Week 5 Flashcards
(187 cards)
1
Q
What is the leading cause of death after a SCI?
A
- Pneumonia
* Other respiratory conditions
2
Q
What are the characteristics of the respiratory system function?
A
- Gas exchange via the lungs
- Ventilatory pump
- Ventilation versus respiration
3
Q
What happens to the chest during expiration and inspiration?
A
Expands during inspiration and relax at expiration
4
Q
What is ventilation?
A
The moving of air between the lungs and the atmosphere
5
Q
What is respiration?
A
The gas exchange that occurs at the level of the alveoli in the pulmonary circulation
6
Q
We must ____ to respirate
A
We must ventilate to respirate
7
Q
What does most people with an SCI have trouble with?
A
Ventilation, unless they have a pneumonia or something of that nature
8
Q
What are the muscles of inhlation?
A
- Diaphragm
- Intercostals, Scalene, Accessory MM
- Abdominals
9
Q
What are the muscles of exhalation?
A
- Abdominals (forceful exhalation)
- Intercostals
- Diaphragm (relaxes and causes the ribcage to relax)
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
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.
12
Q
What does the weakness of the inspiration muscles result in?
A
- Hypoventilation
- Atelectasis
- Secretion and retention
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
14
Q
What is tidal volume?
A
Volume inspired or expired in quiet breath
15
Q
What is vital capacity?
A
Volume expired after max inspiration
16
Q
What is inspiratory capacity?
A
Volume inspired after norm expiration
17
Q
What is total lung capacity?
A
Total volume contained in lungs at max inspiration
18
Q
What is residual volume?
A
Volume remaining in lungs after max expiration
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
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
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
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
23
Q
What impact does a level T1-5 injury have on respiration?
A
Some intercostals preserved, no abs, no forceful cough
24
Q
What impact does a level T6-12 injury have on respiration?
A
Some or most abs, more effective cough
25
What impact does a level below T12 injury have on respiration?
No significant deficits, but respiration is compromise is still possible
26
What are the types of ways patients can get mechanical ventilation?
* Positive-Pressure Ventilators (most common)
* Intermittent abdominal pressure ventilators
* Negative-pressure body ventilators
* Biphasic cuirass ventilators
* Phrenic nerve stimulators
27
What are the other methods of ventilation patients can get?
* Phrenic Nerve Stimulation
* Direct diaphragmatic stimulation
* Non-invasive negative ventilation
* Glossopharyngeal breathing
28
What are the causes of respiratory dysfunction?
* Muscle weakness/paralysis
* Pulmonary Compliance
* Rib Cage Compliance
29
What are the characters of pulmonary compliance?
Lung stiffness; reduced in people with tetraplegia
30
What are the characters of rib cage compliance?
Stiffness of ribcage and its resistance to movement; also
| decreased in people of tetraplegia
31
How is the positive pressure seen in positive pressure ventilators achieved?
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
32
How does a negative pressure body ventilator work?
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
33
What are the disadvantages of the negative pressure body ventilator, in comparison to positive pressure ventilator?
Negative pressure machines are a lot less portable, more difficult to apply, and is infrequently used or contraindicated in soma patients
34
What are some complications of an acute respiratory problem?
* Prolonged bedrest
* Pain and sedation
* Aspiration
* Paralytic ileus: GI system will temporarily cease to function
* Respiratory muscle fatigue
35
What is the PT intervention for patients with respiratory problems?
```
• Positioning
• Assisted cough
- Manual, mechanical, or self
• Breathing pattern
• Strength and endurance
• Necessary chest wall mobility
```
36
How does the lack of abdominals affect expiratory flow?
Weakness impairs ability to forcibly expire and generate high expiratory flow rates
37
What is needed to generate forced expiration?
High intrathoracic positive pressure
38
What is the quality of a functional cough?
Loud, forceful; 2 or more/exhalation
39
What is the quality of a weak functional cough?
Soft, less forceful; 1/exhalation
40
What is the quality of a nonfunctional cough?
Sigh or throat clearing; no true cough or no explosive force
41
What are some ways to augment/assist a cough?
* Mechanical inflation of lungs prior to cough (via noninvasive positive airway pressure support)
* Mechanical insufflation-exsufflation
42
What are other ways of managing secretion in the lungs, if there is no coughing?
* Positioning: sidelying on both sides
* Percussion or vibration
* Suctioning
* Non-invasive airway pressure support
43
What is the biggest cause of death for survivors of > 30 years and those older than 60 after an SCI?
CVD
44
What does disruption of the sympathetic nervous system result in?
Increased hypotension
45
What does decreased arterial pressures result in?
Diminished cardiac ventricular chamber size and function (tetra)
46
What is the cardiovascular presentation of a paraplegic?
• 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
47
What is circulaory hypokinesis as seen in patients with a SCI?
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
48
What are the 3 strikes that patients with a SCI have in regard to their cardiovascular health?
* Reliance on arm exercise
* Lower limb paralysis
* Loss of supraspinal sympathetic nervous control
49
What are the determinance of VO2 max?
* Cardiac Output (central)
| * Arterio-venous oxygen difference (periphery)
50
What are the exercise prescriptions for a patient with a SCI and a cardiovascular problem?
```
• Frequency
• Intensity: 50-60% max
• Time: 20 mins
• Type: Upper extremity most of the time
- Use HR or RPE
```
51
What are some precautions for a patient with a SCI and a cardiovascular problem?
Autonomic dysreflexia, fracture due to osteoporosis, skin breakdown due to lack of sensation
52
What are some of the cardiovascular response to a neurological dysfunction?
• 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
53
How does fiber type change in a person with a brain injury?
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
54
What are the adaptive response to training seen in patients with a neurological dysfunction?
* Increased metabolic efficiency
* Mechanical efficiency
* Improved function
* Lowered energy cost
* Increased exercise tolerance
55
What are the non fitness benefits of exercise on patients with a neurological dysfunction?
* Impact on cognition
* Impact on mood/behavior
* Impact on recovery
56
What are the components of exercise the improves depression in patients with neurological disorders?
* Needed to be exercise that met PAGs
* Moderate to vigorous intensity
* 3-5 days per week
57
What were the effects of exercise maintenance after a TBI?
• 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
58
What are the effects of exercise on the cognition of patients with a TBI?
• > 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
59
According to the "exercise is brain food" paper, which type of exercise had the highest tropinin levels relased?
Low level intensity exercise
60
What are the effects of aerobic training in patients with a neurological problem?
* 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
61
What happens with unrestricted exercise in the immediate acute phase of a concussion?
May increase risk of subsequent injury and/or delay recovery
62
At what point is SOME lever of exercise be beneficial for a concussion?
Once beyond acute injury stage
63
What are the characteristics of cognitive rest in a person that has sustained a concussion?
* 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
64
What are the characteristics of vestibular and oculomotor impairments in a person that has sustained a concussion?
• 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
65
What are the effects of endurance post BI?
• 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!!!
66
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?
- 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)
67
How do we find our predicted HR?
220-age
68
Where is exercise most effective in patients with MS?
More peripheral
69
Dyskinesia is a pathology of what?
Basal ganglia
70
What are the forms of dyskinesia that is common in Huntington’s disease?
Chorea most common; also bradykinesia, dystonia, myoclonus, tics
71
What are the forms of dyskinesia that is common in Parkinson’s disease?
Resting tremor; also bradykinesia
72
What are the forms of dyskinesia that is common in Essential tremor?
Action tremor seen in at least 1 arm during 4 tasks, interfering with one ADL
73
What are the forms of dyskinesia that is common in cerebral palsy?
Choreoathetoid, dystonia
74
What are the forms of dyskinesia that is common in stroke?
Chorea, dystonia, parkinsonism
75
What are some preparatory interventions for dyskinesia?
```
• Pharm
- Botox-A
• Surgical modalities
- Deep brain stimulation (DBS) - mostly in parkinson's, and hungtingtons
• Therapeutic techniques
```
76
What are the therapeutic techniques used as preparatory interventions for dyskinesia?
* 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
What are the interventions applied to function in patients with dyskinesia?
* Task specific practice
* Orthotic devices
* Gait practice
78
What is the most frequently used method of assessing spasticity?
Modified ashworth scale
79
What are the parameters of the Modified ashworth scale?
- Patient has to be supine
| - Limb needs to be moved at a sufficient velocity
80
What outcome measures is best to use if a patient has spasms?
Spasm Frequency Scale
81
What are the possible impairments that needs to be assessed in spasticity?
* PROM, AROM, muscle length
* Strength
* Sensation: pain/increased risk of skin breakdown
82
What are the activity/function that needs to be assessed in spasticity?
* Gait
* Transfers
* ADL
* w/c mobility
83
What else needs to be assessed in spasticity?
Quality of life
84
What are the rehab interventions for spasticity management?
* Accurate assessment
* Maintaining/improving flexibility
* Strengthening
* Weightbearing
* Function
* Education
* Appropriate referral for medical interventions
85
What are the characteristics of flexibility intervention in patients with spasticity?
```
• 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
What are the characteristics of strengthening intervention in patients with spasticity?
• 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
What are the characteristics of weightbearing intervention in patients with spasticity?
• 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
What are the oral medications used for spasticity management?
- Baclofen (most common)
- Clonidine
- Dantrolene sodium
- Tizanidine
- Gabapentin
89
What are the daily max dose, mechanism of action, and common side effects of baclofen?
- Daily Max Dose: 80 mg
divided in 4 doses
- Mechanism of Action: GABA analogue
- Common Side Effects: Drowsiness, dizziness, weakness
90
What are the daily max dose, mechanism of action, and common side effects of clonidine?
- Daily Max Dose: .1 mg qd
- Mechanism of Action: Alpha-adrenergic receptor agonist
- Common Side Effects: Bradycardia, hypotension,
depression
91
What are the daily max dose, mechanism of action, and common side effects of dantrolene sodium?
- Daily Max Dose: 100 mg qd
- Mechanism of Action: Blocks release of Ca from SR
- Common Side Effects: Muscle weakness, hepatotoxicity
92
What are the daily max dose, mechanism of action, and common side effects of Tizanidine?
- Daily Max Dose: 36 mg
- Mechanism of Action: Alpha adrenergic receptor agonist
- Common Side Effects: Drowsiness, dry mouth
93
What are the daily max dose, mechanism of action, and common side effects of Gabapentin?
- Daily Max Dose: 600-800 mg
qd
- Mechanism of Action: GABA analogue
- Common Side Effects: Drowsiness, dizziness, ataxia
94
What are the cons of oral medications?
* Effects ebb and flow
* Must take on schedule
* Sedating side-effects
95
What are the pros of oral medications?
* Non-invasive
* Non permanent
* Effective management of + signs
96
What are the characteristics of oral medications?
* 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
What are the characteristics of chemical denervation intervention for spasticity?
• 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
What are the advantages and disadvantages of chemical neurolysis?
• Advantages: better effect on larger muscles, cost is minimal
• Disadvantages: Difficult procedure, risk of sensory
complications, muscle become fibrotic after repeated injections
99
What are the advantages and disadvantages of neuromuscular blockade?
* 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
What is an intrathecal baclofen (ITB)?
A programmable pump placed in the body that dispenses a certain amount of baclofen into the spinal cord
101
How is intrathecal baclofen (ITB) added into the body?
Diffused into cerebrospinal fluid (CSF) in intrathecal space
| • Catheter attached to mechanical pump implanted in pt
102
What is the mechanism of action of the intrathecal baclofen (ITB)?
Presynaptic inhibition – GABA b receptor agonist
103
What does intrathecal baclofen (ITB) do?
Inhibits both mono and polysynaptic reflexes
104
What are the advantages of intrathecal baclofen (ITB)?
Reversible, easy to titrate dose, fewer side effects, improved function/ease
of care
105
What are the disadvantages of intrathecal baclofen (ITB)?
Mechanical complications, refills required (at least every 3 months), cost
106
What are the effects of ITB for post-stroke hypertonia?
* Improved FIM, SIP, and AS
| * No adverse effect on strength in unaffected limbs
107
What are the ITB consensus panel guidelines?
* 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
What are the soft tissue orthopedic surgery option for treating spasticity in patients that have lost range?
* Selective percutaneous myofascial lengthening (especially in kids)
* Lengthening
* Tendon transfer
* Releases
109
What are the skeletal procedure orthopedic surgery option for treating spasticity?
* Osteotomies
| * Fusions
110
What are the characteristics of selective dorsal rhizotomy?
Selective destruction of
problematic nerve roots
• Nerve roots where spasticity are located are identified using EMG
• Selectively lesioned
111
What is excess muscle activity?
* Compensatory behavior
| * Over recruitment when demand exceeds capacity
112
What do we do in case of suspected spasticity?
• 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
What are the diagnostic to discern spasticity versus musculoskeletal contracture?
* Tardieu Scale (R1 vs R2)
* End feels
* Lidocaine block
* Evaluation under anesthesia
114
What is the 1st principle for seating on a wheelchair?
Stabilize Proximally to Promote Improved Distal Mobility and Function
115
What are the characteristics of the 1st principle for seating on a wheelchair?
• 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
What is the 2nd principle for seating on a wheelchair?
Achieve and Maintain Pelvic Alignment
117
What are the characteristics of the 2nd principle for seating on a wheelchair?
• 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
What is the 3rd principle for seating on a wheelchair?
Facilitate Optimal Postural Alignment in all Body Segments
119
What are the characteristics of the 3rd principle for seating on a wheelchair?
Optimal alignment enhances:
• Stability
• Comfort
• Function
120
What are the important aspects to consider for the 3rd principle for seating on a wheelchair?
* Can an individual attain optimal alignment independently?
| * Do I need accommodative support?
121
What is the 4th principle for seating on a wheelchair?
Limit Abnormal Movement and Improve Function
122
What are the characteristics of the 4th principle for seating on a wheelchair?
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
What is the 5th principle for seating on a wheelchair?
Provide the Minimum Support Necessary to Achieve Anticipated Goals and Expected Outcomes
124
What are the characteristics of the 5th principle for seating on a wheelchair?
* 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
What is the 6th principle for seating on a wheelchair?
Provide Comfort
126
What are the characteristics of the 6th principle for seating on a wheelchair?
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
What is involved in the wheelchair process?
- Determine Need
- Examination
- Prescription
- Funding/Order
- Fitting
- Training
- Maintenance
128
What information is needed during the history portion of patient examination for a wheelchair?
1. Environment
| 2. Transportation
129
What are the test and measures to assess during a patient examination for a wheelchair?
1. Strength and Endurance
2. Sensation and Skin integrity
3. Vision and Hearing
4. Health Status
5. Cognition and Behavior
130
What are the functional abilities to assess during a patient examination for a wheelchair?
1. Toileting
2. Bathing
3. Dressing
4. Eating
5. Communication
6. Transfers
7. Ambulation
8. Wheel Chair Mobility and
Skills
131
What are the clinical reasoning questions to ask when addressing a patient being fitted for a wheelchair?
- 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
Where is the majority of wheelchair prescription done?
The Mat Table exam
133
What does the Mat table exam give us opportunity to look at?
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
What are the seating positions of the Mat table exam?
* Start in supine and move to seated
| * Finish with simulated seating
135
What are the measurements taken for wheelchair measurements?
```
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
What are the general considerations for wheelchair measurements?
• 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
What is Common Postural Deviations and Corrections: pelvic obliquity?
When a side of the pelvis is elevated in sitting. The side of the pelvis that is lower is the obliquity
138
What are the characteristics of a pelvic obliquity?
* 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
What are the characteristics of a pelvic rotation?
* 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
What is the back angle on a wheelchair?
The angle between the patient and their back rest. Can be adjusted based on
available hip flexion
141
How can the seat frame angle and height component of a wheelchair be adjusted?
Can be adjusted to improve
foot clearance or allow foot
propulsion
142
How can the footrest system component of a wheelchair be adjusted?
• Hangers, extensions and
footplates
• Can be fixed, adjustable or
swing away
143
How can the armrest system component of a wheelchair be adjusted?
* Desk and full length
| * Can be adjustable, swing away, rigid
144
How can the wheel options component of a wheelchair be adjusted?
* Wheels can vary in size, tread and material
| * Casters can be varied (small for turn radius, large for terrain)
145
How can the seat width and depth component of a wheelchair be adjusted?
Do you need adjustability?
| Weight gain or loss?
146
What is the optimal height for the seat back on a wheelchair?
Optimal height is just below the inferior angle of the scapula for pushers, lower
if improved trunk control
147
What are the differences between a hard or a sling seat back on a wheelchair?
* Sling can fold easily or tension adjusted
| * Hard can be more supportive and cushioned
148
What are the stages of pressure injuries?
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
What are the risk factors for pressure injuries?
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
What is pressure mapping?
A way of testing at risk locations for skin break down, effectiveness of cushions and efficacy of pressure relief
techniques
151
What are some differing seating systems that can be used for individual patients on a wheelchair?
```
• 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
What are the advantages and disadvantages of using a foam as the cushion on a wheelchair?
• 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
What are the advantages and disadvantages of using air as the cushion on a wheelchair?
• Small air-filled cushions
* Advantages: better weight distribution, lowest interface pressures if inflated properly
* Disadvantages: heavier, easily punctured, decreased stability, transfers difficult
154
What are the advantages and disadvantages of using gel/fluid as the cushion on a wheelchair?
• 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
What are the advantages and disadvantages of using a flexible matrix as the cushion on a wheelchair?
* Made of thermoplastic urethane that is formed into open cells, “honeycomb”
* Advantages/Disadvantages still unknown: Minimal research in the literature
156
How often should wheelchair users perform pressure relief?
EVERY 15-30 MINUTES!
157
What are some methods of performing pressure relief on a wheelchair?
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
What are characteristics of a power wheelchair?
```
• 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
What are characteristics of a manual wheelchair?
* Lower cost
* Maintain physical capacity
* Improved access
* Lower maintenance
160
What are the characteristics of the folding frame on a manual wheelchair?
* Below seat cross bar
* Provide a smoother ride
* Heavier
161
What are the characteristics of the rigid frame on a manual wheelchair?
* Lighter
* Adjustable seat to back angle
* Durable
162
What does the camber on a wheelchair denote?
The angle of the wheel. Out improves efficiency and stability with turning but decreases access
163
What are the characteristics of the axel location on a wheelchair?
Is the chair “tippy”
• The further the axel is forward the more “tippy”
• Optimal is just in line of the glenohumeral joint
164
What are the things that can help with pressure relief on a power chair?
* Tilt in space
* Recline
* Elevating leg rests
165
What are the ways to improve access on a power chair?
* Power seat elevation
| * Standers
166
What are the different wheel systems and their characteristics on a power chair?
```
• Rear Wheel
- Improved speed
• Center Wheel
- Improved turn radius
• Front Wheel
- Improved terrain navigation
```
167
What are the types of power assist on a manual wheelchair?
1. Add on motors
| 2. Power assisted wheels
168
____ is the key way that people in a wheel chair will get around
*Propulsion* is the key way that people in a wheel chair will get around
169
What are the key elements of propulsion?
* 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
What are the propulsion options for manual chair users?
* Two handed push
* One hand push rims
* Foot propulsion
The method of propulsion will effect the chair specifications
171
What are the keys for incline on a wheelchair?
* Short forceful strokes
* Leaning forward enhances the propulsive forces
* Turning sideways allows the user to rest
172
What are the keys for decline on a wheelchair?
* Slowly release pressure on the hand grips
* Leaning back enhances the breaking forces
* Turning sideways allows the user to rest
173
What are the keys for wheelies on a wheelchair?
* 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
What are the keys for navigating curbs on a wheelchair?
• 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
What are the wheelchair functional expectation for a SCI C1-4?
• Independent with POWER mobility
• Electronic controlled pressure relief (Tilt and
Recline)
• Dependent with positioning in chair (Head/Trunk support)
176
What are the wheelchair functional expectation for a SCI C5?
```
• 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
What are the wheelchair functional expectation for a SCI C6?
```
• 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
What are the wheelchair functional expectation for a SCI C7?
* 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
What are the wheelchair functional expectation for a SCI C8?
* 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
What are the wheelchair functional expectation for a SCI T1-12?
* 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
What are the wheelchair functional expectation for a SCI L1-3?
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
What are the wheelchair functional expectation for a SCI L4-SI?
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
What should be done in patient's post concussion to avoid another?
Light physical and neurological exercise
184
What determines the intensity of exercise in a patient post concussion?
Patient response/tolerance
185
What are tics?
Sudden, rapid recurring, non-rhythmic, stereotypical movement or vocalization
186
What is dystonia?
Persistent muscle contraction resulting in incongruous repetitive movements and distorted, unnatural position of the body
187
What is apotosis?
Slow, writhing movements typically involving fingers, hands, toes and tongue
