Test 1: paraplegia Flashcards
what is paraplegia
level of injury is low enough to only affect trunk and LE
no longer UE involved
when to be worried about autonomic dysreflexia
if above T6
can still happen below but much less common
Characteristics of a motor complete injury
above T12 level
no function of LEs or trunk below injury level
may have hyperreflexia, clonus, or tone
ASIA A = motor AND sensory complete
ASIA B = Motor complete sensory incomplete
bowel, bladder, sex = reflexive
chart review for motor complete injury
precautions `
secondary injuries
surgeries
imaging
labs
vitals
which providers are involved
subjective hx for people with motor complete
what is home set up?
support in life?
occupation?
medical equipment already owned?
important note related to skin for motor complete injuries
observe for pressure injury in common areas
observe environment for risks/factors that may cause skin breakdown
GI/GU - what would you want to know during acute care exam `
observe for catheter
ask about bowel/bladder program, sensation, and control
what motor and sensory components are you looking at with an acute care exam of a motor complete injury
complete ASIA
check ROM, mm length, jt restrictions
check reflexes
cardio pulm components of exam for motor complete injury in acute care exam
observe for signs of DVT/PE
check vitals
acute care interventions with motor complete injury
PROM to maintain mm length and prevent contractures
positioning:
-prevent pressure injury
-should be on air mattress
-HOB shouldnt be over 30 deg to prevent sacral shear
-tilt in space WC for weight shift
-weight shift every 15 min for 2 min when in chair for first time
initiate functional mobility training (i.e. short/long sit, scoot, head/hip relation, bed mobility)
what to educate on for pts with motor complete injury in acute care (right after injury)
what SCI is
life changes
functional mobility
what mm are working
bowel/bladder changes/catheter
what their ASIA lvl means
what therapy journey will look like
home mods
BP control
prognosis
risks for PE/DVT
skin/pressure injury edu
secondary injury risks/prevention
describe upright trials used for motor complete injuries in acute care
get pt in tilt in space WC; mechanical lift can be used
start at 15 min and progress by 15 min each time until pt can sit for an hour with no adverse effects
check skin pre and post
check for incontinence
check vitals every 15 min especially if concerned about AD
tilt every 15 min for 2 min while being upright in chair
POC/discharge planning for motor complete injury following acute care
depends on:
severity
other comorbidities
previous level of mobility
medical lvl
insurance
bed availability
most pts benefit from acute rehab for 4-12 wks
if no tolerance then subacute rehab
if they have a qualifying need (i.e. vent) they can go to LTACH and the AR once stable
important things to know when pt arrives at acute rehab from acute care or LTACH
any notes from acute care
what did they already work on while in hospital
confirm ASIA findings
observe current mobility level
what would fall under the umbrella of functional mobility training within acute rehab
balance - short/long sit
bed mobility - prop on elbows, C to sit, roll
scooting - all directions
transfers - slide board, squat pivot (car, WC, toilet)
WC fitting/prescription - manual, power
WC mobility - propulsion, weight shifts, wheelies, curbs, ramps, etc
what preventative interventions are you focusing on in acute rehab with pts with motor complete injury
skin care preventions (i.e. weight shifts)
advocacy
PROM to prevent contractures
WBing to prevent osteo (i.e. in stand frame)
secondary overuse injuries to shoulder (strengthening and body mechanics)
UTI/incontinence - become consistent with bowel/bladder management
POC/discharge from acute rehab
depends on mobility
hope is to go home with out patient PT
may need to go to long term care or LTACH if they have flap sx or other complications
important things to note in out patient exam for ots with motor complete injury
any relevant notes from acute care
functional mobility level; how are they doing things at home, what is the set up, social support, etc
observe chair for risks to skin breakdown
screen for overuse injuries
along with all other normal exam components/questions
interventions specific to outpatient PT with motor complete injuries
edu as needed
mechanics for any functional mobility problems
overall strengthening, efficiency with mobility, and aerobic health training
WC changes as needed
return to sport or work training
when to d/c pt with motor complete injury from outpatient
d/c when they are managing independently and/or have met their functional goal
what is a motor incomplete injury
like complete, but you may still have some mm groups below level of injury that are starting to return
may be able to walk, use LEs to assist functional tasks, or have better bowel/bladder control
ASIA C and D fall into this category
what is the difference in what you might examine in a acute care exam of a pt with a motor incomplete injury compared to an acute care exam of a pt with a motor complete injury
want to check functional mobility in addition to what you would look at with a motor complete exam
acute care intervention for motor incomplete pts
depends on ASIA and how many mm groups are functioning against gravity below level of injury
could look like ASIA A or B at first or they could have enough intact that they start balancing, transferring, walking, and using a WC sooner
d/c typical for motor incomplete injury following acute care
hopefully to acute rehab but depends
could be LTACH if medical need
could be sub acute rehab based on tolerance
could be home if ASIA D
