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PHTH 529 - Neuro > SCI - Interventions > Flashcards

SCI - Interventions Flashcards

1
Q

phase 1

A

rolling
supine to sit
scooting
supine to prone
sitting balance and tolerance

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2
Q

phase 2 - joint stability and transfers

A

w/c set up
body and w/c positioning
weight shifting
assisted transfers
independent transfers

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3
Q

phase 3 - strengthening

A

strength and stretching program
UE strengthening
LE stretching

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4
Q
A
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5
Q

phase 4 coordination

A

balancing @ a higher level
community integration
functional activities
standing activities
coordination

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6
Q

phase 5 - gait

A

start upright in parallel bars or AD
treadmill training
orthotics

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7
Q

overarching outcomes in SCI

A

pathology - decrease pressure sores and education

body structure - muscle performance/flexibility, aerobic capacity/cough, joint mobility

posture - assisted or independent in sitting, assume sitting posture

bed mobiity, transfers, overall mobility (w/c and reintegration into community)

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8
Q

ortho/stress at fx site

precautions/prevention

A

orthotic use after surgery
heterotopic ossification

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9
Q

skin monitor

precautions/prevention

A

pressure relief
equipment
shrearing forces

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10
Q

cardiovascular

precautions/prevention

A

orthostatic hypotension (gradual increase)
DVT

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11
Q

autonomic dysreflexia

precautions/prevention

A

headache
flushing of skin
high BP

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12
Q

respiratory

precautions/prevention

A

cough
diaphragmatic and intercostal

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13
Q

overuse syndrome

precautions/prevention

A

shoulders
overstretching of low back and hands

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14
Q

five activities that SCI pts need to perform

A

rolling
mobilizing from supine to long sitting
unsupported sitting
lifting vertically
transfer from variety or surfaces

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15
Q

C7 SCI for balance on plinth

A

need long hamstring length in long sit
- sitting balance with primarily shoulder and c-spine musculature
- shoulder ext rotation for improved postural control with weak triceps
- tenodesis in finger flexors
- use of wrist extensors for moving lower extremities

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16
Q

sitting balance activities

A
  1. first find alignment and always start with static activities
  2. scooting activities on the mat (depression activities)
  3. use of UE poles, devices: static strategies gaining balance
  4. dynamic activiities: ex. ball toss and catching
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17
Q
A
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18
Q

C6-8 SCI sitting activities

A

need immense practice for various sitting
can practice long and short sit

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19
Q

t1-6 SCI sitting activities

A

short sit at edge of bed or mat
may need UE for dynamic balance

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20
Q

whole body vibration and SCI

A

WBV allows to elicit EMG activities with complete SCI in sitting and passive standing
- specific amp and freq = 45 Hz and 1.2 cm
- variety of postures dont change EMG

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21
Q

process of transfers from w/c

A

position the w/c and pt
hands foward of the pelvis
feet position midway between mat and chair
WB thru base of hand
principles of head-torsion/trunk
- rotation of trunk with head toward the mat
- lifting the butt = no possibility of shearing

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22
Q

Assisted cough for cervical and high t-spine

process

A

place heel of one hand on pt abdomen (just above navel) then place other hand on top of first hand

pt takes a deep breath and holds

pt coughs + provider pushes upward and under rib cage

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23
Q

starting level aerobic activity guidelines

A

20 minutes
2x a week
mod-vigorous intensity

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24
Q

advanced level aerobic activity guideliens

A

30 mins
3x a week
mod-vigorous intensity

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25
aerobic activities
arm ergometer swimming W/C locomotion resistance activities circuit resistive training
26
aerobic exercise guidelines
vigorous-intensity 70% of HR max monitor: - RR - O2 saturation
27
suspending or no initiation of aerobic activities
RR: > 30 SaO2: < 90% Unwarranted accessory breathing Increased rise in HR (20 beats) in resting HR Complaints of headache
28
aerobic ex/cardiovascular fitness above t4
loss of central command of sympathetic nervous system above t4 lack effective orthostatic regulation because of sympathetic function resting hypotension with decrease in activity and blood flow = loss of pumping efficiency - L ventricular atrophy: diminished chamber size
29
aerobic activity/cardiac below t6
higher resting HR or nearly normal slightly elevated BP with depressed stroke volume circulatory hypokinesis = less regulation of blood flow --> increased risk of thrombosis
30
hamstring streching in cervical injuries
need special attention at least 120 deg
31
32
flexibility
pt's with SCI do not need full ROM in all joints some joints benefit from allowing tightness to develop in certain musles to enhance function
33
extensibility in c6-7 quad
long sitting needs tightness in the lumbar extensors and length in hamstrngs to keep upright sitting with quadriplegia = tightness of the lower trunk musculature improves sitting posture - when transfering = increased trunk stability
34
tenodesis grasp and release
biomechanical occurance letting some opening and closing of the fingers by wrist extension after SCI @ C6 or C7 = use of wrist extension to promite a biomechanical grasp
35
tenodesis transfers and sitting
teach pt to WB on balms of the hands and not overstretch the finger flexors - use tenodesis to grasp objects
36
SCI muscular disuse
chronic disuse = slow, fatigue resistance --> fast, fatigable muscles extensive decline in fatigue resistance is seen due to decreased capillary density of muscles e-stim reduce the normal post-SCI deteruiration of muscle
37
Regular pressure relief
individuals with SCI should perform pressure relief maneuvers (weight shifts, leaning forward, etc.) every 15-30 mins with each shift lasting 1-2 minutes
38
skin inspection
daily visual inspection of the skin (specific in areas of high risk) to see for any pressure sores
39
skin protection
by distributing weight across the seating surface decrease shear promite heat exchange and airflow
40
causes of skin wounds
moisture (sweat or urine) bigger people = warmer and may need more airflow in their cushions
41
skin protection and w/c pushups
NO LONGER RECOMMENDED because of the impact on shoulder integrity equal benefits of bending forward and leaning to the side for decrease pressure + more blood flow + oxygenation
42
pressure relief leaning forward
at least 45deg (elbows on knees position) lateral trunk leaning to 15deg reduces pressure and increases blood flow + tissue oxygenation important to be be able to return back normal sitting position
43
cervical or high t-spine level pressure relief
between 25-65 deg = give pressure relief 15 deg or less does not provide proper pressure relief
44
UE theraband and weights
scapular retraction shoulder ER diagonal extension (adduction) serratus anterior
45
UE theraband and weights guidelines
3 sets for each functioning muscle groups mod intensity 2x per week
45
function of standing activities
SCI causes rapid bone demineralization after one year - slows bone decay with supported standing - improved bladder and renal function - decreased spasticity - also functions as a stretching program
46
standing activities
all pt with SCI should be assessed for potential benefits of standing according to level and type of injury - should be assessed once physiologically stable - should stand 3+ a week for 30-60 mins
47
sensory input for gait training in incomplete SCI
contributes to the refinement of locomotor output: important for the modulation of - load receptors - signal hip position - cutaneous receptors
48
sensory information
comes from cutaneous receptors (load and tactile) - coming from afferent feedback
49
sensory info provides formation by | gait training
in stance phase causes inhibition of ipsilateral hip flexion AND activation of contralateral hip flexion
50
body weight supported treatmill training | BWSTT
think lite gait + manual assistance to promote upright posture and LE that mimic normal gait
51
BWSTT practices
"kinematically" correct stepping to increase afferent feedback that is associated with normal locomotion = increased plasticity within spinal and supraspinal neural circuits
52
downside of supported treadmill training
harness reduces the degree stance phase reduces the proper sensory loading that is needed to promote stance phase
53
intensities for treadmill training
mod- to high- intensity to improve walking speed and distance focus on: specificity --> intensity --> reps
54
Treadmill training is beneficial
ONLY with pt's who can't control stance phase stability best to train over the ground or w/o harness w/ increase speed
55
stance phase stability for treadmill training
once able to control stance phase stability - no BENEFIT from supported treadmill at same speeds
56
overground vs treadmill in incomplete SCI
no large difference were found early on BW supported treadmill training later in rehab overground = higher values of independence
57
pros and cons of exoskeletons
pros: - increased mobility - improves circulation - non-invasive - boosts confidence cons: - high costs - exclusive physical needs - not covered by insurance - slow down recovery
58
nociceptive pain | pain syndromes in SCI
rotator cuff injuries/tears/impingements high resistance motoric activities
59
neuropathic | pain syndromes in SCI
burning, stabbing, shooting pain neurogenic origins
60
dx of neuropathic pain
using the international spinal cord injury pain classification system
61
neuropathic pain red flags
determine serious underlying conditions that can cause, aggravating or mimic neuropathic pain assess and manage psychosocial factors that contributes to pain-related distress adn disability
62
ottobock C brace
first stance and swing phase control orthosis which controls stance and swing phase
63
additional braces of SCI
KAFO hip knee ankle foot orthotic
64
wheelchair fit
plumb line posture: ear lobe, shoulder, hip least postural work to sit: 90-90-90
65
w/c posture
look for FHP = increase in shoulder pain c-spine thoracic posture increase use of lats and traps + posterior pelvic tilt
66
w/c tilt ankle
inverse relationship between ankle and pressure - around 30 deg of tilt
67
components for pt education
skin care bed mobility pressure relief w/c mobility functional transfers exercise w/ CV
68
SCI and shoulder pain
30-73% hae shoulder pain 49-73% have CTS | multiple pathomechanic factors that contribute to rotator cuff injury
69
risk factors of SCI and shoulder protection
duration of injury older age higher BMI manual w/c poor seated posture decreased flexibility muscle imbalances in RC and scap stabilizers
70
ten steps of healthy living for SCI pts
1. drink 2 L x day 2. aerobic = 15-60 min x day 3. daily stretching 4. resistive = 2x weekly 5. fall and safety prevention 6. skin monitoring - w/c cushion and pressure relief 7. no smoking 8. regular medical care 9. emotional health 10. report changes in neuro sx

PHTH 529 - Neuro (5 decks)

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