SCI

Question 1

Describe the focus of PT for an SIC that is level ASIA A

Answer 1

WONT: be able to strengthen or recover lost motor function

WILL: need to learn to compensate for loss of motor function (new way to do things)

Question 2

List the factors that affect functional outcome (5)

Answer 2

• social hx
• family support
• work hx
• level of education
• home layout (important regardless of complete/incomplete SCI)

Question 3

Describe the difference between short and long sitting for those with SCI

Answer 3

Short Sit: more difficult, can’t use HS

Long Sit: more stable; can use HS

Question 4

Describe the best way to stretch HS in those with SCI

Answer 4

Supine over Long sitting

Long sit: with tight HS more likely to stretch the Lb than the HS; a tight back is important b/c it is better for transfers (butt won’t sag)

Question 5

Describe tendodesis

Answer 5

Flexing of the fingers they are stretched across the wrist joint during wrist extension.

Can be used for functional grip in quads above C6

Question 6

Describe the difference between tilt and recline

Answer 6

Tilt: hip angle doesn’t change, but chair moves back in space

Recline: hip angle increases

Question 7

List the skin changes that occur in those with SCI (2)

Answer 7

• Thinning of epithelial layer
• Change in collagen and hyperhidrosis (T8 and above)

Question 8

List the reasons that put those with SCI at high risk for pressure ulcers (4)

Answer 8

• impaired sensation
• physiologic changes
• inability to perform pressure relief
• Moisture control

Question 9

List the rules of thumb for tetraplegia (2)

Answer 9

• Above C6 = power WC
• C7-T1 may be manual WC

Question 10

List the rules of thumb for paraplegia (4)

Answer 10

• Typically manual WC
• Rigid frame (more energy efficient)
• Adjustable axel (for confidence in stability)
• Consider weight of WC components

Question 11

List the pros and cons of a rigid back chair

Answer 11

Pro: better posture and shld positioning

Con: hassle in loading into the car

Question 12

List cushions from least to most pressure relief

Answer 12

Foam > Gel > Air

Question 13

List the factors that limit activity tolerance (4)

Answer 13

• upright tolerance
• respiratory status
• endurance
• pain

Question 14

For upright tolerance list the

1. Expected Outcomes
2. Variance

Answer 14

1. Difficulty maintaining BP, may benefit from abdominal binder or ace wrapping
2. Dysreflexia

Question 15

Condition: rise of SBP by 20 mmHg or greater in response to stimulus

Answer 15

(Autonomic) Dysreflexia

Question 16

For respiratory function list the

1. Expected Outcomes
2. Variance

Answer 16

1. C6/7 limited intercostal mm, difficulty handling secretions/coughing
2. More difficulty weaning from vent, possible need for tracheostomy

Question 17

For pain list the

1. Expected Outcomes
2. Variance

Answer 17

1. Pain at injury site, NR pain
2. Neurogenic pain below the level

Question 18

For ROM list the

1. Expected Outcomes
2. Variance

Answer 18

1. WFL, flaccid
2. HO, contracture, spasticity, insufficient PROM

Question 19

For Strength/Tone list the

1. Expected Outcomes
2. Variance

Answer 19

1. Intact above, absent below, low tone initially, increased tone after spinal shock
2. LE stronger than UE, unilateral difference, spasticity interfering w/function, proximal weakness

Question 20

For sensation list the

1. Expected Outcomes
2. Variance

Answer 20

1. absent below, intact above
2. intact below, absent above, pain below

Question 21

For bladder function list the

1. Expected Outcomes
2. Variance

Answer 21

1. Neurogenic bladder (will not empty w/voluntary control)
2. Frequent bladder distention can promote UTI

Question 22

For bowel function list the

1. Expected Outcomes
2. Variance

Answer 22

1. Neurogenic bowel (will not empty w/volitional control)
2. obstruction, ileus

Question 23

Term: absent or decreased bowel sounds and no stool or flatus passing

Answer 23

Ileus

Question 24

Describe how a bowel obstruction in those with SCI may present

Answer 24

May present as diarrhea with loose stool passing around the obstruction

Question 25

List the goals of SCI PT (10)

Answer 25

- prevent secondary complications - tolerance to upright positions - positioning - strengthening - passive ROM - balance - transfer - pressure relief education - energy conservation - ambulation

Question 26

List the acute SCI complication (8)

Answer 26

- Postural hypotension - Pressure sores - HO (warm; no aggressive ROM) - DVT (warm) - Autonomic dysreflexia - Hypo/hyperthermia - Pain - Spasticity

Question 27

List the chornic SCI complications (11)

Answer 27

- Pressure sores - Autonomic dysreflexia - Hypo/hyperthermia - Burns - Pain - Spasticity - Syringomyelia - Contracture - Osteoporosis - Spinal deformities - Shld injury/Carpal tunnel

Question 28

Condition: redness that does not fade in 20 min which may progress to open wounds

Answer 28

Pressure sores \*\*Blanching is good

Question 29

Condition: development of fluid in the SC that may decrease motor function

Answer 29

Syrinomyelia