SCI part 2 Flashcards
(186 cards)
1
Q
order these from most to least common: incomplete paraplegia, incomplete quadriplegia, complete quadriplegia, complete paraplegia
A
incomplete quadriplegia
complete paraplegia
incomplete paraplegia
complete quadriplegia
2
Q
what are the key ms at the C5 level?
A
Rhomboids, deltoids, biceps, brachialis, brachioradialis, partial RC innervation
3
Q
what are the key ms fxns at the C5 level?
A
Scapular adduction, shoulder abduction (partial), some elbow flexion
4
Q
what are the key ms at the C6 level?
A
SA, pec major (partial), biceps, extensor carpi radialis, RC (full innervation)
5
Q
what are the key ms fxns at the C6 level?
A
Full rotation/abduction, full elbow flexion strength, wrist extension
**tenodesis for finger fxn
6
Q
what are the key ms at the C7 level?
A
Lats, pec major (sternal head), triceps, pronator teres, flexor carpi radialis
7
Q
what are the key ms fxns at the C7 level?
A
Elbow extension, forearm pronation, wrist flexion, adn some finger
**essentially no hand fxn, uses tenodesis grip
8
Q
what are the key ms at the C8 level?
A
Flexor digitorum profundus and superficialis, flexor pollicis longus and brevis, abductor pollicus longus, opponens pollicus, adductor pollicus, partial lumbricles, flexor carpi ulnaris, extensor carpi ulnaris
9
Q
what are the key ms fxns at the C8 level?
A
Finger flexion, thumb flex/abd/add/opposition; wrist flexion; full wrist extension
10
Q
what is the tenodesis grip?
A
fxnal grasp/release for pts with no active finger fxn (C6/7) using passive insufficiency of finger flexors to grip
11
Q
how is the tenodesis grip performed?
A
pt performs active wrist extension with reflexive finger flexion
12
Q
how is the tenodesis grip maintained?
A
Prevention and avoidance of stretching finger flexors
Education on proper self-stretching techniques
Use of splints to maintain position
13
Q
what adaptive equipment can be used to increase success with fxnal mobility in SCIs?
A
Leg loops
Transfer board/beazy board
Hospital bed
14
Q
when would a beazy board be used over a transfer board?
A
when higher level assistance is needed
15
Q
all SCI at level _____ and above will be dependent for bed mobility
A
C4
16
Q
what ms motions can be used for rolling with a C5 SCI?
A
partial biceps, use of scapular protraction/retraction w/head movt
17
Q
what ms motions can be used for rolling with a C6 SCI?
A
no triceps, must keep UEs below 90 deg elevation to avoid hitting face, utilize shoulder ER to maintain elbow extension
18
Q
what ms motions can be used for rolling with a C7 SCI?
A
have triceps and can maintain elbow extension, can utilize push up, or cross body swing above 90 deg
19
Q
can SCI C4 or C5 use triceps for transfers
A
nope
20
Q
what SCI levels use C crawling in supine to long sit transfers?
A
C5-7
21
Q
what is the c crawl method to get from supine to long sitting?
A
roll using momentum to land propped on forearm
UE “walk” to bring trunk towards knees
hook CL UE to BLE to pull upright (use active biceps)
think about ms innervation at each level to achieve
throw UE into posterior prop (ER to lock out)
22
Q
what SCI levels use the rocking technique to get from supine to long sit?
A
C6 and below
23
Q
what is the procedure for the rocking technique to get from supine to long sit?
A
initiate trunk lift from surface using wrist extension, elbow flexion, and cervical flexion
medial-lateral rocking motion using to prop onto forearms
throw one UE in full posterior prop
large shift over extended UE to throw CL UE into posterior prop position
24
Q
what fxnal task involves long sitting?
A
dressing
25
when dressing, should we start on the stronger or weaker side first?
the weaker side first
26
t/f: dressing can be easier by having the right posture using pillows, blankets, and towels can help get the right position
true
27
what might make dressing easier?
using pillows, blankets, towels
adding straps or bedrails
using a reacher or dressing stick
28
what is the technique involved in supine to short sit?
from long sit, use biceps (C5) with wrist ext (C6), and elbow ext (C7) to push leg closest to the edge towards the edge, keep weight on the opposite hand or elbow
utilize same techniques to maneuver opposite leg towards edge of mat until off the mat
push trunk upright from propped elbow position to come to short sit
29
how can we use momentum to get from short sit to supine?
from sitting at the edge of the bed/mat, use rocking momentum while holding LEs and quickly “throw” LEs onto the bed
can use leg straps to keep the legs together and to hook onto
30
how can we lower from LSP to supine?
after moving from SSP to LSP, can slowly lower from LSP into supine w/BUE support
use of bed rails and/or lower onto bed with head elevated to make easier when training
31
what is an important thing to use in transfers for all cervical levels C5 and below?
momentum!!!
32
what is the expected outcome for bed mobility for SCI C1-4?
Dependent for all bed mobility
33
what is the expected outcome for bed mobility for SCI C5?
Max-dependent
34
what is the exceptional outcome for bed mobility for SCI C5?
Min-mod A using leg loops
35
what is the expected outcome for bed mobility for SCI C6?
Min-mod I with leg loops
36
what is the exceptional outcome for bed mobility for SCI C6?
Independent with no adaptive equipment
37
what is the expected outcome for bed mobility for SCI C7?
Mod I for all bed mobility
38
what is the expected outcome for bed mobility for SCI C8?
Mod I for all bed mobility
39
what is the expected outcome for transfers for SCI C1-4?
Dependent, usually require mechanical lift
40
what is the expected outcome for transfers for SCI C5?
Max-dependent with slide board
41
what is the exceptional outcome for transfers for SCI C5?
Min-mod A with slide board on even surfaces
42
what is the expected outcome for transfers for SCI C6?
Min-mod I with slide board
43
what is the exceptional outcome for transfers for SCI C6?
Independent on even surfaces w/o slide board
44
what is the expected outcome for transfers for SCI C7?
Independent on even surfaces no slide board
45
what is the exceptional outcome for transfers for SCI C7?
Independent on all uneven surfaces with no slide board
46
what is the expected outcome for transfers for SCI C8?
Independent with all even and uneven surfaces
47
for WC propulsion, what is the ideal technique?
using a semi-circular technique
48
t/f: when propelling a WC, you should use long, smooth strokes with a large contact angle
true
49
what shoulder motions should be avoided with WC propulsion?
shoulder IR and abduction with fw flexion
50
why does WC use increase chance of injury and pain in the shoulder?
WC propulsion is a highly repetitive, BL WBing activity that places high demand on the upper limbs
51
what are the ideal stroke patterns for WC propulsion?
Semicircular (goal)
Arc
Single loop over
Double loop over
52
how do we perform a wheelie?
start with your hands at the 10 o’clock position on the wheel
push the rear wheel fwd quickly by moving your hands to the 2 o'clock position
this quick movt will lift the caster wheels of the ground
53
how is a wheelie maintained?
maintain the center of mass
utilize fw/bwd trunk lean to remain over COG
54
how can a pt ascend a curb in a WC?
approach the curb with high speed
prior to reaching curb, pop into wheelie to get front casters on curb
lean trunk fwd, place hands on back of handrims and push fwd to get drive wheels up onto the curb
55
how can a pt descend the crub in a WC?
prior to reaching the curb, pop up into a wheelie
while maintaining the wheelie and let the handrims slowly glide through your hands to control the descent
56
what are the types of pressure relief?
dependent
fwd
lateral
push up
57
when is dependent pressure relief usually performed?
in a power WC or tilt in space
58
when doing dependent pressure relief, the WC should be tilted back how many deg for how long?
about 45 deg for 2 min
59
how is fwd pressure relief performed?
max fwd lean with elbows on their knees, or hands to ankles, to fully off weight the sacrum, and ischial tuberosities
to return to sit, it may require that a pt walk their hands back up their legs, or hook on the handle of the chair to pull up with their biceps
60
when is lateral pressure relief used?
for pts with limited spinal mobility or ROM restrictions
61
how is lateral pressure relief performed?
lateral lean over the WC to relieve pressure on the opposite ischium
can use surface beyond armrest to further the weight shift
to return, the pt can hook onto the opposite arm rest or push handle
62
how long should lateral pressure relief be performed?
2 min each side
63
what ms must have adequate strength to perform push-up pressure relief?
triceps
64
how is the push-up pressure relief performed?
hands are placed lateral to the buttocks on seat, armrest, or rims
elbow extension and should depression until the buttocks is cleared, and held
65
how often should we be telling our pts to perform pressure relief techniques?
2 hrs
66
every ms of the trunk is both a ____ ms and a ______ ms
respiratory, postural
67
what abdominal ms is very important in the soda pop model for postural control?
the diaphragm
68
when faced with conflict, will the diaphragm always choose respiration or posture?
respiration
69
t/f: when their is an increased need for respiratory fxn, posture will decrease
true
70
postural control is required for what things?
strengthening of residual abdominals
coordination of respiratory and postural control need for fxn
facilitation of anticipatory and reactive postural control responses
maximization of fxn in short and long sitting for dressing, mobility, and transfers
71
what will we often see w/o UE control in SCI?
unstable shaking of the trunk/head
72
what would lead you to want to work on postural control in a pt with SCI?
results from the FIST show imbalance in sitting
73
why is sitting balance important in SCI?
ms responsible for postural control are impaired in SCI
sitting balance correlates to independence (esp transfers)
74
what is the progression of sitting balance?
Static sitting on firm surface--> static sitting on unstable surface--> dynamic balance on firm surface-->dynamic balance on unstable surface
75
what are the levels of ambulation in SCI?
non-ambulator (option for standing)
ambulates for exercise
part-time ambulatory
full-time ambulator
76
what are the considerations for walking after SCI?
if it's functional based on energy expenditure and their environmental setup
if it's safe
if it's realistic based on time, body habitus, and pt goals
financial considerations
77
what are the criteria for walking after SCI?
express desire to ambulate with appropriate goals
body weight not exceeding 10% of ideal weight
ROM available
intact skin
stable CV system
independent fxn at the WC level
78
how much hip ext ROM is needed for walking after SCI?
5 deg
79
how much knee ext ROM is needed for walking after SCI?
full knee ext
80
how much ankle DF ROM is needed for walking after SCI?
5-15 deg
81
how much passive SLR ROM is needed for walking after SCI?
110 deg
82
what are the 4 categories of ambulation?
standing only
exercise
household
community
83
what is an exercise ambulator?
ambulates short distances
84
what is a household ambulator?
ambulates inside the home or work
uses WC much of the time
85
what is a community ambulator?
independent on all surfaces
doesn't use WC
86
what part of the ASIA exam is important in determining ambulation ability after SCI?
ASIA LE motor score at 30 days post injury
87
if a complete paraplegic SCI pt has an LEMS of 0, what is the % chance that they will walk?
<1%
88
if a complete paraplegic SCI pt has an LEMS of 1-9, what is the % chance that they will walk?
45%
89
what is the total % chance that a complete paraplegic SCI pt will walk?
5%
90
if an incomplete paraplegic SCI pt has an LEMS of 0, what is the % chance that they will walk?
33%
91
if an incomplete paraplegic SCI pt has an LEMS of 1-9, what is the % chance that they will walk?
70%
92
if an incomplete paraplegic SCI pt has an LEMS of 10-19, what is the % chance that they will walk?
100%
93
if an incomplete paraplegic SCI pt has an LEMS of 20 or greater, what is the % chance that they will walk?
100%
94
what is the total % chance that an incomplete paraplegic SCI pt will walk?
76%
95
if an incomplete tetraplegic SCI pt has an LEMS of 0, what is the % chance that they will walk?
0%
96
if an incomplete tetraplegic SCI pt has an LEMS of 1-9, what is the % chance that they will walk?
2%
97
if an incomplete tetraplegic SCI pt has an LEMS of 10-19, what is the % chance that they will walk?
63%
98
if an incomplete tetraplegic SCI pt has an LEMS of 20 or greater, what is the % chance that they will walk?
100%
99
what is the total % chance that an incomplete tetraplegic SCI pt will walk?
46%
100
which SCI pt is most likely to walk: complete paraplegia, incomplete paraplegia, or incomplete tetraplegia?
incomplete paraplegia
101
t/f: w/an ASIA A injury that persists for longer than a month, there is a 96% chance it will remain complete
true
102
what factors are associated with a good px and walking ability after 1 yr post injury?
preservation of pinprick sensation in LE or sacral region
103
what factors are considered in the clinical prediction rule for ambulation after SCI?
age <65 yo
motor score of quads (L3) and gastroc (S1) BL
light touch sensation at L3 and S1
104
what is the primary predictor of recovery in SCI?
injury severity
105
order the ASIA levels from most likely to recover to least likely to recover?
D, C, B, A
106
t/f: the more complete the SCI, the less likely they are to recover
true
107
is an ASIA A likely to regain the ability to walk?
no :(
108
what is the chance that an ASIA B will regain ability to walk?
33%
109
what is the chance that an ASIA C will regain ability to walk?
65%
110
____ has been shown to be a significant factor in walking recovery
time
111
t/f: longer time out from dx to NSCI ASIA exam is associated with poorer px
true
112
the ability to use KAFOs and an AD at 1/2 the normal gait speed requires __x the consumption of O2 and utilizes ___x the amount of calories compared to normal controls
6, 10
113
t/f: speed and energy costs of WC propulsion in a properly fit light-weight manual WC is similar to normal walking
true
114
what is the expected fxnal outcome for a SCI C8 or higher?
non-ambulatory
115
what is the expected fxnal outcome for a SCI T1-T9?
unlikely to finally walk
may walk for exercise with lofstrand crutches and BL HKAFOs (higher) or KAFOs (T7-9) w/ or w/o assistance
116
what is the expected fxnal outcome for a SCI T10-L2?
independent within the home
very limited in the community with lofstrand crutches and KAFOs
almost all individuals choose WC due to high energy costs of walking
117
what is the expected fxnal outcome for a SCI L3?
MOd I in the home
potential for independence in the community w/lofstrand crutches or walker and KAFOs
(possible to use AFOs if quads are >/=4/5)
118
what is the expected fxnal outcome for a SCI L4?
mod I in the home
potential for independence in the community with lofstrand crutches or walker with high demand on the UEs, use of AFOs
119
what is the expected fxnal outcome for a SCI L5?
independent community ambulation with lofstrand crutches or standard canes
use of DF-stop AFOs indicated to stop excess ankle DF in late stance
120
what is the expected fxnal outcome for a SCI S1?
independent community ambulation with no AD or standard canes
may require DF-stop AFOs depending on deg of ankle PF strength
121
t/f: L4 and higher levels of lesion will typically choose WC for community distances due to energy requirements and stress on UEs
true
122
the type of orthosis required will depend on what two factors?
level of injury
completeness of injury
123
what clinical decision-making tool can we use to make decision on bracing in SCI?
Rancho R.O.A.D.M.A.P
124
what is the optimal stance for locomotion in SCI?
tripod position
stability through the Y ligs
achieve hyperextension at the hips
125
what would cause the tipping point for complete SCI in stance?
immediate loss of balance due to trunk transitioning too far anterior due to lack of spinal extensors
126
what is involved in the PT exam post SCI?
aerobic capacity/endurance
integ integrity
mental fxn
motor fxn/ms performance
pain
ROM
reflex integrity
assistive technology
balance (sitting vs standing)
gait
mobility (WC, bed, transfers, sit to/from stand)
127
what are the highly recommended outcome measures for pts with complete SCI?
ASIA impairment scale
handheld myometry
WHO BREF
128
what are the highly recommended outcome measures for pts with incomplete SCI?
6MWT
10mWT
ASIA impairment scale
handheld myometry
TUG
walking index for SCI II
WHO BREF
129
what is the avg length of acute care stay for a complete quadriplegic SCI?
21 days
130
what is the avg length of acute care stay for a complete paraplegic SCI?
13 days
131
what is the avg length of acute care stay for an incomplete quadriplegic SCI?
10 days
132
what is the avg length of acute care stay for an incomplete paraplegic SCI?
10 days
133
what is the avg length of inpatient rehab for a complete quadriplegic SCI?
56 days
134
what is the avg length of inpatient rehab for a complete paraplegic SCI?
35 days
135
what is the avg length of inpatient rehab for an incomplete quadriplegic SCI?
35 days
136
what is the avg length of inpatient rehab for an incomplete paraplegic SCI?
26 days
137
what are the major issues in SCI care in the acute care hospital?
neurological, medical, and orthopedic status
prep for transfer to inpatient rehab (promote tolerance to therapy)
138
what are the major issues in SCI care in inpatient rehabilitation?
fxnal status
prevention of secondary oathologies
prep for discharge to home
139
what are the major issues in SCI care in in-home rehabilitation?
fxnal status
prevention of secondary pathologies
adaptation to home environment
140
what are the major issues in SCI care in outpatient rehab?
fxnal status
optimization of fitness and wellness
integration into community environments
141
b4 beginning your exam or interventions, what medical management need to be taken care of?
pt medical stability, ventilatory status, and autonomic stauts
fx site(s) sufficiently stable
must be clear on precautions
142
what precautions may we have to be aware of in the SCI population?
spinal instability, required orthotic devices
concomitant injuries, movt, or WBing restrictions
need for medical
restricted movts or positions
143
what is involved in acute care management of SCI?
prevention of secondary complications
improve/maintain strength of muscles above lesion level
optimize respiratory fxn
assist with cough and secretion clearance
pt/fam education
prepare for discharge to next level of care
144
what are the leading causes of mortality in SCI patients?
respiratory infections
urinary tract infections
145
how do we address respiratory fxn?
deep breathing
glossopharyngeal breathing
air shift maneuver
stretching/strengthening exercise
assisted cough
abdominal support
146
what is involved in prevention of secondary complications in SCI care?
integumentary health
maintain/improve ROM
improve tolerance to upright
147
what is the purpose of respiratory hygiene?
to prevent respiratory complications and treat pulmonary infections
148
what are the various ways a pt with SCI may maintain clear airways?
manual cough
self-manual cough
glossopharyngeal breathing
postural drainages
suctioning (respiratory therapy)
149
what is involved in outpatient SCI care?
progression from inpatient rehab to improve ROM, prevent secondary complications, teach fxnal mobility skills
prepare for independent fxn in the home and community
sit foundation for lifelong wellness
150
what can we do to prepare pts for lifelong wellness?
shoulder health
CV health
independent pressure relief
ROM program
bone density maintenance
151
what is the difference bw compensation and recovery?
compensation uses different techniques to accomplish a task and maximize what abilities are left
recovery is trying to restore maximization of everything not just relying on what's left
152
what is the goal of compensatory training?
teach techniques to move the body using musculature and motor control (preserved motor fxn)
153
what are the principles involved in compensatory training?
momentum
muscle substitution
takes modification
working in and out of task
154
t/f: pts benefit from both task-specific skills training and out of task impairment focused training in SCI
true
155
what is the goal of recovery training?
development of normal movt patterns to perform fxnal tasks
156
t/f: recovery training utilizes neuroplastic principles at the level of the SC
true
157
as a reminder, what are the neuroplastic principles?
use it or lose it
use it and improve it
salience matters
intensity matters
repetition matters
time matters
specificity matters
age matters
transference
interference
158
what are the principles involved in recovery training?
tap in into neuroplasticity
CPGS to assist with activation of LE mss
intervention at the activity and impairment level
159
what are the key UE mss to strengthen?
SA
pecs
RC
lats
triceps
160
the dosage for UE strengthening is based on what?
60-80% 1RM
161
when should we consider using gravity eliminated positions for UE strengthening?
when ms is <2/5
162
t/f: UE strengthening can be done in fxnal positions
true
163
what are some UE focused CV exertion interventions?
UE ergometer
WC propulsion
swimming
FES biking
locomotion
164
is the sympathetic NS is damaged, what VS should we use?
RPE
165
what is the RPE goal with CV exercise?
13-17
166
what is the HRmax goal with CV training?
50-80%
167
t/f: bed mobility should be performed from firm to progressively more compliant surfaces
true
168
what strategy can we use with bed mobility training?
PNF
169
what is bed mobility training inclusive of?
rolling
transitioning supine to/from sitting
prone on elbows
supine on elbows
c sitting
long sit from supine (straight)
170
transfers are dependent on ___ ability
sitting
171
should we start transfers w/ or w/o initial support and assistance?
with support and assistance
172
what is one of the most critical things to teach SCI pts to aid in transfers?
the head hip relationship
173
what is the head hip relationship?
to facilitate moving the hips where you want them to go, move the head in the opposite direction
174
t/f: we should work in part to whole tasks practice with transfer training in SCI
true
175
what are the benefits of prone positioning?
it prevents hip flexion contracture
it activates posterior chain
it reduces lung compression for efficient gas exchange
176
what are the benefits of quadruped positioning?
it promotes UE WBing
it develops core activation and hip stabilization
it improves intra-interlimb coordination
177
what are the benefits of standing in SCI?
rescue risk of bone osteoporosis
decrease risk of pressure sores
spasticity management
improved fxn of digestive system
improved CV/resp fxn
178
what equipment may be used to get pts with SCI standing?
tilt table
standing frame
standing WC
179
what is a contraindication for standing with SCI?
low bone density
180
when should a DEXA scan be required to stand a pt?
if they haven't stood in the past 4 months
181
when should pt ed begin?
very early after the injury and continue throughout recovery
182
what should be involved in pt ed?
medical complications
skin care
AD
sexuality
WC maintenance
183
what are the principles of acute phase rehab?
therapy focuses on resp fxn, selectively maintaining jt ROM, and preventing skin breakdown
184
when can out of bed activities, including fxnal mobility and orientation to vertical, begin in acute phase?
once pt is medically stable and spinal stability has been achieved
185
what are the principles of rehab phase?
the focus of therapy is on physical skill training, WC skills, SCI ed, home and environmental modifications, driver training, vocational training, FES for ther ex, and body weight supported ambulation training on a treadmill
186
what are the principles of the chronic phase?
adjustment to disability, QOL, and late neurologic decline are the major concerns
