PT Management of pt with SCI Flashcards
skin care
passive pressure relief initially
observe/monitor
pt education to self monitor ASAP; teach active pressure relief techniques
order WC cushion or other to relief pressure (heel protectors)
Early intervention pressure relief
turn pt q 2 hours
check skin each time
avoid direct sidelying position
use pillows, foam, blocks to protect bony landmarks
types of beds for pressure relief
low-air-loss bed
rotating bed
air-fluidized bed (clinitron- beads floating)
Active pressure relief techniques
WC pushups- C7 for triceps, trunk leans forward
forward leans- C5-C6
side leans C5- biceps
Devices to help respiration
positive pressure ventilators (PPV)- helps inhalation; uses trach
non-invasive positive pressure ventilators (NPPV)- through face mask
phrenic N stimulator- Sx puts electrode on diaphragm, must have intact nerve
GPB
glossopharyngeal breath; for high level C injuries
pt inspire small amts air repeatedly using sip or gulp
improves chest expansion, voice volume
pt still has trach for breathing
PT way to help respiration
encourage diaphragmatic breathing- visual FB
quick stretch to diaphragm; breathe with resistance to help strengthen
quick stretch to accessory ms
Strengthening exercises for breathing
diaphragm- MR, weights
trainers- dial changes resistance of inhalation
Assisted cough
assists mvt of secretions
pt pushed in and up on epigastric area
use abdominal binder- helps resting position of diaphragm and helps postural hypotension
tolerance to vertical
gradual acclimation- elevate head of bed, tilt table, back support, reclining WC most common
monitor vitals- BP
use compression garments
ROM post SCI
begin PROM/ positioning don't overstretch low back or long finger FL instruct pt/caregiver in self ROM splint/ brace to protect ROM may need substitution techniques
selective stretching C7 above fingers
no long finger FL preserve tenodesis stretch finger Ext with wrist fully FL stretch finger FL with wrist fully Ext IP flexed with WB activities don't overstretch wrist Ext
Selective stretching C7 above back
keep some tightness n low back don't dissociate upper/lower trunk important for stability/transfers stretch HS in supine (100 degrees) avoid long-sitting with short hamstrings (uses back)
Strengthening program options
isometric PRE (conc/ecc) through functional activities PNF FES avoid stress on unstable vertebral areas
Exercise guidelines
check chart for contraindications monitor response to activity watch for autonomic dysreflexia acute- avoid ex that are assymmetrical or rotational forces on spine until stable warm up, activity, cool down phases vary pt position incorporate breathing ex amap be creative individual vs group include function address life long fitness needs
pool therapy
increase mobility buoyancy resistance relaxation for painful WB endurance psychological, socialization, fun, variety
pool contraindications
open wound
colostomy/ bowel incontinence
fear
temp regulation above T6
balance training
learn to manage new COM determine LOS impact of orthotics, body type long sitting, short sitting, POE during transfers recovery/protective responses must be taught- let em fall
mobility skills/ ADL
bed mobility transfers WC skills/ gait how to fall and get back up assess equipment needs work with OT/speech
Compensation vs restoration
compensation- motor function absent below lesion (ASIA A or B)
restoration- motor function preserved or neurons (ASIA C or D)
ms substitutions
using gravity: SH ABD/ IR for pronation
tenodesis
fixation of distal extremity- ant delt/ pec mj to ext elbow; SH ER/ ant delt to ext elbow
Head hips relationship
to move butt- move head in opposite direction
eg- to move butt up and left, move head down and right
start with head in direction you want to go and swing opp
momentum
mass+velocity
throwing vs placing extremity
rolling (throwing head and arms)
sitting to supine with leg loops
intertia
easier to keep object moving than start it moving
transfer with 2-3 long pushes vs short pushes
keep WC moving
