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26 Cards in this Set
- Front
- Back
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Motions and Muscles with C4 pt
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Full: Traps
Partial: Rhomboids, Lev Scapulae, & Supraspinatus Motions: Down Rotation, Elevation, Retraction |
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Motions and Muscles with C5 pt
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Full: Rhomboids and Lev Scap
Partial: SA, RC, Deltoid, Biceps, Pec Major, brachialis, brachioradialis Key Differences: -Protraction -Slight Scap Stability to hold oneself up -Partial shld mvmt -Partial bicep strength Weak GH jt stability |
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Motions and Muscles with C6 pt
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Full: RC, deltoid, Biceps and forearm flexors
Partial: Lats Dorsi, SA, Coracobrachialis, wrist extensors, pec minor Key Differences: Extend elbow passively with shoulder musculature -Full bicep strength -Fxn Shld and Scapular Stability - |
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Motions and Muscles with C7 patient
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Full: SA, Coracobrachialis
Partial: Pec Major, Wrist Flexors, Wrist extensors, Triceps Key differences: Use of Tricep for arm extension -Better sitting p/u with full SA -Maintain tenodesis grip in C5-C7 pts |
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Motions and muscle with C8 pt
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Full: Lats Dorsi, Triceps, Wrist Extensors, Pecs
Partial: Finger Flexors--lumbricales & interossei Key Differences: Full tricep strength -Use fist with sitting p/u to get higher off mat b/c now have good co-contraction |
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What is the anatomical definition and clinical significance of a fully innervated mm?
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-All of the nerve roots that supply a muscle are intact, giving the muscle a 5/5 with MMT
-Clinically, a muscle is able to perform multiple reps, able to go against resistance, and pt is able to be more functional with their mvmts instead of depending on momentum to move a body part |
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Anatomical definition and clinical significance of a partially innervated muscle
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-The caudal nerve root has been damaged and the muscle will test as a 3/5.
-Pt is able to lift the limb AG but not pick things up & decreased ability to do multiple reps -Joint instability will likely be present |
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Hallmark C4
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-Unstable scapula
-Dep on most bed mobility -Can shrug shlders -Some retraction -no fxn innervation of UE joints -Use head/neck motions & strength to assist caregiver |
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Hallmark C5
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-More GH jt stability & some scapular stability
-Likely need bracing for wrist & hand d/t lack of ECRL, ECRB, and brachioradialis -At risk for shld problems d/t GH instability and elbow flexion contractures -Able to get their arm into position to extend their elbows passively in sitting using shoulder shrug and ER--may need assist placing hand -Can achieve CKC elbow ext with deltoids and RC to maintain sitting balance -Most cannot do sitting p/u -Can move hand toward and away from body |
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Hallmark C6
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-GH joint more stable & more potential for UR
-Almost reach overhead with partial SA -Can place UE's for sitting p/u and can extend elbows with distal fixation for effective mobility -Can use wrist extensors(especially radial side) slightly--WC propulsion -More Scap stability -Can upwardly rotate to get arm higher overhead |
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Hallmark C7
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-Fully innervated SA provides scapular stability for Open and CKC
-Active elbow ext with triceps -Get more lats here for increased height on sitting p/u -Actively & fully extend wrist |
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Hallmark c8
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-Stable co-contraction @ the wrist so they are able to WB through it in a fist
-Dont need to conserve tenodesis grip -Limited finger mvmt & dexterity -Full lats and triceps for strong scap depression resulting in very good sitting p/u |
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T1
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Fully innervated
-Full finger ext and dexterity d/t innervated finger intrinsics |
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Rules for MMT with SCI pts
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1. Test 1st in gravity minimized position
2. Stabilize joints above and below as well as joint being tested to assure compensations are not being used |
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When testing wrist ext MMT what is a key sign that C6 is intact and C7 is not
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Wrist ext will deviate radially bc ECRL &B are innervated here
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When testing what will show that a muscle doesnt quite have 5/5 strength
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Muscle will fatigue easily with multiple reps
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Give 4 muscles of respiration and cord levels
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1. Diaphragm (C3-C5)
2. Intercostals (T1-T12) 3. Accessory mm: scalene, pecs, SA & SP 4. Abdominals (T6-T12): Obliques, TA, Rectus Abd |
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Explain mechanics of inspiration
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-Diaphragm flattens & drops to draw air into lungs
-Intercostals & accessory mm's stabilize ribs to prevent them from being drawn downward & causing paradoxical breathing pattern -Abs provide support to the abdominal viscera, which supports the diaphragm--diaphragm cant drop if abdominal viscera does not distend forward--which is allowed by eccentric contraction of abdominals--if abdominals are weak diaphragm will ride lower and have less distance to create inspiration |
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Explain mechanics of Expiration
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-Decrease chest volume to expel air
-Abs push abdominal viscera back in and up causing diaphragm to rise pushing air out of the lungs -Intercostals draw the ribs together, depresses the rivs, and reduces AP and ML dimensions of thoracic cavity -Diaphragm contracts eccentrically for 2/3 of expiration against contents of abdomen--slows flow of air from the lungs which is important in phonation |
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Describe an ineffective cough
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-Loud, forceful cough 2x
-Can clear the airway if trachea is blocked or when secretions need to be cleared |
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Give 4 Phases of coughing
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1. Max inhalation
2. Glottis closure 3. Contraction of the mm of forced expiration with glottis closed 4. Contd forced expiration with glottis open |
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What are the parts of a respiratory exam?
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1. Observe respiratory pattern: divide motion into four parts according to what region she breathes with the most b/t diaphragmatic, intercostal, and accessory
2. RR--normal 12-16 bpm 3. Chest excursion/vital capacity: measure for max inhalation & exhalation--should have at least 2 in b/t max inhale & exhale 4. Posture: Avoid kyphotic posture & posterior pelvic tilt 5. Cough--number, volume, and sound are indicators for effective cough--they need to be able to move secretion 6. Auscultation |
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Respiratory Goals of PT
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1. Effective Air exchange
2. Prevent Pneumonia, Atelectasis(effective cough)--could result from lying for too long or ineffective cough 3. Ventilatory support for phonation |
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Give 6 treatments to maximize breathing
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1. Work on proper breathing sequence
2. Strengthen weak inspiratory mm's 3. Inc amt of air exchange 4. Chest mobilization--stretching for tight mm's 5. Air Shifting--esp for paradoxical breathing pattern 6. Manual Techniques for self assitive cough |
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What does visible contraction of the SCM and scalenes during inhalation indicate?
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Weak diaphragm
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What is a paradoxical breathing pattern?
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A decrease in chest excursion during inhalation--indicates intercostal functioning is poor
-treat with Air Shifts |
