurologic conditions > Spinal cord injury SCI❗️❗️❗️ > Flashcards

Spinal cord injury SCI❗️❗️❗️ Flashcards

1
Q

L1-L5; S1-S5 SCI deficits

A

L1-L5: partial paralysis in hip and leg

S1-S5: some fx loss of hip and leg; walk with assistance

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2
Q

Information collected during Ax

A
  1. OT profile
  2. Sensori-motor evaluation
  3. Psychological issues
  4. ADL IADL
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3
Q

What and how to assess OT profile?

A
  • Cause of injury
  • Premorbid
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4
Q

What and how to assess sensori-motor function?

A
  1. identify medical precautions, including how much movement and load the client is allowed
  2. upper-extremity ROM, strength, muscle tone, sensation, and trunk balance
  3. hand and wrist function (dynamometer for grip strength and pinch gauge for pinch strength)
  4. light touch, pain, and proprioception
  • ASIA (sensory and motor level)
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5
Q

What and how to assess psychological status?

A

Interview, observation

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6
Q

What and how to assess ADL IADL?

A
  • The Spinal Cord Independence Measure III (measures of ADL performance, sphincter control, respiration, and mobility)
  • Canadian Occupational Performance Measure (changes in clients’ self-perception of their occupational performance over time but is not specific to SCI)
  • Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF–PAI)
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7
Q

Occupational performance issues

A
  1. pressure sores or decubitus ulcers
  2. limited ROM
  3. Orthostatic hypotension
  4. Spasticity
  5. Bowel and bladder function is affected
  6. Decreased ADL independence
  7. Community re-integration
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8
Q

Tx goal and Tx plan (pressure sores or decubitus ulcers)

A

Sensory loss increases the risk of skin breakdown

skin examination and techniques to provide pressure relief

􏰀 Regular bed turning regime
􏰀 weight-shift routine
􏰀 Proper Body Positioning (side lying: wedge pillow on the back + second pillow between legs)
􏰀 Assistive equipment
􏰀 Patient’s / Care’s Education

e.g. for a client using a wheelchair and developing upright sitting tolerance, pressure ulcer awareness and reduction should begin, and the client should be trained to shift weight every 30–60 minutes

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9
Q

Tx goal and Tx plan (limited ROM)

A

Maintaining normal upper-extremity ROM, which can be done through ROM exercises and positioning, including splinting

Maintain affected joint integrity

Maintain intact limb mobilization

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10
Q

Tx goal and Tx plan (Orthostatic hypotension)

A

positioning the client in supine and elevating the feet above the heart

caution when transferring a client from supine to sitting to avoid a rapid drop in blood pressure

move slowly to allow time for the blood pressure

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11
Q

Tx goal and Tx plan (Spasticity)

A

bed and wheelchair positioning to prevent contractures

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12
Q

Tx goal and Tx plan (Bowel and bladder function is affected)

A

Establishing new routines and habits for bowel and bladder elimination

support new skill and habit acquisition for transfers, clothing management, safety with task performance, and bowel elimination and catheter care

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13
Q

Tx goal and Tx plan (Decreased ADL independence)

A
  • ADL Training
  • compensatory adaptive equipment
    e.g. Grasping and holding objects require wrist stabilization and use of an assistive device such as a
    universal cuff or C-clamp
    feeding: non-slip mat
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14
Q

Tx goal and Tx plan (Community re-integration)

A

􏰀 Home Visit / Environmental Assessment
􏰀Rehousing (MSW)
􏰀 Recommendations on Home modification
􏰀 Assistive device prescription
􏰀 Work Rehabilitation
􏰀 School / Worksite Visit
􏰀 Workplace Modification
􏰀 Recreation pursuit

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15
Q

Expected outcomes of C5 SCI
1. Which area still have sensation and muscle group

  1. Independent/some assist/total assist/equipment
    - eating
    - bowel care, bladder care
    - dressing
    - grooming
    - bathing
    - pressure relief on w/c
    - pressure relief on bed
    - bed mobility
    - transfer
    - wheelchair
  2. Availability of personal care assistance?
A
  1. reserve deltoid, biceps, brachialis –> can move head and neck, raise arm, bend elbow
    • eating (I/S; Long opponens splint; Adaptive devices)
  • bowel care, bladder care (T - commode chair; transfer tub bench)
  • dressing (S-UG; T-LG)
  • grooming (S/T)
  • bathing (T - commode chair; transfer tub bench)
  • pressure relief on w/c (I - power recline/tilt-in; pressure relief cushion, postural support device)
  • pressure relief on bed (S - pressure relief mattress)
  • bed mobility (S)
  • transfer (T - transfer board, power lift)
  • power w/c (recline/tilt in with arm drive control)
  • manual w/c (S/T with modified hand rim)
  1. Availability of personal care assistance (16 hours daily; personal care and home- making)
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16
Q

Expected outcomes of C6 SCI
1. Which area still have sensation and muscle group

  1. Independent/some assist/total assist/equipment
    - eating
    - bowel care, bladder care
    - dressing
    - grooming
    - bathing
    - pressure relief on w/c
    - pressure relief on bed
    - bed mobility
    - transfer
    - wheelchair
  2. Availability of personal care assistance?
A
  1. reserve supinator, extensor carpi radialis –> can move head and neck, raise arm, bend elbow, extend wrist, radial deviation, turn palms up, tenodesis
    • eating (I/S; Universal cuff, tenodesis splint, adapted utensils and plate guard)
  • bowel care, bladder care (S/T - commode chair; transfer tub bench)
  • dressing (I-UG; I/S-LG)
  • grooming (I/S - U-cuff, adapted handles)
  • bathing (I - UL; I/S - transfer tub bench; handheld shower)
  • pressure relief on w/c (I - power recline/tilt-in; pressure relief cushion, postural support device)
  • pressure relief on bed (I/S - pressure relief mattress)
  • bed mobility (S - side rails)
  • transfer (S - transfer board, power lift)
  • power w/c (recline/tilt in)
  • manual w/c (S/T with modified hand rim)
  1. Availability of personal care assistance (10 hours daily; personal care and home- making)
17
Q

Expected outcomes of C7-8 SCI
1. Which area still have sensation and muscle group

  1. Independent/some assist/total assist/equipment
    - eating
    - bowel care, bladder care
    - dressing
    - grooming
    - bathing
    - pressure relief on w/c
    - pressure relief on bed
    - bed mobility
    - transfer
    - wheelchair
  2. Availability of personal care assistance?
A
  1. limited use of fingers
    reserve tripceps (extend elbow), pronators (turn palms down), extensor carpi ulnaris (extend wirst), flexor carpi radialis (flex wrist), extensor communis (partially extend fingers), ALL pollicis (thumb), interrosi (separate fingers)
    • eating (I - adapted equipment)
  • bowel care, bladder care (S/T - commode chair; transfer tub bench)
  • dressing (I-UG; I/S-LG)
  • grooming (I)
  • bathing (I - UL; I/S - transfer tub bench; handheld shower)
  • pressure relief on w/c (I - power recline/tilt-in; pressure relief cushion, postural support device)
  • pressure relief on bed (I - pressure relief mattress)
  • bed mobility (I/S)
  • transfer (I/S - transfer board)
  • manual w/c (I/S)
  1. Availability of personal care assistance (8 hours daily; personal care and home- making)
18
Q

Expected outcomes of T1-9 SCI
1. Which area still have sensation and muscle group

  1. Independent/some assist/total assist/equipment
    - eating
    - bowel care, bladder care
    - dressing
    - grooming
    - bathing
    - pressure relief on w/c
    - pressure relief on bed
    - bed mobility
    - transfer
    - wheelchair
  2. Availability of personal care assistance?
A
  1. LL paralysis
    • eating (I)
  • bowel care, bladder care (I - elevated toilet seat)
  • dressing (I)
  • grooming (I)
  • bathing (I - transfer tub bench; handheld shower)
  • pressure relief on w/c (I - pressure relief cushion, postural support device)
  • pressure relief on bed (I)
  • bed mobility (I)
  • transfer (I/S - transfer board, leg lifter)
  • manual w/c (I)
  1. Availability of personal care assistance (3 hours daily; home- making)
19
Q

What does OT do for SCI patients?

A
  • Address goals related activities of daily living such as self-care, work, and leisure
  • Assess individual needs for equipment and assistive devices
  • Recommend home modifications and adaptive equipment
  • Assist and navigate the system to obtain funding for equipment and services and help ensure that all of the client’s needs are met
  • Provide psychosocial support to help the client adapt to their new abilities and lifestyle
  • Educate client regarding self-care and exercise to help minimize secondary complications
  • Teach family members and caregivers to help minimize their risk of injury, manage caregiver stress, and to find balance in life

Neurologic conditions (5 decks)

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