L9 Compensatory Strategies

Question 1

What are the choices when it comes to selecting an intervention for SCI?

Answer 1

1. mobility training
2. Therex
3. Equipment selection
4. Education

Question 2

Capacity of recovery of mobility is dictated by

Answer 2

the amount of voluntary motor function that is preserved after injury

Question 3

Activity Training Tips

Answer 3

Progressively build more challenging skills
Demonstrate and explain the skill
Do not give up on training if they fail, it takes a long time
Do a movement analysis to determine what is happening

Question 4

Substitution

Answer 4

use of tension in passive structures to create movement

Question 5

Compensatory Strategies

Answer 5

Substitution
Angular Momentum
Head Hips
Strengthening of preserved musculature
Development and preservation of ROM
Use of equipment

Question 6

What pts will need compensatory strategies for rolling?

Answer 6

ASIA A or B, T6 and higher are most likely to benefit
pts with C5-C6 will need equipment
pts with above C4 will be dependent

Question 7

Compensatory strategies for rolling

Answer 7

angular momentum
use of equipment to allow biceps to assist

Question 8

How to recognize if activity is too hard or easy

Answer 8

pt perception of exertion
more erros than desirable
cant complete task
can only do the activity once
activity causes pain or other distress

Question 9

Long sit w/T1 complete SCI

Answer 9

hamstrings and lumbar paraspinals will help individual from falling forward

sitting tall would cause the pt to fall backwards

flexing knees could cause the pt to fall

Question 10

Why do you need long sitting?

Answer 10

getting dressed
to prepare for transfer out of bed

mid thoracic to C5 pts would benefit from long sitting

Question 11

To practice gross mobility in sitting, the pt has to be able to

Answer 11

tolerate an upright sitting position
prop on their arms with elbows extended
lift or unweight their buttocks in long sitting

Question 12

Progression/REgression of Long Sit

Answer 12

arm support (double, single, none)
Explore the LOS
Static to dynamic activity

Question 13

Why would you need to short sit?

Answer 13

prepare for transfers
prepare for sitting in W/C

Question 14

Pt must be able to ____ to short sit

Answer 14

tolerate upright position
prop on UE with elbows extended

Question 15

Why do you need to be able to transfer with SCI?

Answer 15

transfer between two surfaces, either laterally or vertically

Question 16

Transfers require…

Answer 16

patient to tolerate upright
prop on UE with elbows extended
perform pelvic lift w/heads hips technique

Question 17

Can someone without triceps perform a lateral transfer?

Answer 17

very unusual to do it independently
patients with injury above C5 will be dependent

Question 18

Locomotion

Answer 18

ability to move from one place to another

manual, power assist, power W/c, gait training for SCI

Question 19

Outcome measures for w/c

Answer 19

6 minute roll test
Craig handicap (CHART)–measures activity and participation
Spinal Cord Injury Independence–activity measurement

Question 20

To propel a w/c, patient has to be able to

Answer 20

tolerate upright sitting
be able to position self and maintain position
perform pressure relief
handle w/c
drive w/c

Question 21

Easier to propel w/c

Answer 21

friction increasing tools
tubing wrapped on wheel rim
fingerless gloves

Question 22

If hand function is compromised, what are the options for w/c?

Answer 22

wrists splints to allow for base of hand propulsion
propulsion with hand rim projections
power assist w/c

Question 23

Prediction of ambulation

Answer 23

age
motor and sensory function–> L3 and S1 dermatome and myotomes
accurate for Ais A and D

Question 24

Gait Training Cost

Answer 24

-pts with complete or AIS B are less likely to return to walking
-energy cost is high, price of orthotics, risk of falls
-can help with spasticity, bowel and bladder function, pain

Question 25

Orthotics for Gait

Answer 25

can prevent, limit, assist, or resist movement of joints AFO = controls ankle, for L4-S1 KAFO = controls knee and ankle, T12-L3 HKAFO = controls hip, knee, ankle, T1-T12

Question 26

ADs for Gait

Answer 26

many pts will require an AD to off load LE and provide stability during gait the more motor preservation, the least restrictive the device can be FWW, Forearm crutches, SPC

Question 27

Training of Gait

Answer 27

start in parallel bars with orthoses very close guarding use feedback, and try to help them find stable point with passive tension

Question 28

Jackknife

Answer 28

if COM is anterior to the hips, they have not muscular control to recover balance

Question 29

After parallel bars

Answer 29

can transition to crutches or FWW once they can maintain standing will little pulling use a swing to gait (LESS STABLE) or swing through gait when HKAFO or KAFO are used must teach how to take off orthotics, sit to stand, and floor transfer for falls

Question 30

Reach and Grasp

Answer 30

needed for eating, dressing, manipulating objects pt needs innervation to UE and control of posture within LOS

Question 31

Central Cord Syndrome

Answer 31

most common incomplete cervical SCI caused by hyperextension and trauma, often with older adults presents as weakness of UE, more than LE. Loss of pain and temperautre in UE

Question 32

Compensatory strategies for Reach and Grasp

Answer 32

tenodesis grip orthotics and ADs strengthening of muscles referral to OT medical procedure to transfer high functioning tendons to less functioning tendons