How do we classify SCI?
ASIA
ASIA
American Spinal Injury Association
incomplete SCI
- has sacral sparing (sensation and/or motor at S4-S5 - anus)
- tested with gloved finger inserted
After a pt survives an SCI, what generally happens?
surgeons will typically stabilize the injury (bones)
surgical stabilization: c-spine
- ACDF (anterior cervical disc fusion)
- may do a PLIF (posterior lumbar interbody fusion) if ACDF doesn’t work
c-spine stabilizaztion: post surgical issues (c-spine specific)
- low speech volume
- pain
- difficulty swallowing
- raspy voice
should not have voice issues weeks later
surgical stabilization: thoracic/lumbar
- typically start with PLIF
- put as much metal in the back as possible if there’s bone to screw into
What happens if the SCI pt is hypermobile after a PLIF?
- they’ll do an ALIF (anterior)
- hugely invasive, going through viscera
general post-surgical issues
abdominal swelling, bloating
gastric issues during surgery
- sepsis
- lack of peristalsis
ileus
- peristalsis stops
- stomach doesn’t process anything into the intestines
reverse peristalsis
- start vomiting like crazy
- can get reverse peristalsis from intestines and vomit feces (usually circling death’s door)
tx for an ileus?
NG tube to suck up stomach acid and other crap from the stomach
How could a PT dx an ileus?
- ask if they’re having bowel movements or farting
- listen to bowel sounds (rumbling, grumbling
What will you hear if there’s an ileus with bowel sounds?
won’t hear anything
PT and cervical traction
- PT won’t be moving them while they’re in cervical traction
- waiting for surgery
Orthoses for post surgery
- halo
- Minerva
- SOMI
- soft collar
- Philadelphia collar, Miami J collar, Aspen collar
- CTO
- TLO
- TLSO
- LSO
halo
- 4-6 holes in the cranium
- metal uprights hold the head completely stable
- limits all cervical movement
- heavy and it sucks ass
halo effect on PT
moving and txfs are very difficult
Minerva
- prefab (off the shelf)
- not as much stability as the halo, but removable
- likely had some fixation surgery and we don’t want them to move a lot
- Minerva is a type of CTO
What SC levels is the Minerva commonly used for?
C1-C6
SOMI
sternal occipital mandibular immobilizer
What is a SOMI?
- primarily limits flexion, they can extend
- can be used for a lot of patients
- more than likely, have been stabilized
soft collar
- just a piece of foam and fabric to remind you to not do a lot of fast/large movements
- annoying, rub on the skin
- likely will only wear for a few days
-
1.12 Skin38
-
1.12 Wounds 138
-
1.19 Burns 131
-
1.19 Burns 216
-
1.19 Burns 338
-
1.20 Burns 434
-
1.20 Other Wound Types31
-
1.20 Other Wound Types 213
-
1.21 Differentiating Ulcers45
-
1.21 Ulcers and debridement24
-
1.25 Topical Agents/Modalities61
-
1.26 Amputation25
-
1.26 Wound closure33
-
1.27 Lymphedema18
-
1.27 Diabetic foot27
-
2.1 Maggots, Discharge24
-
2.2 Viruses20
-
2.2 Bacteria28
-
EXAM 2: 2.8 Motor Control36
-
2.9 Tone and Reflexes50
-
2.10 Feedback30
-
2.22 Neuro Exam24
-
2.22 Neuro Exam 225
-
2.22 Neuro Exam 345
-
2.23 PPS28
-
2.23 GBS, MG26
-
2.24 SCI44
-
3.1 Meningitis, Encephalitis28
-
3.1 Transverse Myelitis25
-
2.29 SCI 233
-
2.29 SCI 322
-
2.29 SCI 438
-
3.2 Other SCI issues29
-
3.2 Other SCI issues 232
-
3.2 Functional Outcomes for SCI12
-
3.7 Goal Setting, Spinal Shock14
-
3.8 Corrected Functional Outcomes34
-
EXAM 3: 3.21 PNF26
-
3.28 Stroke45
-
3.28 Stroke 226
-
3.30 Stroke 320
-
4.16 Stroke 427
-
4.16 Stroke 522
-
4.16 Post-Stroke16
-
4.16 Post-Stroke 220
-
4.16 Synergies19
-
4.19 Eyes, Rood's33
-
4.19 CVA types14
-
4.19 Cranial Nerves26
-
4.19 Cranial Nerves 235
-
4.19 Balance24
-
4.19 TBI30
-
PNF techniques22
-
PNF techniques 226
-
4.25 TBI 223
-
4.25 TBI 310
