Week 5 Flashcards

1
Q

What is the leading cause of death after a SCI?

A
  • Pneumonia

* Other respiratory conditions

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2
Q

What are the characteristics of the respiratory system function?

A
  • Gas exchange via the lungs
  • Ventilatory pump
  • Ventilation versus respiration
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3
Q

What happens to the chest during expiration and inspiration?

A

Expands during inspiration and relax at expiration

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4
Q

What is ventilation?

A

The moving of air between the lungs and the atmosphere

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5
Q

What is respiration?

A

The gas exchange that occurs at the level of the alveoli in the pulmonary circulation

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6
Q

We must ____ to respirate

A

We must ventilate to respirate

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7
Q

What does most people with an SCI have trouble with?

A

Ventilation, unless they have a pneumonia or something of that nature

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8
Q

What are the muscles of inhlation?

A
  • Diaphragm
  • Intercostals, Scalene, Accessory MM
  • Abdominals
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9
Q

What are the muscles of exhalation?

A
  • Abdominals (forceful exhalation)
  • Intercostals
  • Diaphragm (relaxes and causes the ribcage to relax)
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10
Q

What happens when a person has a SCI in regards to breathing?

A

Weakness or paralysis of muscles responsible for:
• Inspiration
• Expiration
• Cough

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11
Q

What would a weakness of the inspiration muscles cause?

A

There will be a marked decrease in all lung volumes and capacities, except for residual volumes.

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12
Q

What does the weakness of the inspiration muscles result in?

A
  • Hypoventilation
  • Atelectasis
  • Secretion and retention
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13
Q

What is the PT evaluation of respiratory function?

A
  • Respiratory muscle strength
  • Breathing pattern
  • Cough
  • Chest mobility
  • Postural Alignment
  • Breath support for speech
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14
Q

What is tidal volume?

A

Volume inspired or expired in quiet breath

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15
Q

What is vital capacity?

A

Volume expired after max inspiration

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16
Q

What is inspiratory capacity?

A

Volume inspired after norm expiration

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17
Q

What is total lung capacity?

A

Total volume contained in lungs at max inspiration

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18
Q

What is residual volume?

A

Volume remaining in lungs after max expiration

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19
Q

What impact does a level C1,2 injury have on respiration?

A

No diaphragm, minimal SCM, a little bit of trap and erector spinae action. Not compatible with survival, not going to be able to clear airway, they’re going to be ventilator dependent

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20
Q

What impact does a level C3 injury have on respiration?

A

They have partial diaphragm, most of their SCM, some levator, scalenes, and rhomboids, most require long term ventilation, and unable to clear airway

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21
Q

What impact does a level C4 injury have on respiration?

A

Almost full diaphragm, no abs or intercostals, sitting compromises inhalation, require assist for airway clearance, vital capacity will be less than a 3rd

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22
Q

What impact does a level C5-8 injury have on respiration?

A

Full diaphragm, near full accessories, some cough, vital capacity is between a 3rd and half of predicted normal

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23
Q

What impact does a level T1-5 injury have on respiration?

A

Some intercostals preserved, no abs, no forceful cough

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24
Q

What impact does a level T6-12 injury have on respiration?

A

Some or most abs, more effective cough

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25
Q

What impact does a level below T12 injury have on respiration?

A

No significant deficits, but respiration is compromise is still possible

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26
Q

What are the types of ways patients can get mechanical ventilation?

A
  • Positive-Pressure Ventilators (most common)
  • Intermittent abdominal pressure ventilators
  • Negative-pressure body ventilators
  • Biphasic cuirass ventilators
  • Phrenic nerve stimulators
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27
Q

What are the other methods of ventilation patients can get?

A
  • Phrenic Nerve Stimulation
  • Direct diaphragmatic stimulation
  • Non-invasive negative ventilation
  • Glossopharyngeal breathing
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28
Q

What are the causes of respiratory dysfunction?

A
  • Muscle weakness/paralysis
  • Pulmonary Compliance
  • Rib Cage Compliance
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29
Q

What are the characters of pulmonary compliance?

A

Lung stiffness; reduced in people with tetraplegia

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30
Q

What are the characters of rib cage compliance?

A

Stiffness of ribcage and its resistance to movement; also

decreased in people of tetraplegia

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31
Q

How is the positive pressure seen in positive pressure ventilators achieved?

A

By applying a positive pressure higher than the atmospheric pressure at the airway opening, which produces a pressure gradient that generate an inspiratory flow, which in turn results in the delivery of a breath

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32
Q

How does a negative pressure body ventilator work?

A

By producing negative pressure at the chest and abdomen, which then moves across the chest and the diaphragm and causes air to move into the lungs in normal fashion, when the negative pressure stops being applied, the chest return to the atmospheric pressure and the inspired air is then exhaled

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33
Q

What are the disadvantages of the negative pressure body ventilator, in comparison to positive pressure ventilator?

A

Negative pressure machines are a lot less portable, more difficult to apply, and is infrequently used or contraindicated in soma patients

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34
Q

What are some complications of an acute respiratory problem?

A
  • Prolonged bedrest
  • Pain and sedation
  • Aspiration
  • Paralytic ileus: GI system will temporarily cease to function
  • Respiratory muscle fatigue
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35
Q

What is the PT intervention for patients with respiratory problems?

A
• Positioning
• Assisted cough
   - Manual, mechanical, or self
• Breathing pattern
• Strength and endurance
• Necessary chest wall mobility
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36
Q

How does the lack of abdominals affect expiratory flow?

A

Weakness impairs ability to forcibly expire and generate high expiratory flow rates

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37
Q

What is needed to generate forced expiration?

A

High intrathoracic positive pressure

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38
Q

What is the quality of a functional cough?

A

Loud, forceful; 2 or more/exhalation

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39
Q

What is the quality of a weak functional cough?

A

Soft, less forceful; 1/exhalation

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40
Q

What is the quality of a nonfunctional cough?

A

Sigh or throat clearing; no true cough or no explosive force

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41
Q

What are some ways to augment/assist a cough?

A
  • Mechanical inflation of lungs prior to cough (via noninvasive positive airway pressure support)
  • Mechanical insufflation-exsufflation
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42
Q

What are other ways of managing secretion in the lungs, if there is no coughing?

A
  • Positioning: sidelying on both sides
  • Percussion or vibration
  • Suctioning
  • Non-invasive airway pressure support
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43
Q

What is the biggest cause of death for survivors of > 30 years and those older than 60 after an SCI?

A

CVD

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44
Q

What does disruption of the sympathetic nervous system result in?

A

Increased hypotension

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45
Q

What does decreased arterial pressures result in?

A

Diminished cardiac ventricular chamber size and function (tetra)

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46
Q

What is the cardiovascular presentation of a paraplegic?

A

• Normal to slightly increased BP, left ventricular mass,
and cardiac output nd inc
• Lower stroke volume secondary to decreased venous return

They have increased CO and low SV, because they have increased HR

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47
Q

What is circulaory hypokinesis as seen in patients with a SCI?

A

Significantly lower blood volume and velocity in LE
arterial circulation due to lost autonomic control of blood flow and decreased control by vascular endothelium and results in an increased risk of thrombosis

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48
Q

What are the 3 strikes that patients with a SCI have in regard to their cardiovascular health?

A
  • Reliance on arm exercise
  • Lower limb paralysis
  • Loss of supraspinal sympathetic nervous control
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49
Q

What are the determinance of VO2 max?

A
  • Cardiac Output (central)

* Arterio-venous oxygen difference (periphery)

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50
Q

What are the exercise prescriptions for a patient with a SCI and a cardiovascular problem?

A
• Frequency
• Intensity: 50-60% max
• Time: 20 mins
• Type: Upper extremity most of the time
- Use HR or RPE
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51
Q

What are some precautions for a patient with a SCI and a cardiovascular problem?

A

Autonomic dysreflexia, fracture due to osteoporosis, skin breakdown due to lack of sensation

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52
Q

What are some of the cardiovascular response to a neurological dysfunction?

A

• Severe deconditioning
• VO2 Peak significantly decreased in all neuro dx
• NO RESERVE
• Most with neuro dx don’t have the VO2 peak to meet
demands for daily living of older adult
• Growth hormone insufficiency
• For most with neuro dx, VO2 requirements increase
secondary to gross motor insufficiencies
• Low level of fitness associated with increased
mortality
• Decrease in available motor units . –> decrease in
metabolically active tissue —> decrease in oxidative
potential

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53
Q

How does fiber type change in a person with a brain injury?

A

Slow fatigue fiber types gets replaced by the fast fibers, so we lose the capacity for slow aerobic conditions and use/have more fast anaerobic muscle fibers

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54
Q

What are the adaptive response to training seen in patients with a neurological dysfunction?

A
  • Increased metabolic efficiency
  • Mechanical efficiency
  • Improved function
  • Lowered energy cost
  • Increased exercise tolerance
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55
Q

What are the non fitness benefits of exercise on patients with a neurological dysfunction?

A
  • Impact on cognition
  • Impact on mood/behavior
  • Impact on recovery
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56
Q

What are the components of exercise the improves depression in patients with neurological disorders?

A
  • Needed to be exercise that met PAGs
  • Moderate to vigorous intensity
  • 3-5 days per week
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57
Q

What were the effects of exercise maintenance after a TBI?

A

• Decreased score on BDI
• Maintained improvement over time
• Increased physical activity
• Exercise greater than 90 minutes per week resulted in
lower BDI and higher perceived QOL and mental health
• 52% of subjects were exercising greater than 90 minutes per week at 6 months

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58
Q

What are the effects of exercise on the cognition of patients with a TBI?

A

• > 50% of TBI survivors still experiencing cognitive problems several years
post TBI
• Vigorous training: 3 times/wk x 30 minutes on treadmill x 12 wks, supervised
• Improved cognitive function with aerobic training in TBI
- Processing speed, executive function, overall cognition
• Aerobic exercises associated with physical adaptations and positive cortical functions like angiogenesis and neurogenesis

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59
Q

According to the “exercise is brain food” paper, which type of exercise had the highest tropinin levels relased?

A

Low level intensity exercise

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60
Q

What are the effects of aerobic training in patients with a neurological problem?

A
  • Aerobic exercise-induced increase in BDNF
  • Increased BDNF may facilitate motor learning and neuroplasticity
  • Also a benefit to cognitive function
  • Improves efficiency and reserve
  • Priming for Neuroplasticity
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61
Q

What happens with unrestricted exercise in the immediate acute phase of a concussion?

A

May increase risk of subsequent injury and/or delay recovery

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62
Q

At what point is SOME lever of exercise be beneficial for a concussion?

A

Once beyond acute injury stage

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63
Q

What are the characteristics of cognitive rest in a person that has sustained a concussion?

A
  • Increased cognitive activities post concussion increase symptom recovery time and prolong recovery
  • Reduction in brain stimulating activity
  • “prolonged cognitive rest and reduction of school events have the potential to exacerbate symptoms or cause negative mental health issues”
  • Key is during acute phase; symptoms are guide
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64
Q

What are the characteristics of vestibular and oculomotor impairments in a person that has sustained a concussion?

A

• Occurs in approx 60% of athletes
• Vestibular: peripheral or central
• Vestibular issues: benign paroxysmal positional vertigo (BPPV), vestibuloocular reflex (VOR) impairment, visual motion sensitivity, balance
dysfunction, cervicogenic dizziness, and exercise-induced dizziness.
• Vestibulo-ocular: dizziness, vertigo, blurred/unstable vision, nausea, difficulty with busy environments
• Vision Therapy
• Pharmacological interventions
• May predict prolonged recovery

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65
Q

What are the effects of endurance post BI?

A

• In sample of stroke survivors 1 year post stroke, only
50% could complete 6 minute walk
• Those who completed the walk did so at only 40% of
predicted distance
• Strong relationship between endurance as measured by 6 minute walk and community integration
• Increasing endurance could reduce handicap!!!

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66
Q

According to the “physical fitness for survivors of stroke based on best available evidence” what are the recommended exercise training intensity guidelines for stroke survivors?

A
  • If a graded exercise program is performed, we should target 50-80% max HR
  • If no graded exercise program is performed, work at a 40- 70% of predicted HR
  • Use borg scale/10 point scale and target a level of 4 (moderate)
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67
Q

How do we find our predicted HR?

A

220-age

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68
Q

Where is exercise most effective in patients with MS?

A

More peripheral

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69
Q

Dyskinesia is a pathology of what?

A

Basal ganglia

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70
Q

What are the forms of dyskinesia that is common in Huntington’s disease?

A

Chorea most common; also bradykinesia, dystonia, myoclonus, tics

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71
Q

What are the forms of dyskinesia that is common in Parkinson’s disease?

A

Resting tremor; also bradykinesia

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72
Q

What are the forms of dyskinesia that is common in Essential tremor?

A

Action tremor seen in at least 1 arm during 4 tasks, interfering with one ADL

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73
Q

What are the forms of dyskinesia that is common in cerebral palsy?

A

Choreoathetoid, dystonia

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74
Q

What are the forms of dyskinesia that is common in stroke?

A

Chorea, dystonia, parkinsonism

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75
Q

What are some preparatory interventions for dyskinesia?

A
• Pharm
   - Botox-A
• Surgical modalities
   - Deep brain stimulation (DBS) - mostly in parkinson's, and hungtingtons
• Therapeutic techniques
76
Q

What are the therapeutic techniques used as preparatory interventions for dyskinesia?

A
  • Whole body vibration to reduce tremor
  • Exercise and bracing to reduce contracture in dystonia
  • Sensorimotor training, mental rehearsal, mirror therapy
  • Vibration
  • CIMT
  • TENS, biofeedback
  • Orthotics: decrease degrees of freedom
  • Kinesiotaping
  • Weightbearing
77
Q

What are the interventions applied to function in patients with dyskinesia?

A
  • Task specific practice
  • Orthotic devices
  • Gait practice
78
Q

What is the most frequently used method of assessing spasticity?

A

Modified ashworth scale

79
Q

What are the parameters of the Modified ashworth scale?

A
  • Patient has to be supine

- Limb needs to be moved at a sufficient velocity

80
Q

What outcome measures is best to use if a patient has spasms?

A

Spasm Frequency Scale

81
Q

What are the possible impairments that needs to be assessed in spasticity?

A
  • PROM, AROM, muscle length
  • Strength
  • Sensation: pain/increased risk of skin breakdown
82
Q

What are the activity/function that needs to be assessed in spasticity?

A
  • Gait
  • Transfers
  • ADL
  • w/c mobility
83
Q

What else needs to be assessed in spasticity?

A

Quality of life

84
Q

What are the rehab interventions for spasticity management?

A
  • Accurate assessment
  • Maintaining/improving flexibility
  • Strengthening
  • Weightbearing
  • Function
  • Education
  • Appropriate referral for medical interventions
85
Q

What are the characteristics of flexibility intervention in patients with spasticity?

A
• Target tissues: muscle, joint capsule, nerve
• PROM exercises not sufficient
• Need low load prolonged stretch
   - Positioning
   - Casting/splinting
• Special attention to 2 joint muscles
• AROM is best, E-stim may augment
• Remember your manual skills for joint and soft tissue
mobilization
• Neural gliding is also necessary
86
Q

What are the characteristics of strengthening intervention in patients with spasticity?

A

• A spastic muscle is a weak muscle
• The muscles that oppose spastic and/or contracted
muscles are ALSO weak muscles
• Close chain progressing to open chain
• Isometric, eccentric, concentric
• Specificity of strengthening is important
• Strengthening DOES NOT promote/increase spasticity

87
Q

What are the characteristics of weightbearing intervention in patients with spasticity?

A

• Can help normalize muscle tone
• HOWEVER, good biomechanical alignment is critical for weightbearing to be effective
• Weightbearing + biomechanical alignment = best chance
for more normal muscle tone
• Good biomechanical alignment allows antagonist to
activate
• Get activation and good control in weightbearing prior to
progressing to open chain

88
Q

What are the oral medications used for spasticity management?

A
  • Baclofen (most common)
  • Clonidine
  • Dantrolene sodium
  • Tizanidine
  • Gabapentin
89
Q

What are the daily max dose, mechanism of action, and common side effects of baclofen?

A
  • Daily Max Dose: 80 mg
    divided in 4 doses
  • Mechanism of Action: GABA analogue
  • Common Side Effects: Drowsiness, dizziness, weakness
90
Q

What are the daily max dose, mechanism of action, and common side effects of clonidine?

A
  • Daily Max Dose: .1 mg qd
  • Mechanism of Action: Alpha-adrenergic receptor agonist
  • Common Side Effects: Bradycardia, hypotension,
    depression
91
Q

What are the daily max dose, mechanism of action, and common side effects of dantrolene sodium?

A
  • Daily Max Dose: 100 mg qd
  • Mechanism of Action: Blocks release of Ca from SR
  • Common Side Effects: Muscle weakness, hepatotoxicity
92
Q

What are the daily max dose, mechanism of action, and common side effects of Tizanidine?

A
  • Daily Max Dose: 36 mg
  • Mechanism of Action: Alpha adrenergic receptor agonist
  • Common Side Effects: Drowsiness, dry mouth
93
Q

What are the daily max dose, mechanism of action, and common side effects of Gabapentin?

A
  • Daily Max Dose: 600-800 mg
    qd
  • Mechanism of Action: GABA analogue
  • Common Side Effects: Drowsiness, dizziness, ataxia
94
Q

What are the cons of oral medications?

A
  • Effects ebb and flow
  • Must take on schedule
  • Sedating side-effects
95
Q

What are the pros of oral medications?

A
  • Non-invasive
  • Non permanent
  • Effective management of + signs
96
Q

What are the characteristics of oral medications?

A
  • Clinical usefulness limited by side effects
  • Lack of high-quality evidence
  • Choose medication based on “side effect profile”
  • Minimal dose, minimal side effect
  • Should not be the “first-line” of treatment
97
Q

What are the characteristics of chemical denervation intervention for spasticity?

A

• Chemical Neurolysis: phenol or alcohol applied to nerve via
injection with EMG guidance
- Cause demyelination of axon
- Effects last up to 6 months
• Neuromuscular Blockade:
Botulinum neurotoxin injected into muscle, binds to presynaptic cholinergic nerve terminal; blocks release of ACH
- This is not just Botox
- Immediate use of the muscle so it can work better

98
Q

What are the advantages and disadvantages of chemical neurolysis?

A

• Advantages: better effect on larger muscles, cost is minimal
• Disadvantages: Difficult procedure, risk of sensory
complications, muscle become fibrotic after repeated injections

99
Q

What are the advantages and disadvantages of neuromuscular blockade?

A
  • Advantages: less painful, easier to perform, no sensory side effects, not permanent
  • Disadvantages: only reinject every 3 months, not permanent, cost, can develop antibodies
100
Q

What is an intrathecal baclofen (ITB)?

A

A programmable pump placed in the body that dispenses a certain amount of baclofen into the spinal cord

101
Q

How is intrathecal baclofen (ITB) added into the body?

A

Diffused into cerebrospinal fluid (CSF) in intrathecal space

• Catheter attached to mechanical pump implanted in pt

102
Q

What is the mechanism of action of the intrathecal baclofen (ITB)?

A

Presynaptic inhibition – GABA b receptor agonist

103
Q

What does intrathecal baclofen (ITB) do?

A

Inhibits both mono and polysynaptic reflexes

104
Q

What are the advantages of intrathecal baclofen (ITB)?

A

Reversible, easy to titrate dose, fewer side effects, improved function/ease
of care

105
Q

What are the disadvantages of intrathecal baclofen (ITB)?

A

Mechanical complications, refills required (at least every 3 months), cost

106
Q

What are the effects of ITB for post-stroke hypertonia?

A
  • Improved FIM, SIP, and AS

* No adverse effect on strength in unaffected limbs

107
Q

What are the ITB consensus panel guidelines?

A
  • Collaboration between therapists and physicians
  • Positive effects of ITB
  • For those who did not respond or tolerate other treatment interventions
  • As early as 3-6 months post stroke
  • Optimal dose is goal dependent
  • No evidence regarding superior dosing mode
108
Q

What are the soft tissue orthopedic surgery option for treating spasticity in patients that have lost range?

A
  • Selective percutaneous myofascial lengthening (especially in kids)
  • Lengthening
  • Tendon transfer
  • Releases
109
Q

What are the skeletal procedure orthopedic surgery option for treating spasticity?

A
  • Osteotomies

* Fusions

110
Q

What are the characteristics of selective dorsal rhizotomy?

A

Selective destruction of
problematic nerve roots
• Nerve roots where spasticity are located are identified using EMG
• Selectively lesioned

111
Q

What is excess muscle activity?

A
  • Compensatory behavior

* Over recruitment when demand exceeds capacity

112
Q

What do we do in case of suspected spasticity?

A

• Improve our movement analysis to discern causes of
abnormal movement
• Manipulate the person, environment, and/or task to get a more normal movement
- Fix biomechanical constraints or compensate for them
- Manipulate task and/or environment difficulty to better match demand to capacity
- Increase patient’s capacity…how?
- Decrease degrees of freedom

113
Q

What are the diagnostic to discern spasticity versus musculoskeletal contracture?

A
  • Tardieu Scale (R1 vs R2)
  • End feels
  • Lidocaine block
  • Evaluation under anesthesia
114
Q

What is the 1st principle for seating on a wheelchair?

A

Stabilize Proximally to Promote Improved Distal Mobility and Function

115
Q

What are the characteristics of the 1st principle for seating on a wheelchair?

A

• Derived from basic underlying theory of movement development
• For wheelchairs your central focus becomes the pelvis
• Evaluate control at joints distally from a stabilized pelvis
- If mobility is lost then reassess with the proximal joint stabilized

116
Q

What is the 2nd principle for seating on a wheelchair?

A

Achieve and Maintain Pelvic Alignment

117
Q

What are the characteristics of the 2nd principle for seating on a wheelchair?

A

• Optimal positioning: neutral to slight anterior tilt without oblique positioning or rotation

  • Improves weight bearing across the ischial tuberosities
  • Flexion at the pelvis can decrease tonal patterns
118
Q

What is the 3rd principle for seating on a wheelchair?

A

Facilitate Optimal Postural Alignment in all Body Segments

119
Q

What are the characteristics of the 3rd principle for seating on a wheelchair?

A

Optimal alignment enhances:
• Stability
• Comfort
• Function

120
Q

What are the important aspects to consider for the 3rd principle for seating on a wheelchair?

A
  • Can an individual attain optimal alignment independently?

* Do I need accommodative support?

121
Q

What is the 4th principle for seating on a wheelchair?

A

Limit Abnormal Movement and Improve Function

122
Q

What are the characteristics of the 4th principle for seating on a wheelchair?

A

Observational Skills are KEY
• Abnormal movement leads to secondary sequela related to seated
postures and limits function
• Hunt and look for abnormal movement patterns and their causes

123
Q

What is the 5th principle for seating on a wheelchair?

A

Provide the Minimum Support Necessary to Achieve Anticipated Goals and Expected Outcomes

124
Q

What are the characteristics of the 5th principle for seating on a wheelchair?

A
  • People are often LAZY
  • If you lower expectations, provide equipment, and support then individuals WILL rely on them
  • Don’t allow equipment to limit functional improvement. Use it to FACILITATE recovery
125
Q

What is the 6th principle for seating on a wheelchair?

A

Provide Comfort

126
Q

What are the characteristics of the 6th principle for seating on a wheelchair?

A

Loss of comfort leads to:

  1. Abnormal movement
  2. Asymmetry
  3. Fatigue
  4. Poor endurance
  5. Lack of attention
  6. Poor concentration
  7. AVOIDANCE
127
Q

What is involved in the wheelchair process?

A
  • Determine Need
  • Examination
  • Prescription
  • Funding/Order
  • Fitting
  • Training
  • Maintenance
128
Q

What information is needed during the history portion of patient examination for a wheelchair?

A
  1. Environment

2. Transportation

129
Q

What are the test and measures to assess during a patient examination for a wheelchair?

A
  1. Strength and Endurance
  2. Sensation and Skin integrity
  3. Vision and Hearing
  4. Health Status
  5. Cognition and Behavior
130
Q

What are the functional abilities to assess during a patient examination for a wheelchair?

A
  1. Toileting
  2. Bathing
  3. Dressing
  4. Eating
  5. Communication
  6. Transfers
  7. Ambulation
  8. Wheel Chair Mobility and
    Skills
131
Q

What are the clinical reasoning questions to ask when addressing a patient being fitted for a wheelchair?

A
  • How often and long will the user be in the chair?
  • How will the user propel the chair?
  • What activities will the user be doing?
  • How will the user transfer?
  • How will the chair be transported?
  • Where will the chair be used? (environmental considerations)
  • Is the users condition stable?
132
Q

Where is the majority of wheelchair prescription done?

A

The Mat Table exam

133
Q

What does the Mat table exam give us opportunity to look at?

A

Look at pelvic, spine and hip alignments
• Look for scoliotic curves, pelvic rotations/obliquities, contractures
• Are you able to move and adjust the individual to normalize these joint positions?

134
Q

What are the seating positions of the Mat table exam?

A
  • Start in supine and move to seated

* Finish with simulated seating

135
Q

What are the measurements taken for wheelchair measurements?

A
A. Sitting Depth (buttocks to popliteal fossa)
B. Popliteal fossa to heel
C. Knee flexion angle
D. Back height from surface to PSIS
E. Surface to lower scapula
F. Surface to top of shoulder
G. Surface to back of occiput
H. Surface to crown of head
I. Hanging elbow to sitting surface
J. Width of trunk
K. Depth of trunk
L. Width of hips
M. Foot length
136
Q

What are the general considerations for wheelchair measurements?

A

• Seat depth should be 1-2 in back from the popliteal space
• Floor to seat height should include the cushion height
- Aim for 2 in of foot clearance
• Back height will improve trunk stability but can limit propulsion
• The chair should be as narrow as possible
- Leave space for weight fluctuation, clothes and to prevent skin irritation
• Removable arm rests and foot rests can improve transfers
• Additional equipment may be needed based on environment and functional needs

137
Q

What is Common Postural Deviations and Corrections: pelvic obliquity?

A

When a side of the pelvis is elevated in sitting. The side of the pelvis that is lower is the obliquity

138
Q

What are the characteristics of a pelvic obliquity?

A
  • Named after the lower side of the pelvis
  • Often accompanied by a compensatory lateral flexion of the spine, which can throw off our alignment in the trunk and upper extremities, therefore limiting our mobility and function in the arms
139
Q

What are the characteristics of a pelvic rotation?

A
  • Named after the posterior half of the pelvis
  • Often accompanied by a compensatory counter rotation of the spine in the direction of the pelvis, and this can lead to awkward positioning of the pelvis and UEs, and problems in the hip and creates a false leg length discrepancy
140
Q

What is the back angle on a wheelchair?

A

The angle between the patient and their back rest. Can be adjusted based on
available hip flexion

141
Q

How can the seat frame angle and height component of a wheelchair be adjusted?

A

Can be adjusted to improve
foot clearance or allow foot
propulsion

142
Q

How can the footrest system component of a wheelchair be adjusted?

A

• Hangers, extensions and
footplates
• Can be fixed, adjustable or
swing away

143
Q

How can the armrest system component of a wheelchair be adjusted?

A
  • Desk and full length

* Can be adjustable, swing away, rigid

144
Q

How can the wheel options component of a wheelchair be adjusted?

A
  • Wheels can vary in size, tread and material

* Casters can be varied (small for turn radius, large for terrain)

145
Q

How can the seat width and depth component of a wheelchair be adjusted?

A

Do you need adjustability?

Weight gain or loss?

146
Q

What is the optimal height for the seat back on a wheelchair?

A

Optimal height is just below the inferior angle of the scapula for pushers, lower
if improved trunk control

147
Q

What are the differences between a hard or a sling seat back on a wheelchair?

A
  • Sling can fold easily or tension adjusted

* Hard can be more supportive and cushioned

148
Q

What are the stages of pressure injuries?

A
  1. Stage 1
  2. Stage 2 – Partial Thickness
  3. Stage 3 – Full Thickness (unstageable)
  4. Stage 4 – Deep Tissue Exposure (deep tissue injury, due to injury being under the surface)
149
Q

What are the risk factors for pressure injuries?

A
  1. Sensory Loss
  2. Decreased mobility
  3. Increased heat and/or moisture
  4. Poor posture
  5. Previous pressure injury
  6. Poor nutrition and/or hydration
  7. Increased Age
  8. Body weight (increased or decreased)
  9. Tobacco use
150
Q

What is pressure mapping?

A

A way of testing at risk locations for skin break down, effectiveness of cushions and efficacy of pressure relief
techniques

151
Q

What are some differing seating systems that can be used for individual patients on a wheelchair?

A
• Planar Surfaces
  - Hard wood or foam
• Deformable Surfaces
  - Softer foam
• Contoured Surfaces
  - Foam inserts to mold shapes
• Custom Molded Surfaces
  - Made to fit the users body contours
152
Q

What are the advantages and disadvantages of using a foam as the cushion on a wheelchair?

A

• Viscoelastic foam, variety of thickness and density

• Advantages: light, inexpensive
• Disadvantages: can’t be washed, increased skin temperature, must be
replaced every 6 months

153
Q

What are the advantages and disadvantages of using air as the cushion on a wheelchair?

A

• Small air-filled cushions

  • Advantages: better weight distribution, lowest interface pressures if inflated properly
  • Disadvantages: heavier, easily punctured, decreased stability, transfers difficult
154
Q

What are the advantages and disadvantages of using gel/fluid as the cushion on a wheelchair?

A

• Made of inflated pouches with gel inside on top of a foam base

• Advantages: better weight distribution, minimizing shear forces during transfers,
good choice for the active individual
• Disadvantages: heavy, promote increased skin temperature and moisture build-up at the sitting surface, stability is decreased, difficulty
of transfers is increased

155
Q

What are the advantages and disadvantages of using a flexible matrix as the cushion on a wheelchair?

A
  • Made of thermoplastic urethane that is formed into open cells, “honeycomb”
  • Advantages/Disadvantages still unknown: Minimal research in the literature
156
Q

How often should wheelchair users perform pressure relief?

A

EVERY 15-30 MINUTES!

157
Q

What are some methods of performing pressure relief on a wheelchair?

A
  1. Push up maneuver
  2. Leaning to the side (Hook)
  3. Leaning forward
    • MUST reach 45 degrees
    • All pressure relief should be held for 15-30 seconds
158
Q

What are characteristics of a power wheelchair?

A
• The user is a marginal selfpropeller or cannot self-propel
• Limited endurance for
community mobility
• When manual use has the
potential to lead to long term
sequela
• Higher costs
• More adaptable to the user
159
Q

What are characteristics of a manual wheelchair?

A
  • Lower cost
  • Maintain physical capacity
  • Improved access
  • Lower maintenance
160
Q

What are the characteristics of the folding frame on a manual wheelchair?

A
  • Below seat cross bar
  • Provide a smoother ride
  • Heavier
161
Q

What are the characteristics of the rigid frame on a manual wheelchair?

A
  • Lighter
  • Adjustable seat to back angle
  • Durable
162
Q

What does the camber on a wheelchair denote?

A

The angle of the wheel. Out improves efficiency and stability with turning but decreases access

163
Q

What are the characteristics of the axel location on a wheelchair?

A

Is the chair “tippy”
• The further the axel is forward the more “tippy”
• Optimal is just in line of the glenohumeral joint

164
Q

What are the things that can help with pressure relief on a power chair?

A
  • Tilt in space
  • Recline
  • Elevating leg rests
165
Q

What are the ways to improve access on a power chair?

A
  • Power seat elevation

* Standers

166
Q

What are the different wheel systems and their characteristics on a power chair?

A
• Rear Wheel
  - Improved speed
• Center Wheel
  - Improved turn radius
• Front Wheel
  - Improved terrain navigation
167
Q

What are the types of power assist on a manual wheelchair?

A
  1. Add on motors

2. Power assisted wheels

168
Q

____ is the key way that people in a wheel chair will get around

A

Propulsion is the key way that people in a wheel chair will get around

169
Q

What are the key elements of propulsion?

A
  • Long symmetrical strokes
  • Leaning forward enhances the propulsive forces
  • Pushing forward on one side and pulling back on the other = sharp turns

Users need to be able to propel forward, backward and over multiple terrains

170
Q

What are the propulsion options for manual chair users?

A
  • Two handed push
  • One hand push rims
  • Foot propulsion

The method of propulsion will effect the chair specifications

171
Q

What are the keys for incline on a wheelchair?

A
  • Short forceful strokes
  • Leaning forward enhances the propulsive forces
  • Turning sideways allows the user to rest
172
Q

What are the keys for decline on a wheelchair?

A
  • Slowly release pressure on the hand grips
  • Leaning back enhances the breaking forces
  • Turning sideways allows the user to rest
173
Q

What are the keys for wheelies on a wheelchair?

A
  • Balance point: where front casters are off the ground and in equilibrium
  • User pushes forward on the rims to lean back
  • Pushes back on the rims to lean forward

Users need to be able to attain, maintain and move in the wheelie position

174
Q

What are the keys for navigating curbs on a wheelchair?

A

• For ascent the user pops a wheelie to get the front casters over the curb and
uses forward leverage of the wheel against the curb to ascend
- Casters can rest on the curb during the leverage portion
• For descent the user pops a wheelie once the front casters are at the edge of the curb and uses leverage of the
wheel against the curb to descend.

175
Q

What are the wheelchair functional expectation for a SCI C1-4?

A

• Independent with POWER mobility
• Electronic controlled pressure relief (Tilt and
Recline)
• Dependent with positioning in chair (Head/Trunk support)

176
Q

What are the wheelchair functional expectation for a SCI C5?

A
• Independent to some assist
with MANUAL mobility 
• Requires plastic-coat hand
rims/extensions 
• Recommend power-assist
mobility 
• Recommend electronic
controlled pressure relief (Tilt
and Recline) 
• Dependent with positioning in
chair (Head/Trunk support)
177
Q

What are the wheelchair functional expectation for a SCI C6?

A
• Independent with MANUAL
mobility on level surfaces 
• Requires plastic-coat hand
rims/extensions 
• Recommend power-assist
mobility in the community 
• Recommend independent
pressure relief 
• Independent with positioning in chair (Head/Trunk support)
178
Q

What are the wheelchair functional expectation for a SCI C7?

A
  • Independent with MANUAL mobility in home and community
  • Recommend plastic-coat hand rims/extensions
  • Some assist with ramps, curbs and uneven terrain
  • May benefit power-assist mobility in the community
  • Independent pressure relief
  • Independent with positioning in chair (Head/Trunk support)
179
Q

What are the wheelchair functional expectation for a SCI C8?

A
  • Independent with MANUAL mobility in home and community
  • Improved ability with ramps, curbs and uneven terrain (DUE to improved hand control!)
  • Independent pressure relief
  • Independent with positioning in chair (Head/Trunk support)
180
Q

What are the wheelchair functional expectation for a SCI T1-12?

A
  • Independent with manual mobility in home and community
  • Independent ability with rams, curbs, and uneven terrain
  • Independent pressure relief
  • Independent with positioning chair (Head/trunk support)
  • Improved trunk control with more caudal injury
181
Q

What are the wheelchair functional expectation for a SCI L1-3?

A

Independent in home ambulation.
May choose to use a chair for endurance:
• Independent with manual mobility in home and community
• Independent ability with ramps, curbs, and uneven terrain
• Independent pressure relief
• Independent with positioning in chair (head/trunk support)

182
Q

What are the wheelchair functional expectation for a SCI L4-SI?

A

Independent in ambulation.
May choose to use a chair for endurance:
• Independent with manual mobility in home and community
• Independent ability with ramps,, curbs, and uneven terrain
• Independent pressure relief
• Independent with positioning in chair (head/trunk support)

183
Q

What should be done in patient’s post concussion to avoid another?

A

Light physical and neurological exercise

184
Q

What determines the intensity of exercise in a patient post concussion?

A

Patient response/tolerance

185
Q

What are tics?

A

Sudden, rapid recurring, non-rhythmic, stereotypical movement or vocalization

186
Q

What is dystonia?

A

Persistent muscle contraction resulting in incongruous repetitive movements and distorted, unnatural position of the body

187
Q

What is apotosis?

A

Slow, writhing movements typically involving fingers, hands, toes and tongue