Sci-Lecture 3

Front 1

What are 6 consequences to SCI (long term management)?

Back 1

1) Skin care
2) Osteoporosis
3) Spasticity
4) Pain
5) Management of musculoskeletal overuse
6) Adjustment

Front 2

What are 3 components of a skin care program after SCI?

Back 2

1) Procedural--interventions
2) Education--teach
3) Coordination--team professionals

Front 3

What are 2 procedural interventions for skin care after SCI?

Back 3

1) Examine pressure areas and problem solve where sore came from
2) Positioning

Front 4

What are 3 educational interventions for skin care after SCI?

Back 4

1) Bowel and bladder--consequences of incontinence
2) Teach how to adjust cushion in WC
3) Teach how to examine skin since at risk for breakdown

Front 5

How often should you change positions in bed?

Back 5

Every 2hrs

Front 6

How often should you change positions if pressure sore is present?

Back 6

Every 15 minutes

Front 7

What 3 coordination interventions would you use for SCI pt?

Back 7

1) WC cushions
2) How to move at night
3) Mattresses

Front 8

What type of SCI pts have more pronounced osteoporosis?

Back 8

ASIA A/Bs who have flaccid paralysis

Front 9

What is the amount of bone loss proportional to?

Back 9

Immobility

Front 10

What must you do before treadmill training?

Back 10

Screen for osteoporosis

Front 11

When are SCI pts at highest risk for osteoporosis?

Back 11

First 6 weeks after injury--level out in loss after 1 year

Front 12

What is the most common location for osteoporosis in SCI pts?

Back 12

Distal femor and proximal tibia

Front 13

What is osteoporosis due to in SCI pts?

Back 13

Disuse

Front 14

What is the bone mass like for a paraplegic?

Back 14

Increase in bone mass in UE

Front 15

What is the bone mass like for tetraplegic?

Back 15

Decrease in bone mass in UE depending on use with WC

Front 16

What are the signs and symptoms of fractures in SCI pts? (4)

Back 16

1) Redness
2) Swelling
3) Heat
4) Bruising

Often patient won't notice it

Front 17

What diet must a SCI pt with osteoporosis follow?

Back 17

Balanced diet with enough protein (no extra calcium since prone to kidney stones)

Front 18

What are 2 experiences of spasticity with SCI pts?

Back 18

1) Resistance to motion (passive or active)
2) Involuntary contractions

Front 19

What 2 things are resistance to motion due to?

Back 19

1) myoplastic hyperstiffness--change in muscle origin
2) neural changes--due to changes in stretch response or length of muscle

Front 20

What are 3 types of involuntary contractions (spasms) that can occur in SCI pts?

Back 20

1) Clonus
2) Flexor spasms
3) Extensor spasms

Front 21

What is clonus?

Back 21

Continual muscle contraction after a quick stretch

Front 22

How can you stop clonus once it occurs? (2)

Back 22

1) WB through limb slowly
2) Unwt the limb

Front 23

What are extensor spasms triggered by?

Back 23

Extension at the hip when lengthened (change in length of the hip flexors)

Front 24

How do you test for extensor spasms with SCATS?

Back 24

Test pt in supine:
Pick up their leg PROM knee/hip in flexion and slowly lower leg down to feel spasm

Measure strength of it and how long it lasts

Front 25

How can you stop extensor spasms?

Back 25

Get pt into flexion

Rock leg in IR/ER in order to bend knee

Front 26

What are functional consequences to extensor spasms? (4)

Back 26

1) Long sitting
2) Bed mobility
3) Dressing
4) Transfers

Front 27

What are flexor spasms triggered by?

Back 27

Exaggerated flexor withdrawal response

Front 28

How do you measure flexor spasms using SCATS?

Back 28

Pin prick on foot and measure the degrees of joint motion rather than duration of spasm

Front 29

What are the functional consequences to flexor spasms?

Back 29

1) In the shower with water hitting feet
2) Transfers

Front 30

What type of spasms often wake up SCI pts at night?

Back 30

Flexor spasms

Front 31

What scales are used for spasticity?

Back 31

1) MAS
2) Tardieu
3) SCATS

Front 32

What does the MAS measure? Speeds? What does it look for?

Back 32

Spasticity with 1 speed--speed of gravity

Looks for the resistance in the stretch of the muscle

Front 33

What does the Tardieu mesure? Speeds? What does it look for?

Back 33

Spasticity with 3 speeds

Looks for feel of resistance or catch in the motion

Front 34

What is defined as a contracture?

Back 34

Greater than 10 degrees of loss of motion

Front 35

Which reported more problems with spasticity, complete or incomplete?

Back 35

Incomplete, b/c they have more function and notice it more

Front 36

What do cervical SCI pt typically report with spasticity problems?

Back 36

Stiffness in the morning and spasticity at night

Front 37

What do cervical incomplete SCI pts report with spasticity?

Back 37

Spasms in morning and less at night due to muscle stiffness

Front 38

What do cervical complete SCI pts report with spasticity?

Back 38

Less spasms in morning and more at night due to fatigue

Front 39

What are spasms like for paraplegics (thoracic/lumbar) pts?

Back 39

Same level of spasms throughout the day

Front 40

What is the clinical significance of spasticity in SCI pts? (4)

Back 40

1) Pts must manage their spasticity daily
2) Pt may find it useful for function
3) PTs must decipher what is useful vs what is bothersome
4) Develop a sixth sense to illness approaching (spasms will be more apparent)

Front 41

What is the difference b/w acute and chronic pain?

Back 41

Acute--injury associated with pain (visceral or muscular)

Chronic--pain outlasts the injury (stimulus is no longer there)

Front 42

What is nociceptive pain?

Back 42

Has identifiable stimulus (musculoskeletal or visceral) to receptor to pathway to the brain

Often dull, aching, tender to palpate over site of problem (positional or activity related)

Front 43

What is neuropathic pain? (5)

Back 43

1) Direct damage to the nervous system
2) Nerve root pain going in dermatomal pattern
3) Constant/unrelenting, burning, shooting pain
4) Spinal cord itself is damaged
5) Plasticity changes in brain and SC

Front 44

What are 2 ways to treat pain in SCI pts?

Back 44

1) PT--treat what you can; plasticity
2) Medication

Front 45

What is the clinical significance of overuse injuries to the UE in SCI pts?

Back 45

Limits independence and can lead to secondary complications from immobility

Front 46

How can we prevent overuse? (3)

Back 46

1) ROM
2) Strengthen/stretch
3) Proper mechanics

Front 47

How can we manage spasticity and do they work? (3)

Back 47

1) ROM-prevents contractures, reduces intensity of muscle contraction in reaction to stretch
2) Positioning-maintains mm length
3) Strengthen/stretch-keeps muscles balanced

Front 48

What are the 6 areas of the patient client management model?

Back 48

1) Examination
2) Evaluation
3) Diagnosis
4) Prognosis
5) Intervention
6) Outcomes

Front 49

What are the precautions for cervical/upper thoracic injury? (4)

Back 49

1) No PROM shoulder flexion/abd above 90
2) No SLR >60
3) No ROM of neck/trunk
4) Resisted exercises must be done bilaterally in supine

Front 50

What exercises can be done at 3 weeks for cervical/upper thoracic SCI pt?

Back 50

Bilateral shoulder isometrics below 90

Front 51

What exercises can be done at 4 weeks for cervical/upper thoracic SCI pt?

Back 51

Bilateral shoulder AROM below 90

Front 52

What exercises can be done at 6-8 weeks for cervical/upper thoracic SCI pt?

Back 52

Bilateral resistance exercise in supine <10lbs

Front 53

What are the precautions for lower thoracic/lumbar SCI pts? (7)

Back 53

1) Log roll
2) Exercises done in supine
3) No rotation
4) No SLR >60
5) No hip/knee flexion >90
6) No hip resistance exercises
7) Can do WB UE activities

Front 54

How do you know if you have gone too far with a SCI pt during precautions? (2)

Back 54

1) Decrease in neuro function--motor or sensory during or after treatment
2) Pain at fracture site

Front 55

What 3 areas does the examination contain?

Back 55

1) Impairments
2) Participation
3) Activities

Front 56

What areas do you examine for impairments? (5)

Back 56

1) Motor
2) Sensory
3) Skin
4) Respiratory
5) Cardiovascular

Front 57

What are the risk areas for skin breakdown in supine? (7)

Back 57

1) Occiput
2) Scap
3) Elbow
4) Sacrum
5) Coccyx
6) Heels
7) Vertebrae

Front 58

What are the 2 questions to ask yourself in the participation portion of the exam?

Back 58

1) Can pt fulfill prior and future roles, plus participate in rehab?
2) Can pt direct own care?

Front 59

What are the 2 questions to ask that are important for an eval?

Back 59

1) What are the secondary complications at risk for and why?
2) What prevents pt from going to next level of care?

Front 60

What 4 things can prevent a pt from going to the next level of care in acute care?

Back 60

1) Medical instability
2) Skeletal instability
3) Decrease tolerance for activity
4) Degree of dependence

Front 61

What are 2 components of prognosis?

Back 61

1) D/C planning
2) Goals

Front 62

What needs to be considered for d/c a pt? (3)

Back 62

1) Current level of function--can they tolerate activity/upright
2) Demands of d/c environment
3) Any benefits available?

Front 63

What are the 4 signs of of potential skin breakdown?

Back 63

1) Redness that does not change in 30 min
2) Swelling
3) Heat
4) Abrasions

Front 64

What are the 8 ways to manage UE overuse?

Back 64

1) Task analysis--vary tasks/limit reps
2) Ergonomic analysis--alignment of joints
3) Avoid shoulder flexion and IR
4) Motion analysis--mechanics of overhead activities
5) Body weight of pt
6) Equipment review
7) Environment review--adapt environment
8) ROM/strength of opposing muscle groups

Front 65

What are 3 compensatory movement strategies available to enable a person with complete SCI to be most functional?

Back 65

1) Muscle substitution
2) Momentum
3) Head hips relationship

Front 66

What are 3 ways to use muscle substitution?

Back 66

1) Gravity
2) Tension in passive structures
3) Fixation of distal extremity