SCI Medical Management and Rehab

Question 1

What is the potential for recovery with SCI?

Answer 1

Greater recovery with incomplete lesions

70% of patients with cervical lesions recover 1 level below level of injury

Question 2

At 4 months, what is one thing that is associated with a good prognosis for motor recovery at 1 year?

Answer 2

Preservation of pin prick

Question 3

At what time after injury does motor function generally plateau?

Answer 3

12-18 months

Question 4

When is surgical stabilization required?

Answer 4

Unstable fracture site
Gross malalignment
Cord compression
Deteriorating neurological status

Question 5

What is minerva?

Answer 5

Cervical orthosis that effectively limits motion in all planes

Question 6

What are primary goals of PT in the acute stage following and SCI?

Answer 6

Prevent secondary complications
Provide patient education
Begin early mobilization when medical clearance received

Question 7

What are some respiratory factors you want to evaluate?

Answer 7

Observe strength of diaphragm
Respiratory rate
Chest excursion
Vital capacity
Cough Function

Question 8

What are some ways you can encourage diaphragmatic breathing?

Answer 8

Can use light pressure just below sternum to facilitate inspiration and expiration
Use mirror for feedback

Question 9

What is Glossopharyngeal Breathing?

Answer 9

Utilizae lips, pharyngeal muscles, and tongue to inhale air

Used with high cervical lesions

Question 10

How can you help assist with respiration?

Answer 10

Abdominal binder
Manual stretching (chest wall muscles)

Question 11

What’s the most effective management of skin?

Answer 11

Prevention!!!
Positioning
Pressure relief
Skin inspection
Education

Question 12

When in bed, how often does a patient need to be re-positioned?

Answer 12

At least every 2 hours

Question 13

How often should a patient perform pressure relief in a wheelchair?

Answer 13

Every 15 minutes

must be maintained for 2 minutes to be effective

Question 14

Name some pressure relief techniques for a patient in a wheelchair.

Answer 14

Push-up
Leaning forward (>45 degrees)
Leaning to side
Tilt feature (at least 65 degrees)

Question 15

How often should ROM be completed in the acute stage?

Answer 15

Daily

Question 16

What are the precautions if a patient has an injury to the lumbar spine?

Answer 16

Straight leg raise

Question 17

What are the precautions if the cervical spine is injured?

Answer 17

Motion of head and neck contraindicated and caution when stretching shoulders (flexion and abduction

Question 18

Why is selective stretching important?

Answer 18

Some joints and muscles benefit from tightness to enhance function
(Tetraplegia = tightness of lower trunk may improve sitting posture)

Question 19

How much hamstring length is required for functional activities such as long sitting and dressing?

Answer 19

100 degrees

Question 20

What do you want to make sure of before any upright activities?

Answer 20

Fracture site is stable and patient is cleared

Question 21

How can you test aerobic capacity/endurance?

Answer 21

6-minute arm test
10-30 watts tetraplegia
30-60 watts paraplegia

Question 22

How many people who experience a traumatic SCI may also experience a TBI

Answer 22

60%

Question 23

True/False: Abnormal tone and spasms can cause involuntary muscle contractions or make it appear that a muscle moved or is stronger than it really is.

Answer 23

True

Question 24

What do you want to be careful of with MMT?

Answer 24

Watch out for substitution (supinate forearm to extend wrist)

Question 25

How can you assess self-care?

Answer 25

FIM Spinal cord injury independence measure (SCIM) = reliable, vald, and may be more responsive than FIM Quadriplegia index of function (QIF) Capabilities of Upper Extremity Instrument (CUE)

Question 26

What factors affect functional outcomes?

Answer 26

``` Motor level Age Concurrent injuries Secondary complications Body type Psychosocial Support ```

Question 27

What are some key muscles innervated by C1, C2, C3, C4?

Answer 27

Face and neck muscles Cranial nerve innervation Diaphragm (Partial at C3 and C4)

Question 28

What are some available movements at C1, C2, C3, C4?

Answer 28

``` Talking Mastication Sipping Blowing Scapular elevation ```

Question 29

What are some key muscles innervated by C5?

Answer 29

``` Biceps Brachialis Brachioradialis Deltoid Infraspinatus Rhomboid Supinator ```

Question 30

What are some available movements with C5?

Answer 30

Elbow flexion and supination Shoulder ER Shoulder abd and flexion to 90 degrees

Question 31

What are some available movements with C6?

Answer 31

Shoulder flexion, extension, IR and add Scapular abduction, protraction, and upward rotation Forearm pronation Wrist extension

Question 32

What are some available movements with C7?

Answer 32

Elbow extension Wrist flexion Finger extension

Question 33

What movements do you gain with C8?

Answer 33

Finger flexion