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36 Cards in this Set

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Examination

Outcome MeasuresTreatments

What does into an examination



1) Vital Signs - Edu pt on orthostatic hypo tension and autonomic dysreflexia


2) Resp Function- action of diaphragm, cough


3) Skin Integ - Edu pt on skin checks, Pressure Injuries*


4) Muscle Tone - speasticity


5) Reflexes


6) Sensation (ASIA) - sharp/dull, light touch


7) Motor function (ASIA) - MMT


8) Functional Mobility - Bed mobility, transfers, wheelchair mobility

C2 skeletal muscle innervation

Head and neck movements


--SCM and Trap

C3 skeletal muscle innervation

Head and neck movements


--SCM and Trap




Breathing; Elevate Scap


--Levator Scap, Diaphragm

C4 skeletal muscle innervation

Breathing; Elevate Scap


--Levator Scap, Diaphragm




Shoulder Adduction


--Rhomboids

C5 skeletal muscle innervation

Breathing; Elevate Scap


--Levator Scap, Diaphragm




Shoulder Adduction


--Rhomboids




Elbow Flexion


--Supraspin


--Serratus Ant


--Brachialis


--Deltoid


--Pec Major (Clavicular)

C6 skeletal muscle innervation

Elbow Flexion


--Supraspin


--Serratus Ant


--Brachialis


--Deltoid


--Pec Major (Clavicular)




Wrist Extension


--Supinator


--Pronator teres


--Lats


--Long extensors of wrist and fingers


--Pec major (Sternal)

C7 skeletal muscle innervation

Elbow Flexion


--Serratus Ant


--Pec Major (Clavicular)




Wrist Extension


--Supinator--Pronator teres


--Lats


--Long extensors of wrist and fingers


--Pec major (Sternal)




Elbow Extension


--Triceps

C8 skeletal muscle innervation

Elbow Flexion


--Serratus Ant




Wrist Extension


--Long extensors of wrist and fingers


--Pec major (Sternal)




Elbow Extension


--Triceps




Finger Flexion


--Long flexors of wrist and fingers



T1 skeletal muscle innervation

Wrist Extension


--Pec major (Sternal)




Elbow Extension


--Triceps




Finger Flexion


--Long flexors of wrist and fingers




Finger Abduction


-Hand Intrinsics

T7-12 skeletal muscle innervation

Move/Stabilize Trunk


--Abdominals

L2 skeletal muscle innervation

Hip Flexion and Adduction


--Iliopsoas


--Adductors

L3 skeletal muscle innervation

Hip Flexion and Adduction


--Iliopsoas


--Adductors




Knee Extension


--Quad Femoris

L4 skeletal muscle innervation

Hip Flexion and Adduction


--Iliopsoas


--Adductors




Knee Extension


--Quad Femoris




Ankle Dorsiflexion


--Tib Ant


--Tib Pos


--Glute med/min/TFL

L5 skeletal muscle innervation

Hip Flexion and Adduction


--Adductors




Ankle Dorsiflexion


--Tib Ant


--Tib Pos


--Glute med/min/TFL




Long Toe Extensors


--Glute Med


--Hamstrings


--Ext Dig Longus


--Ext Hallucis Long


--Peroneus

S1 skeletal muscle innervation

Ankle Dorsiflexion


--Glute med/min/TFLLong




Toe Extensors


--Glute Med


--Hamstrings


--Ext Dig Longus


--Ext Hallucis Long


--Peroneus




Ankle Plantarflexion


--Triceps surae (gastroc +soleus)


--Foot Intrinsics

S2 skeletal muscle innervation

Long Toe Extensor


--Glute Maximus




Ankle Plantarflexion


--Triceps surae (gastroc +soleus)


--Foot Intrinsics

S3 skeletal muscle innervation

Ankle Plantar Flexion


--Foot Intrinsics

Describe the Reintegration to Normal Living Index

ICF: Participation




Purpose: assessesthe degreeto which individuals who have experienced traumatic or incapacitatingconditions achieve reintegration into normal social activities




Timetoadminister: 10 minutes




Populationstested: stroke, TBI, SCI, MVA, amputation, Parkinson's, Guillain-Barre, femoralneck fracture, MS

DescribeCraigHandicap Assessment and Reporting Technique (CHART)

ICF: activity,participation




Purpose: Assessesthe degree of limitation and restriction in 6 areas (physicalindependence, cognitive independence, mobility, occupation, socialintegration, economic self-sufficiency)




Timeto administer: approx 15minutes




Populationstested: SCI, stroke, TBI, MS, burns, amputee

Describe Capabilitiesof Upper Extremity Functioning Instrument

ICF: Bodyfunction




Purpose: tomeasure upper extremity functional limitations in individuals with tetraplegia




Timeto administer: approx 30minutes

Describe SpinalCord Independence Measure

ICF:Activity




Purpose: Assessestraumatic and non-traumatic, acute and chronic SCI




Timeto administer: 30-45 min by observation; 10-15 min withinterview

Describe SCIFunctional Ambulation Inventory

ICF:Activity




Purpose: SCI-specificambulationmeasure focusing on gait abnormalities


--Gaitparameters (weight shift, step width, step rhythm, step height, foot contact,step length)


--Assistivedevices used (degree of assistance provided by each device; cane, walker,parallel bars)


--Walkingmobility (distance, speed, frequency)


–Canonlybe used with patients who can ambulate independently for up to 2 minutes withor without AD


–Notedceilingaffects




Timetoadminister: 5 min

DescribeWalkingIndex for SCI II (WISC II)F-8

ICF: Activity




Purpose


-–Assessestheamount of physical assistance needed as well as devices required for walkingfollowing paralysis that results from SCI


-–Designedto bea more precise measure of walking ability specific to SCI




Timeto administer: 5 minutes

Outcome measures for WalkingFunction

--Six-minute walk test (6MWT) –endurance


--10-meter walk test (10MWT) –gait speed


--Timed-Up-and-Go (TUG) –Fall risk; may use task to assess quality of movement during transitionalmovements, walking, turning

Treatment in acute care and inpatient rehab

1) Reorientto vertical


–Tilttable or wheelchair


–Abdominalbinder and stockings


2) Bedmobility


–Independentrolling


3) Transfertraining


–Improvesitting tolerance


4) Wheelchairmobility


–Basicsof propulsion


5) Pressurerelief


–30seconds every 15 min OR 2 min every hour


–Moreoften with skin integrity issues


5) Generalizedstretching and strengthening


6) Balance


–Sitting


–Standingif able


7) Standingactivities


–Ifstable enough

Rules for early strengthening and ROM

ROM dialy but with caution


--Too intense stresses vertebra


--Pelvis in Neural


--Tretaplegia - head/neck motion contraindication till cleared medically // Shoulder flexion/abd to 90


--Lumbar spine - SLR lmt to 60 // Hip fx lmt to 90




All innervated muscles can be strengthend maximally

Rules for Selective Stretching

Preserve tightness


--Lower Trunk: tight hip flexors may inc trunk stability


--Long finger flexors facilitate grop




Fully lengthen hamstrings


--100 SLR to facilitate long sit for dressing

Progressing to Outpatient

1) Bedmobility


2) Transfertraining


–Addfloor transfers and Multipleheights


3) Wheelchairmobility


4) Pressurerelief


5) Generalizedstretching and strengthening


6) Corestability and balance


7) Cardiovascularprogram


8) Gaittraining


9) Communityre-entry

What should be assessed in the Chronic Phase

1) Car training - getting in and out // driving


2) Generalized Exercise program - home to community gym


3) Scoliosis management


4) Gait training


5) Wheelchair assessment (repairs, new chair)


6) MSK asymmetries


7) Orthotics

Expectations for gait training in Chronic SCI

Expectations


--Speed (0.75-1.32m/s, 1.7-2.9mph)


--Max sustainable load ( <35% BWS)


--Upright and extended trunk and head


--At least 30 min (3000-45000 steps)

Sensory cues in gait training Chronic SCI

-Symmetry in stepping and interlimb coordination


-Approximating normal hip, knee ankle kinematics


-Minimize WB on UE and normal arm swing


-Minimizingsensory stimulation that conflicts with sensory information

When to use Aquatic therapy

Pre-gait and gait t raining


Strengthening with gravity eliminated


PNF that would be difficult land-based


Core stability, balance training


Decreased Spasticity




Contraindicated - lack of bowel and bladder control

ACSM Guidelines for SCI

•Followguidelines for general population


•Aerobictraining


•Tetraplegia- peripheral before central fatigue


•Autonomicdysreflexia


•Decreasedcapacity


•Decreasedsensation, increased tolerance


•Highercore temperatures

What are precautions to improving CV endurance in SCI patients? (i think thats what slide 89 is TRYING to say....)

•Bluntedtachycardia


•Lackof pressor response


•Verylow blood pressure


•Normsrange around 100-110/60

Pt goals tetra vs paraplegia

Tetra:


-Hand function


-Bladder


-Bowel


-Sexual


-Walking




Para:


-Bladder


-Bowel


-Sexual


-Walk