Week 5- SCI Treatment Considerations Part 2 Flashcards
(98 cards)
1
Q
PART 1: PHYSICAL ACTIVITY
A
PART 1: PHYSICAL ACTIVITY
2
Q
Physical Activity After SCI:
- __ strength, endurance, mobility, sleep, self-image, blood lipid profiles
- __ risk of premature mortality
- __ anxiety, loneliness, depression, stress, heart disease, BP, respiratory illness, diabetes, obesity, and other medical complications
A
- ↑
- ↓
- ↓
3
Q
What are some methods we implement physical activity with SCI patients?
A
- arm ergometry
- FES UE or LE cycle
- WC propulsion
- adaptive rowing machines
- adaptive biking
4
Q
What are the (2) primary guidelines for SC physical activities?
A
- Cardiovascular fitness and muscle strength
- Cardiometabolic health benefits
5
Q
Cardiorespiratory Fitness and Muscle Strength:
- ____ minutes mod-vigorous intensity aerobic exercise _x/week.
- __ sets of strength exercises _x/week for each major functioning muscle group with mod-vigorous intensity.
A
- 20 minutes mod-vig aerobic 2x/week
- 3 sets mod-vig strength exercises 2x/week
6
Q
Cardiometabolic Health:
-___ minutes _x/week of mod-vigorous intensity aerobic exercise.
A
-30 minutes 3x/week
7
Q
Be sure to take any of the following into consideration when looking at changes that can occur after an SCI:
- Musculoskeletal = decreased _____________
- Respiratory = decreased _____________
- Cardiovascular = ________________
- ANS = _____ regulation and impaired ___________
A
- Musculoskeletal: decreased bone density
- Respiratory: decreased pulmonary reserve
- Cardiovascular: orthostatic hypotension
- Autonomic nervous system: temperature regulation, impaired sweat glands
8
Q
For anyone with an injury at ____ or above, we should be concerned of ANS dysfunction.
A
-T6
9
Q
- Do individuals with tetraplegia and high paraplegia experience blunted HR response to low activity and a low VO2 peak?
- What may be warranted?
A
- Yes
- Vascular support (TED stockings, abdominal binder) may be warranted
10
Q
Contraindications to Exercise Testing and Training in SCI. (7)
A
- Autonomic Dysreflexia
- Severe or infected skin on weight bearing surfaces
- Symptomatic hypotension
- Urinary tract infection
- Unstable fractures
- Uncontrolled hot/humid environments
- Insufficient ROM to perform exercises task
11
Q
PART 2: MANUAL WHEELCHAIRS
A
PART 2: MANUAL WHEELCHAIRS
12
Q
Picking out a WC….
- What_________is used in fabricating the wheelchair frame.
- What_______or design of the frame is chosen.
- What________are included.
- What________are available.
A
- material
- shape
- components
- adjustments
13
Q
What is the primary goal of WC prescription?
A
-Finding the combination of parts that produces the LIGHTEST wheelchair.
14
Q
Why do we want a lightweight WC?
A
-Less force needed for propulsion, less stress on shoulders.
15
Q
- What must a WC be made out of to be considered an Ultra-Lightweight Manual WC?
- What are the wheelchairs called?
- Why are titanium WCs more common than carbon fiber?
A
- Titanium or carbon fiber (titanium more common, carbon fiber lighter)
- K0005 (or K5)
- Carbon fiber is more expensive, material is more difficult to shape, less impact resistance (doesn’t minimize vibration)
16
Q
In regards to K5 WCs, what are the types of frames? (3)
A
- Box frame
- Cantilever frame
- Folding frame
17
Q
- What is the difference between a box frame and cantilever frame?
- What is the good things about folding frames?
A
- Cantilever folds in half differently and tends to be easier to travel around.
- Footrests are swing-away in folding frame.
18
Q
What are the 3 main types of cushions?
A
- Air
- Gel
- Hybrid
19
Q
Air Cushion:
- _________ level of protection for skin
- Comes in low-, mid-, high-grade
- ______ maintenance, can pop.
- More disruptive to ___________.
A
- highest
- high maintenance
- posture
20
Q
Gel Cushion:
- ____ protective of skin, but still highly superior to typical foam cushions
- _____ maintenance
A
- less protective of skin
- less maintenance
21
Q
Hybrid Cushion:
- Combination air or gel and _______.
- Offers additional stability over ________ thighs.
- Good option for patients who need air but struggle with postural implications.
A
- foam
- posterior thighs
22
Q
- If you patient has skin breakdown or a history, which cushion will they use?
- What are the biggest cons to this?
A
- Air Cushion
- Often pop, low stability in regards to support
23
Q
Which cushion is better for postural support?
A
-Gel Cushion
24
Q
Which cushion offers stability over the posterior thighs?
A
Hybrid Cushion
25
What are the 3 types of back rests?
- Low Back
- Mid Back
- High Back
26
Low Back:
- _______ supportive.
- Allows for _____ upper trunk movement.
- Least likely to get in way of _________.
- least supportive
- full
- propulsion
27
Mid Back:
- Extends to just below ___________ of scapula.
- May get in way of ________ movements.
- inferior angle
| - scapular
28
High Back:
- ______ supportive.
- Restrictive to scapular movement and certain _________ movements.
- most supportive
| - shoulder
29
- Each height option for backrests also come with different options for _______.
- What are the 2 options?
- DEPTH
| - Lateral and Deep
30
- _______ depth has minimal lateral support to trunk and allows for more freedom of trunk movements.
- ______ offers much more lateral support but is more restrictive?
- Lateral
| - Deep
31
What is one way we can offset instability provided from someone who is using air roho cushion?
-Lateral support to help with postural sway.
32
What are the 3 types of armrests?
- None
- Swing-away
- Flip-back
33
Armrests (None):
- For more _________ wheelchair users.
- Offers more freedom of movement, but lose benefits of armrest (stability, ___________ surface).
- advanced
| - push up surface
34
Armrests (Swing-away):
- Easiest to operate, do not need _______/______.
- Unable to attach trough or table if needed.
-wrist/hand
35
Armrests (Flip-back):
- Need adequate ______ and ______ use.
- More versatile - Able to attach trough or table.
-hand and finger
36
What are the 2 types of Footrests?
- Rigid
| - Swing-away
37
Footrests (Rigid):
- _____ maintenance.
- Extra thing to maneuver feet around during transfers.
-Less maintenance
38
Footrests (Swing-away):
- Ideal for individuals participating in ____ trials.
- Need adequate ______ and _______ function to operate.
- gait trials
| - hand and wrist
39
What are the 3 considerations when looking at wheels?
- Rubber
- Air
- Push-Rims
40
- ________ wheels are the lighter option and provide for a smoother ride but have more maintenance and can pop.
- -_________ wheels are the heavier option but have way less maintenance.
- _________ allow for easier propulsion and can build up to compensate for weaker grip. They also make the chair wider and can make it difficult to negotiate tight spaces.
- Air
- Rubber
- Push-Rims
41
Casters:
- ______ casters are more lightweight.
- ______ casters are beneficial when frequently negotiating outdoors/rough terrain.
- Small
| - Large
42
What does deciding on WC parts come down to?
-Patient capabilities, patient limitations, and patient preferences.
43
PART 3: POWER WHEELCHAIRS
PART 3: POWER WHEELCHAIRS
44
What are the 3 primary drive systems?
- Rear-wheel
- Mid-wheel
- Front-wheel
45
- The primary consideration with power wheelchairs is the _________ which includes 360-degree turning circumference and turning radius.
- What is 360-degree turning circumference?
- What is turning radius?
- Maneuverability (360-degree turning circumference and turning radius)
- Room needed to complete a full 360.
- How tight the are able to turn.
46
Rear-Wheel Drive:
- ________ 360-degree circumference and turning radius.
- ________ chair.
Mid-Wheel Drive:
- Most maneuverable, excellent _______ chairs.
- Fair maneuverability over ________ surfaces.
Front-Wheel Drive:
- _________ turning radius than mid-wheel, but excellent at navigating tight corners.
- Helpful with negotiating ______ terrain.
- largest
- fastest
- indoor
- outdoor
- larger
- rough
47
-Which power chair is the most stable on slopes? Why?
-Mid-wheel drive, because they are the only ones that have front and rear casters.
48
Power wheelchairs are for _______ spinal cord injuries and will always have high-back due to loss of trunk control.
-higher
49
What are some other power wheelchair considerations? (6)
- Head Array
- Sip and Puff
- Low-resistance joystick (Tongue control)
- Chin control
- Football post joystick
- Standard joystick
50
What are the 2 main ways to navigate a power wheelchair with arms or hands?
- Standard joystick
| - Football post joystick
51
What is the good thing about chin control and drawback of tongue control?
Chin control allows ability to talk and drink while tongue control does not.
52
- At what levels do we use sip and puff, tongue control, and chin control?
- At what level can we usually transition to using joystick control?
- C4/C5
| - C6
53
What is the last option for our highest injuries that have minimal to no movement below the neck?
-Head array
54
```
General WC Considerations:
___-___
-power WC
-head array, chin, tongue, or sip and puff controls
-portable respiratory may be attached
```
____
- Can use a manual chair with propulsion aids, but will likely need PWC for distance and energy conservation
- Sip and puff, chin, tongue or football post controls
____
-Manual wheelchair with friction surface hand rims
Should progress to independent on smooth surfaces
____
-Manual wheelchair with friction surface hand rims but increased propulsion ability
____
-Manual wheelchair with standard hand rims
- C1-C4
- C5
- C6
- C7
- C8
55
At what level do we consider full time use of manual wheelchair only?
C6 and down
56
PART 4: MODALITIES
PART 4: MODALITIES
57
What is Functional Electrical Stimulation (FES)?
-The use of electrical stimulation of the peripheral nervous system to contract muscles during functional activities.
58
What are the 2 main uses of FES?
- Independent Application
| - FES Dependent Application
59
Independent Application:
- Use of FES for a finite time period to minimize impairments and to encourage motor _________ in context of function.
- What is the expectation of independent application of FES?
- relearning
| - Patient will be weaned off of FES.
60
FES Dependent Application:
- This enables the patient to perform functional activities that wouldn’t otherwise be possible.
- "___________"
-"Neuroprosthesis"
61
What are the (4) indications for FES?
- UMN injury
- Absent/diminished motor function (focal/diffuse)
- Demonstrates active contraction when e-stim provided over motor point of muscle belly
- Able to tolerate stimulus provided by FES
62
RT300 FES Bike Indications/Uses:
- Relaxation of muscle _________.
- Prevention or reduction of _____ ______.
- Increasing local ______ ___________.
- Maintaining or increasing _________.
- Improve muscle ________ with intact innervation..
- spasms
- disuse atrophy
- blood circulation
- ROM
- endurance
63
RT300 FES Bike Considerations:
- Risk of raising _______ expectations.
- Difficult to predict outcome.
- Insufficient evidence for _______ and ______ of treatment.
- unrealistic expectations
| - duration and dosage
64
What are the contraindications for FES? (9)
- Lower motor neuron pathology
- Cardiac pacemaker
- Pregnancy
- Unhealed fracture in area
- Skin breakdown in area
- Internal stimulator near area (ex: Phrenic nerve/bladder stimulator)
- DVT in area
- Malignancy in area of treatment
- Uncontrolled autonomic dysreflexia
65
What are the relative contraindications for FES? (5)
- Absent sensory
- Severe spasticity
- Heterotopic ossificans
- Severe osteoporosis
- Chronic pain syndrome
66
PART 5: WALKING
PART 5: WALKING
67
What is the Lokomat?
-Robotic assisted BW treadmill system.
68
Is Lokomat training appropriate for complete or incomplete injuries?
-Both
69
What are the benefits of lokomat training in complete injuries?
-Upright benefits with standing
70
What are the benefits of lokomat training in incomplete injuries?
- Individually adjustable gait pattern and guidance
- Real-time biofeedback
- Neuroplasticity, CPGs
71
What are the main considerations with Lokomat training? (4)
- Realistic expectations/goals
- Hemodynamic stability
- Skin integrity
- Autonomic Dysreflexia
72
Lokomat Contraindications:
- Fixed LE __________.
- Considerably reduced _____ ________ (osteopenia or osteoporosis).
- Bone _________.
- Non-consolidate fractures, unstable spinal column, severe OP.
- Significant _________ disease/compromise.
- __________ concerns (uncooperative, aggressive behavior, agitation).
- ___________
- >_____lbs, >__ft __in
- contractures
- bone density
- bone instability
- cardiac
- behavioral
- >300lbs, >6ft 1in
73
What is a ReWalk?
-Exoskeleton device that enables the device user to sit, stand, walk, turn, and has the ability to climb/descend stairs.
74
Are ReWalk users able to independently operate the systems?
-Yes
75
Prerequisites for ReWalk Trials:
- Hands and shoulders can support ______/_______.
- Healthy ______ _______.
- No unhealed _________.
- Adequate __________ tolerance.
- No ______,_______,_______ comorbidities of concern.
- Height is between ___-___cm (5′ 3″ – 6′ 2″)
- Weight does not exceed ____ kg (220 lbs)
- crutches/walker
- bone density
- fractures
- standing tolerance
- cardiac, respiratory, autonomic
- 160-190cm
- 100kg
76
What is BWSTT?
-Bodyweight Supported Treadmill Training
77
Is this used for incomplete or complete injuries?
-Incomplete (ASIA B, C, or D)
78
BWSTT:
- BWSTT promotes spinal cord _______/_______ of spinal locomotor pools.
- Variable levels of loading.
- During early training, what do therapists help with?
- _____ frequency (__x/week).
- _____ duration (___-___ minutes).
- Typically __-__ weeks.
- learning/activation
- foot placement
- high frequency (4x/week)
- moderate duration (20-30 minutes)
- 8-12 weeks
79
What does progression with BWSTT look like in 4 steps?
- Decreased BWS
- Increased speed
- Eliminate manual assistance
- Progression to over ground locomotor training for community ambulation
80
What are some types of orthotics? (4)
- HKAFO (Hip-Knee-Ankle-Foot Orthosis)
- RGO (Reciprocating Gait Orthosis)
- KAFO (Knee-Ankle-Foot Orthosis)
- AFO (Ankle-Foot-Orthosis)
81
What 2 orthotics are mainly only used for SCIs?
- HKAFO
| - KAFO
82
What is the difference between a RGO and HKAFO?
- RGO consists of L and R HKAFO connected to a central pelvis section that has a reciprocating mechanism that acts as a pivot joint and spring loaded hip hinge.
- Causes momentum from reciprocating mechanism.
83
What are the 2 considerations with orthotics?
- Ambulation goals
| - Weight of orthosis
84
Home Modification Considerations:
- Ramps
- 1ft length/ __in hieght
- Doorframe Widths and Doors
- Width of WC seat +__in
- Easier to _____ door
- Door and Appliance Handles
- Consideration of patient's hand function
- Hallway Considerations
- More width required to allow turn in/out
- PWC: Consider _______ ______
- Ramps
- 1ft length/ 1in hieght
- Doorframe Widths and Doors
- Width of WC seat + 6in
- Easier to PUSH door
- Door and Appliance Handles
- Consideration of patient's hand function
- Hallway Considerations
- More width required to allow turn in/out
- PWC: Consider drive type
85
```
Home Modification Considerations:
-Surface considerations
-_______ vs ________
-Thresholds
Bathroom modifications
-Bathrooms tend to be VERY narrow/small
-_____/_____ height
-Tub shower vs. shower stall
-____ ____ are a must
Kitchen modifications
-Countertop type, height
-Appliance type, location
```
-Surface considerations
-Hardwood vs carpet
-Thresholds
Bathroom modifications
-Bathrooms tend to be VERY narrow/small
-Toilet/sink height
-Tub shower vs. shower stall
-Grab bars are a must
Kitchen modifications
-Countertop type, height
-Appliance type, location
86
- ___% of SCI employed after 1 year.
| - ___% of SCI employed after 20 years.
- 12%
| - 33%
87
PART 6: OUTCOME MEASURES
PART 6: OUTCOME MEASURES
88
What are the main outcome measures? (9)
- Multidimensional Pain Inventory – SCI Version(MPI-SCI)
- Satisfaction With Life Scale
- Reintegration to Normal Living Index (RNL)
- Penn Spasm Frequency Index
- Capabilities of UE Functioning Instrument
- Spinal Cord Independence Measure (SCIM)
- Wheelchair Skills Test
- Walking Index for SCI II (WISCI-II)
- SCI Functional Ambulation Inventory (SCI-FAI)
89
MPI-SCI:
- The MPI-SCI puts emphasis on subjective ______ and impact of ____ on patient's lives.
- What are the 3 sections?
- How long does it take to complete?
- Final score = ____ score
- High correlation with __________
- Moderate correlation with ___________ and ____________.
- distress and impact of pain
- Pain impact, Response by Significant Others, General Activities
- 20 minutes
- final score = mean score
- High correlation with Brief Pain Inventory (BPI)
- Mod correlation with Beck Depression Inventory (BDI) and Functional Independence Measure (FIM)
90
Satisfaction with Life Scale:
- Assesses satisfaction with patient's life as a whole.
- Quick easy ____-_______.
- Excellent validity with other scales assessing well-being and recommended to complement other scales.
- Scoring is from __-__ with higher scores being ______ satisfaction.
- self-report
| - 5-35, higher
91
Reintegration to Normal Living Index (RNL):
| -11 item (1-10) scale looking at patient's ability to do what?
-How patient is able to move around house/community for "Reintegration to Normal Living".
92
Penn Spasm Frequency Index:
- Self-report measure that assesses what?
- Best to use alongside __________.
- Grades from 0-4 with 0 being _______.
- Patient's perception of spasticity frequency and severity following SCI.
- Modified Ashworth Scale (MAS)
- no spasm
93
Capabilities of UE Functioning Instrument:
- Measures UE Functional limitations in individuals with _________.
- 32 item questionnaire with what 7 domains?
- tetraplegia
| - Unilateral (L and R) items, bilateral items, reaching, pulling/pushing, wrist function, hand and finger function
94
What are the (4) more commonly used outcome measures in SCI patients?
- Spinal Cord Independence Measure (SCIM)
- Wheelchair Skills Test
- Walking Index for SCI II (WISCI-II)
- SCI Functional Ambulation Inventory (SCI-FAI)
95
Spinal Cord Independence Measure (SCIM):
| -Score from 0-100 in what 3 domains?
- Self-care (6 items, 0-20)
- Respiration and sphincter management (4 items, 0-40)
- Mobility (9 items, 0-40)
96
Wheelchair Skills Test:
- Comprehensive, objective WC mobility assessment.
- _______ or ______ versions.
- >___% = advanced WC skills
- manual or power versions
| - >60% = advanced WC skills
97
Walking Index for SCI II (WISCI-II):
- Rank orders ability to walk ___m after SCI from most to least severe impairment.
- What are some considerations?
- 10m
| - Amount of assistance, AD, braces
98
SCI Functional Ambulation Inventory (SCI-FAI):
- Observational _____ assessment.
- What are the3 subscales?
- gait assessment
| - Gait parameters (20pts), Assistive device (14pts), Temporal distance (5pts)
