Neuro 2 > Functional Expectations post SCI & Treatment > Flashcards

Functional Expectations post SCI & Treatment Flashcards

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1
Q

C5 key muscles available and movements

A
  • biceps and supinator - elbow flexion and supination
  • brachialis
  • brachioradialis
  • deltoid - shoulder abduction and flexion ~90 deg
  • infraspinatus - shoulder ER
  • rhomboids
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2
Q

C6 muscles available

A
  • extensor carpi radialis
  • infraspinatus
  • lat dorsi
  • pec major
  • pronator teres
  • serratus anterior
  • teres minor
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3
Q

C6 available movements

A
  • shoulder flexion, extension, ER, IR, and adduction
  • scapular abduction, protraction, and UR
  • forearm pronation, wrist extension
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4
Q

respiratory status of C6

A

weak cough and will require cough assist

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5
Q

Can a C6 drive and live independently?

A

Drive with hand controls
- assist for slideboard transfer in car

May be able to live w/o assistance if well motivated

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6
Q

C7 key muscles and available movements

A
  • extensor pollicis longus and brevis
  • extrinsic finger extensors, flexor carpi radialis - wrist flexion and finger extension
  • triceps - elbow extension
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7
Q

respiratory status of C7

A

independent with cough and secretion clearance

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8
Q

C8 key muscles and available movements

A
  • extrinsic finger flexors, flexor carpi ulnaris
  • flexor pollicus longus and brevis
  • intrinsic finger flexors - finger flexion
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9
Q

T1-T12 key muscles

A
  • intercostals
  • long muscles of back (sacrospinalis, semispinalis)
  • abdominals (~T7 and below)
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10
Q

T1-T9, T10-T11, and T12 ambulation

A

T1-T9 - no functional ambulation
T1-T11 - short distance with assist H/KAFOs may be possible
T12 - may reach mod I short distances w/ H/KAFO

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11
Q

L1-L3 key muscles and available movements

A
  • ilipsoas
  • gracilis
  • quadratus lumborum
  • rectus femoris
  • sartorius

Hip flexion and abduction
knee extension

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12
Q

L4 key muscles

A

quads

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13
Q

L5 key muscles

A

anterior tibialis

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14
Q

L5-S1 key muscles

A

hamstrings

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15
Q

S1 key muscles

A

gastroc

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16
Q

L5-S1 key muscles

A
  • glute max and med
  • extensor digitorium
  • posterior tib
  • flexor digitorium
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17
Q

Botox injections are good for which patients?

A

SCI with flexor spasticity and w/o fixed contractures

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18
Q

What level of innervation is needed to achieve tenodesis grip? What level SCI is this done with?

A

C6 = wrist extension
- use passive shortening of the finger flexors as the wrist is extended

  • done with C6 and C7 SCIs
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19
Q

What can provide stability and balance in short and long sitting positions? What ROM SLR must be maintained?

A

combo of lengthened hamstrings and adaptive shortening of back extensors
- Need to maintain 110-120 deg SLR without overstretching back muscles

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20
Q

What type of exercises should be prioritized if >/= 3/5 MMT?

A

closed chain and function-based activities

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21
Q

What are key muscles targeted for strengthening?

A
  • serratus anterior
  • lat dorsi
  • pec major
  • rotator cuff
  • triceps
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22
Q

benefits of supine positioning during strengthening

A
  • gravity eliminated
  • easy to facilitate rest breaks
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23
Q

considerations of supine positioning during strengthening

A
  • can be compromising for respiratory muscles - may need propping or wedge
  • least functionally relevant position
  • harder to facilitate closed chain activities
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24
Q

benefits of side lying positioning during strengthening

A
  • gravity eliminated
  • more comfortable than supine if vertebral fractures present
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25
considerations of side lying positioning during strengthening
- don't want to over-flexing trunk - can compromise respiration - difficult to incorporate LE closed chain - able to implement some function based UE tasks (side lying > elbow prop, side lying push up)
26
benefits of prone positioning during strengthening
- great way to extend back, hip flexors, even knee flexors - allows for full pressure relief of butt - can progress position (prone on elbows or elbows extended) - allow for neck extension strengthening
27
considerations of prone positioning during strengthening
- be cognizant of neck ROM - need to be able to move freely to allow for comfort and breathing - if neck ROM limitations - use towel rolls to prop chest and head - primarily a position to target UE
28
What position is primarily a position used to target UEs when strengthening?
prone
29
benefits of quadruped positioning during strengthening
- great for functional position, closed chain UE/LE - challenges proximal muscles - incorporates trunk muscles and pelvic stabilizers - can allow for neck extension strengthening
30
considerations of quadruped positioning during strengthening
- challenging position - consider use of equipment to help patient maintain quadruped position
31
benefits of high kneeling positioning during strengthening
- great position for glutes, pelvic muscles, low back stabilizers, if intact - for higher levels - targets intact trunk muscles and can incorporate balance strategies
32
considerations of high kneeling positioning during strengthening
watch leg positioning - pelvis and hips need to be in neutral to avoid inappropriate load through hips and knees
33
benefits of sitting positioning during strengthening
- core stabilization - closed chain UE exercises
34
considerations of sitting positioning during strengthening
great position to incorporate dual-task balance activity while strengthening targeted muscles
35
benefits of (assisted) standing positioning during strengthening
- great functional position, closed-chain UE/LE - challenges proximal muscles - incorporates trunk muscles and pelvic stabilizers - allows for neck extension strengthening
36
considerations of (assisted) standing positioning during strengthening
- challenging position - consider use of equipment to help patient maintain position
37
With loss of trunk strength and variable UE strength, small perturbations would what muscles?
head/neck, upper shoulder and upper trunk muscles
38
What are some guidelines available for cardiorespiratory fitness and strengthening post SCI?
- 20 min moderate to vigorous intensity aerobic exercise 2x/wk - 3 sets of strength exercises 2x/week for each major functioning muscle group o Moderate to vigorous intensity
39
What are some guidelines available for cardiometabolic health and strengthening post SCI?
- 30 min 3x/week of moderate to vigorous intensity aerobic exercise
40
Precautions to exercise testing and training in SCI patients
- Autonomic dysreflexia - Sever or infected skin on weight bearing surface - Symptomatic hypotension - UTI - Unstable fractures - Uncontrolled hot/humid environments - Insufficient ROM to perform exercises task
41
Contraindications to exercise testing and training in SCI patients
- Episode of dysreflexia = stop exercise - Unstable fx - If hypotension is symptomatic - UTI – monitor closely if symptomatic - Do not push patients past their contractures
42
_______ control of respiration is needed for normal speech productions. How can a patient practice this?
eccentric - Patient inhales maximally and then counts or says, “ah” or “oh” for as long as possible before taking another breath - goal is 10-12 sec
43
What is the ideal posture for enhanced respirations
- anterior pelvic tilt - erect trunk - adducted scapulae - neutral head and back alignment
44
how to train diaphragmatic breathing
- belly breathing - supine: Place a large, light object (ex: box of tissues) on abdomen and instruct the patient to watch themselves breathe - can progress with more resistance
45
What is upper chest strengthening good for? How is it done?
- increasing inspired air to enhance coughing - improve breath support for speech or during increased activity - Therapist places hands on upper chest and asks patient to push against them while breathing deeply - Quick stretch to SCM, Pec Major, and Scalenes by pushing the upper chest in and caudally just before asking the patient to inhaling
46
What is glossopharyngeal breathing?
Use of tongue and pharyngeal muscles; force air in lungs through series of “gulps”
47
for a normal cough, how many coughs per breath out should there be
2 coughs per 1 breath out
48
Factors that reduce vent weaning potential in C3 or lower SCI
- respiratory or other medical complications - pre-existing respiratory conditions - > 50 years old - VC < 1000 - max negative inspiratory pressure < 30 cm H2O - hx of smoking
49
What is independent application of FES? Example?
- use of FES for a finite time period to minimize impairments and to encourage motor relearning in context of function - expectation is the patient will be weaned off FES ex: FES over anterior tib to improve foot drop during ambulation
50
What is FES dependent application? Example?
- enables the patient to perform functional activities that wouldn't otherwise be possible ex: FES on LE musculature of patient with paraplegia while peddling on leg ergometer
51
T/F: FES should only be done on UMN injuries
true - peripheral nerves are still intact which is needed for FES
52
Indications for FES
- UMN injury - absent or diminished motor function in arms, trunk, or legs - demonstration of active contraction when e-stim is provided over motor point of muscle belly - pt able to tolerate FES
53
Precautions of FES
- absent sensory - severe spasticity - heterotropic ossificans (bone formation in muscle) - severe osteoporosis - chronic pain syndrome
54
Contraindications of FES
- LMN injury - cardiac pacemaker - pregnancy - unhealed fx - skin breakdown - internal stimulator in area - DVT - malignancy - uncontrolled autonomic dysreflexia
55
What FES Bioness is used for foot drop? Knee instability?
L300: foot drop, poor foot clearance L300+: knee instability, poor foot clearance
56
Indications for use of FES bike
- relaxation of muscle spasms - prevention or reduction of disuse atrophy - increasing local blood circulation - maintaining or increasing ROM - improve muscle endurance with intact innervation
57
Considerations of FES bike
- risk of raising unrealistic expectations - difficult to predict outcome - insufficient evidence for duration and dosage of treatment
58
contraindications of lokomat training
- fixed LE contractures - reduced bone density - bone instability (fractures, unstable spinal column, severe OP) - significant cardiac disease - behavioral concerns - pregnancy - > 300 lbs, > 6 ft 1 in
59
prerequisites for ReWalk
- hands and shoulders can support crutches or walker - healthy bone density - no unhealed fractures - adequate standing tolerance - no cardiac, respiratory, autonomic comorbidities - height between 160-190 cm (5"3 - 6"2) - < 100 kg (220 lbs)
60
What gait pattern is done with ReWalk?
4 point gait pattern
61
frequency and duration of bodyweight supported treadmill training
- high frequency (4 days a wk) - moderate duration - 20-30 min - typically for 8-12 weeks
62
required ramp length
1 ft in length for every 1" of height needed
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