Test 1: paraplegia

Question 1

what is paraplegia

Answer 1

level of injury is low enough to only affect trunk and LE

no longer UE involved

Question 2

when to be worried about autonomic dysreflexia

Answer 2

if above T6

can still happen below but much less common

Question 3

Characteristics of a motor complete injury

Answer 3

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

Question 4

chart review for motor complete injury

Answer 4

precautions `
secondary injuries
surgeries
imaging
labs
vitals
which providers are involved

Question 5

subjective hx for people with motor complete

Answer 5

what is home set up?
support in life?
occupation?
medical equipment already owned?

Question 6

important note related to skin for motor complete injuries

Answer 6

observe for pressure injury in common areas

observe environment for risks/factors that may cause skin breakdown

Question 7

GI/GU - what would you want to know during acute care exam `

Answer 7

observe for catheter

ask about bowel/bladder program, sensation, and control

Question 8

what motor and sensory components are you looking at with an acute care exam of a motor complete injury

Answer 8

complete ASIA

check ROM, mm length, jt restrictions

check reflexes

Question 9

cardio pulm components of exam for motor complete injury in acute care exam

Answer 9

observe for signs of DVT/PE

check vitals

Question 10

acute care interventions with motor complete injury

Answer 10

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)

Question 11

what to educate on for pts with motor complete injury in acute care (right after injury)

Answer 11

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

Question 12

describe upright trials used for motor complete injuries in acute care

Answer 12

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

Question 13

POC/discharge planning for motor complete injury following acute care

Answer 13

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

Question 14

important things to know when pt arrives at acute rehab from acute care or LTACH

Answer 14

any notes from acute care

what did they already work on while in hospital

confirm ASIA findings

observe current mobility level

Question 15

what would fall under the umbrella of functional mobility training within acute rehab

Answer 15

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

Question 16

what preventative interventions are you focusing on in acute rehab with pts with motor complete injury

Answer 16

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

Question 17

POC/discharge from acute rehab

Answer 17

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

Question 18

important things to note in out patient exam for ots with motor complete injury

Answer 18

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

Question 19

interventions specific to outpatient PT with motor complete injuries

Answer 19

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

Question 20

when to d/c pt with motor complete injury from outpatient

Answer 20

d/c when they are managing independently and/or have met their functional goal

Question 21

what is a motor incomplete injury

Answer 21

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

Question 22

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

Answer 22

want to check functional mobility in addition to what you would look at with a motor complete exam

Question 23

acute care intervention for motor incomplete pts

Answer 23

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

Question 24

d/c typical for motor incomplete injury following acute care

Answer 24

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

Question 25

in acute rehab, what additional things do you want to look at specifically in your exam for a patient with motor incomplete injury

Answer 25

check acute therapist notes

confirm ASIA testing

check functional mobility - transfers (sit to stand, stand pivot, gait if appropriate based in level)

Question 26

acute rehab interventions for motor incomplete injury

Answer 26

depends on amount of mm available for mobility

could be ASIA B or functional enough to walk

if ambulatory, can take them through progression

balance training might get modified to standing ot tall kneel

transfers may involve sit to stands and pivots

may need to bring in a CPO for bracing needs

Question 27

discharge/POC for motor incomplete following acute rehab

Answer 27

hopefully home

can get outpatient services

could be LTACH if med complications

could be Long term care if self care ability isnt optimal

Question 28

specific things to look at in outpatient exam of motor incomplete injury aside from normal exam

Answer 28

acute rehab notes

functional mobility level, how things are at home, set up, social support

screen for secondary overuse injury

Question 29

outpatient interventions for motor incomplete

Answer 29

edu as needed

mechanics for functional mobility

overall strength, efficiency, aerobic

prevent secondary complications

WC/bracing as needed

return to sport or work

gait training as needed

Question 30

what is a incomplete LMN injury

Answer 30

below T12

conus medullaris and below

will have mixed/LMN/incomplete presentation because nerves start spreading out from the cord there

flaccid paresis

faccid bowel and bladder below this level

Question 31

how is an incomplete LMN exam different than UMN

Answer 31

likely will be incontinent of bowel

should have no UMN signs

should be flaccid (except with mixed presentation)

Question 32

acute care intervention for incomplete LMN

Answer 32

depends on ASIA and how many mm groups work against gravity

could be ASIA B initially or could start with enough intact they can start with balance/transfers/walking

most likely presentation is C or D

will need to start training on bowel/bladder management early - one of biggest functional challenges

Question 33

POC/discharge for incomplete LMN following acute care

Answer 33

hopefully acute rehab but depends

LTACH if medical needs

SAR based on tolerance

could be home if ASIA D

Question 34

acute rehab exam for incomplete LMN injury - unique things you want to look at

Answer 34

acute therapy notes

confirm ASIA

functional mobility check - including transfers

Question 35

interventions in acute rehab for LMN incomplete injury

Answer 35

depends on mm available for mobility

if ambulatory, take through progresssion (i.e. BWSTT)

balance training can be modified to tall kneel or standing

transfers may involve sit to stands and stand pivot

may need to brin in a CPO for bracing

bowel/bladder edu

Question 36

discharge/POC for LMN incomplete pts from acute rehab

Answer 36

hopefully home

can get outpatient services

LTACH if medical needs

LTC if self care ability is not optimal

Question 37

unique things to look at in outpatient exam for pts with LMN incomplete injury

Answer 37

acute rehab notes

functional mobility, how things are at home, set up, social support

observe current mobility including transfers

Question 38

outpatient interventions for LMN incomplete

Answer 38

edu as needed
mechanics for functional mobility problems
overall strength, efficiency, and aerobic
prevent secondary complications
WC/bracing changes as needed
return to sport or work
gait training as needed