Spinal Cord Injury (68 - 91)

Front 1

In this section...

Back 1

Examination

Outcome MeasuresTreatments

Front 2

What does into an examination

Back 2

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

Front 3

C2 skeletal muscle innervation

Back 3

Head and neck movements

--SCM and Trap

Front 4

C3 skeletal muscle innervation

Back 4

Head and neck movements

--SCM and Trap

Breathing; Elevate Scap

--Levator Scap, Diaphragm

Front 5

C4 skeletal muscle innervation

Back 5

Breathing; Elevate Scap

--Levator Scap, Diaphragm

Shoulder Adduction

--Rhomboids

Front 6

C5 skeletal muscle innervation

Back 6

Breathing; Elevate Scap

--Levator Scap, Diaphragm

Shoulder Adduction

--Rhomboids

Elbow Flexion

--Supraspin

--Serratus Ant

--Brachialis

--Deltoid

--Pec Major (Clavicular)

Front 7

C6 skeletal muscle innervation

Back 7

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)

Front 8

C7 skeletal muscle innervation

Back 8

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

Front 9

C8 skeletal muscle innervation

Back 9

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

Front 10

T1 skeletal muscle innervation

Back 10

Wrist Extension

--Pec major (Sternal)

Elbow Extension

--Triceps

Finger Flexion

--Long flexors of wrist and fingers

Finger Abduction

-Hand Intrinsics

Front 11

T7-12 skeletal muscle innervation

Back 11

Move/Stabilize Trunk

--Abdominals

Front 12

L2 skeletal muscle innervation

Back 12

Hip Flexion and Adduction

--Iliopsoas

--Adductors

Front 13

L3 skeletal muscle innervation

Back 13

Hip Flexion and Adduction

--Iliopsoas

--Adductors

Knee Extension

--Quad Femoris

Front 14

L4 skeletal muscle innervation

Back 14

Hip Flexion and Adduction

--Iliopsoas

--Adductors

Knee Extension

--Quad Femoris

Ankle Dorsiflexion

--Tib Ant

--Tib Pos

--Glute med/min/TFL

Front 15

L5 skeletal muscle innervation

Back 15

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

Front 16

S1 skeletal muscle innervation

Back 16

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

Front 17

S2 skeletal muscle innervation

Back 17

Long Toe Extensor

--Glute Maximus

Ankle Plantarflexion

--Triceps surae (gastroc +soleus)

--Foot Intrinsics

Front 18

S3 skeletal muscle innervation

Back 18

Ankle Plantar Flexion

--Foot Intrinsics

Front 19

Describe the Reintegration to Normal Living Index

Back 19

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

Front 20

DescribeCraigHandicap Assessment and Reporting Technique (CHART)

Back 20

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

Front 21

Describe Capabilitiesof Upper Extremity Functioning Instrument

Back 21

ICF: Bodyfunction

Purpose: tomeasure upper extremity functional limitations in individuals with tetraplegia

Timeto administer: approx 30minutes

Front 22

Describe SpinalCord Independence Measure

Back 22

ICF:Activity

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

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

Front 23

Describe SCIFunctional Ambulation Inventory

Back 23

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

Front 24

DescribeWalkingIndex for SCI II (WISC II)F-8

Back 24

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

Front 25

Outcome measures for WalkingFunction

Back 25

--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

Front 26

Treatment in acute care and inpatient rehab

Back 26

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

Front 27

Rules for early strengthening and ROM

Back 27

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

Front 28

Rules for Selective Stretching

Back 28

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

Front 29

Progressing to Outpatient

Back 29

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

Front 30

What should be assessed in the Chronic Phase

Back 30

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

Front 31

Expectations for gait training in Chronic SCI

Back 31

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)

Front 32

Sensory cues in gait training Chronic SCI

Back 32

-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

Front 33

When to use Aquatic therapy

Back 33

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

Front 34

ACSM Guidelines for SCI

Back 34

•Followguidelines for general population

•Aerobictraining

•Tetraplegia- peripheral before central fatigue

•Autonomicdysreflexia

•Decreasedcapacity

•Decreasedsensation, increased tolerance

•Highercore temperatures

Front 35

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

Back 35

•Bluntedtachycardia

•Lackof pressor response

•Verylow blood pressure

•Normsrange around 100-110/60

Front 36

Pt goals tetra vs paraplegia

Back 36

Tetra:

-Hand function

-Bladder

-Bowel

-Sexual

-Walking

Para:

-Bladder

-Bowel

-Sexual

-Walk