L13 SCI Intervention

Question 1

phases of SCI intervention

Answer 1

1: bed mobility
2: joint stability/transfers
3: strengthening/stretching
4: coordination/balance/functional activities
5. gait/orthorics

Question 2

precautions with activity in SCI pt

Answer 2

orthopedic stress at Fx site
heterotopic ossification
autonomic dysreflexia
monitor skin
respiratory
CV: OH, DVT
Overuse: shoulder, UE

Question 3

5 most important activities SCI pts need to learn

Answer 3

rolling
supine to long sit
unsupported sititng
lifting vertically
transfers from one surface to another

Question 4

rolling for SCI pt

Answer 4

for C spine injury
arm positioned to use momentum of arms and head to roll

Question 5

supine to long sit for SCI

Answer 5

roll then push self up from side
push directly up using triceps if able
need hamstring length

Question 6

C7 long sitting balance

Answer 6

hamstring length
use shoulders and C spine to balance
use shoulder ER to compensate for weak triceps
tenodesis with fingers curled
wrist extension can move LE

Question 7

sitting balance activities

Answer 7

static sitting: therapist or UE support
scooting
balance strategies
dynamic activities: wring towel, overhead toss, etc
C6-8 require lots of practice

Question 8

WBV and SCI

Answer 8

elicit EMG activity in sitting and passive standing
45 Hz and 1.2 cm amplitude

Question 9

outcome measures appropriate for SCI

Answer 9

berg
TUG for SCI
wheelchair skills test
SCI measure
10m walk test

Question 10

WC to short sit on bed transfer

Answer 10

position WC at angle to table
hands planted in front of pelvis with feet positioned halfway from chair to bed
WB through hands
use momentum of head and arms and push up to avoid shear while rotating

Question 11

assisted cough

Answer 11

used for cervical and high thoracic pts
place heel of hand on abdomen, pt holds breath then as they cough you push up towards rib cage

Question 12

diaphragmatic breathing

Answer 12

strengthen diaphragm in SCI
start supine, then seated/standing

Question 13

aerobic guidelines for SCI

Answer 13

start: 20 min 2x week mod-intense (70%)
adv: 30 min 3x week mod to intense
activities include: arm bike, swimming, WC locomotion, resistance activities, circuit resistive training
monitor vitals

Question 14

endurance and aerobic: when to suspend or stop aerobic training

Answer 14

respiratory rate 30+ above resting
pulse ox <90%
accessory breathing starts
increased rise in HR 20+ bpm to resting
headache

Question 15

considerations for aerobic exercise with SCI pts T4 and above

Answer 15

loss of sympathetic control
orthostatic, hypotensive at rest
less pumping efficiency and L ventricle atrophy

Question 16

considerations for aerobic exercise with SCI pts T6 and below

Answer 16

higher resting HR that’s nearly normal
slight elevated BP
decerased SV
circulatory hypokinesis: less regulation of blood flow and increased clotting risk
better exercise tolerance

Question 17

fitness vs cardiometabolic health exercise recommendations for SCI pts

Answer 17

20 min 2x week + resistance 2x week for fitness/strength
30 min 3x week aerobic activity for cardiometabolic benefits

Question 18

hamstring length required in SCI

Answer 18

120 degrees
+ good hip ER
daily stretching

Question 19

muscles that can be functionally tightened in SCI

Answer 19

C6/C7
tenodesis flexion contracture in hands for grasp
tight lumbar extensors to maintain upright sitting

Question 20

muscular disuse in SCI

Answer 20

transformation from slow fatigue resistant fibers to fast fatiguable fibers due to disuse
decreased resistance to muscle fatigue due to decreased capillary density
can be combated with estim

Question 21

pressure relief recommendations for SCI

Answer 21

every 15-30 min should weight shift/lean for pressure relief
1-2 min on each side

Question 22

skin protection for SCI pts

Answer 22

distribute weight across seat
decrease sheer
promote heat and air flow
decrease moisture
avoid tricep push up

Question 23

pressure relief: electric wheelchair

Answer 23

used in cervical/high thoracic patients
25-65 degrees of tilt for pressure relief

Question 24

resistance training exercises for SCI

Answer 24

2x week 3 sets each mod intensirt
scap retraction
ahoulder ER
adduction
SA

Question 25

benefits of standing activities in SCI

Answer 25

avoid bone demineralization without WB improve bladder/renal function decrease spasticity stretching program helps generally across many outcomes 3x+, 30-60 min each time

Question 26

gait training for incomplete SCI

Answer 26

CPG: central pattern generator for stepping response stimulate sensory: load receptors with WB and cutaneous positioning hip will increase propulsion change speeds to change sensory input, add weight, different directions to create different input to CPG

Question 27

body weight supported treadmill training

Answer 27

stepping practice with option to unload body weight with harness manual assistance for postural control work on kinematics use at mod-high intensity to increase neuroplasticity

Question 28

cons of BWSTT

Answer 28

harness reduces degree of stance phase reduce sensory input to promote stance

Question 29

when should treadmill training be discontinued in SCI pts

Answer 29

once that have stance phase stability, there is no continued benefit to the treadmill and training should occur overground instead to increase speed not a big difference between then but best to start treadmill then progress to overground

Question 30

pros of exoskeleton for gait

Answer 30

increased mobility, circulation non invasive confidence boost

Question 31

cons of exoskeleton for gait

Answer 31

high cost exclusive physical requirements not covered with insurancw can slow down recovery

Question 32

spinal implants

Answer 32

used in complete injury to recover ability to walk using stimulator responding to sensory cues

Question 33

why do we need to find cause and treat neuropathic pain in SCI?

Answer 33

high risk of depression and suicide

Question 34

ottobock C brace

Answer 34

stance and swing phase control orthotic provides support throughout cycle and controls release and locking knee joint

Question 35

orthotics used for SCI

Answer 35

KAFO HKAFO

Question 36

how should WC fit pt?

Answer 36

plumb line aligned 90/90/90 alignment for energy efficiency decrease forward head reduce posterior pelvic tilt

Question 37

pt education should include:

Answer 37

skin protection bed mobility transfers WC pressure relief exercise/CV fitness

Question 38

shoulder protection in SCI

Answer 38

many have carpal tunnel and shoulder pain due to overuse shoulder pain from RC

Question 39

risk factors for shoulder pain in SCI

Answer 39

older, duration of injury, high BMI, manual WC, poor seated posture, decreased flesibility, muscle imbalances

Question 40

prevention of shoulder injury when using manual WC

Answer 40

band pull downs rows lat raises stretch traps, anterior/posterior capsule 3x week for 12 weeks

Question 41

10 steps for healthy living in SCI pt

Answer 41

1. drink 2L every day 2. aerobic exercise 15-60 min per day 3. stretching daily 4. resistive exercise 2x week 5. safety precautions and fall prevention 6. skin monitoring, pressure relief, and WC cushion 7. stop smoking 8. regular medical care 9. emotional health 10. report changes in neuro system