What are the strategies for vertebral stabilization and immobilization after a SCI?
- Closed reduction - Traction by cervical tongs (not often used, temporary before halo or surgery) and/or halo brace (assures fixation)
- Open reduction - Surgical decompression and stabilization
Whta are the advantages of using a halo?
- Reduces time in bed - screwed into head
- Earlier progression to upright activities and rehabilitation
- Left in place until x-ray indicates fracture is stable – approx. 12 weeks
- disadvantages: difficult for positioning in bed/ WC, unable to move head
What are the types of orthoses are used during SCI?
- Sterno-occipital-mandibular immobilizer (SOMI)
- Hard Collar
- TLSO
What should you look while performing a respiratory assessment?
- Function of respiratory muscles
- Respiratory rate
- Chest expansion - normal 2.5-3 inches
- Breathing patterns
- Ability to produce a productive cough
- Vital capacity - spirometer
What should you look while performing a skin assessment?
- Everyone’s responsibility
- Patient education
- Use of a mirror
- Proper cushion in W/C
What is emphasized in sensory testing?
pinprick and light touch
What are the functional assessments for SCI?
- Wheelchair Skills Test (Pg. 915) - Manual W/C skills
- Power Chair Test - Using various switches
- SCI Functional Ambulation Inventory (SCI-FAI) (Pg. 916) - Gait Parameters, Assistive Devices, Distance Measures
What is a participation assessments for SCI?
Craig Handicap Assessment and Reporting Technique (CHART)
- Designed to provide an objective measure of the degree to which impairments and disabilities affect participation in the years after a SCI
- 15 min interview consisting of 32 questions
What is respiratory management of someone with SCI?
- Glossopharyngeal breathing
- Diaphragmatic breathing
- Abdominal support
- Assisted coughing and teaching indep coughing techniques
What do you want to keep in mind when performing ROM and positioning with SCI?
- Fracture site healing
- Acutely ankle boots or splints for heel cords and to prevent pressure sores and external rotation of LE
- Selective stretching:
- Need lordotic posture
- C6 or C7 Preserve tenodesis – keep fingers flexed
100 degrees ROM in hamstrings – but no more
- Increase tolerance to prone position
What do you want to keep in mind when doing selective strengthening with SCI?
- Avoid stress on fracture site
- Emphasize bilaterally to avoid rotational stress on the spine
- Quadriplegia emphasis on: Anterior deltoid, Shoulder extensors, Biceps and lower trapezius
- Paraplegia in addition to above emphasis on: Shoulder depressors, Triceps, Latissimus dorsi
What are functional expectations pts with SCI need to responsible for?
- Skin inspection
- Pressure relief
- Bowel and bladder care
- Wheelchair management
- Orthotic management
- Leg management
- Coughing
What are functional expectations of someone with a SCI C4 or higher?
- Full time help required
- Max assist for transfers
- Mechanical lifts are used
- Power W/C with tilt is needed
- Unable to drive
What are functional expectations of someone with a SCI C5?
- Assistance for set up with bed skills and ADL’s
- Manual W/C with projections but more likely power W/C with joystick
- Transfers with assistance using slideboard
- Dependent skin inspection
- Tilt-in-space chair for independent pressure relief
- Driving with hand controls
- Part time help required
What are functional expectations of someone with a SCI C6?
- Independent bed skills and ADL’s
- Manual W/C with projections or friction surface hand rims but may need power W/C with joystick for longer distances
- Independent transfers with slideboard on level surfaces
- Independent skin inspection and pressure relief
- Driving with hand controls, usually requires assistance getting W/C into car
What are functional expectations of someone with a SCI C7?
- Manual W/C with friction surface hand rims
- Independent transfers without slideboard
- Driving with hand controls, able to get W/C in and out of car
What are functional expectations of someone with a SCI C8-T1?
- Increased independence with less adaptive equipment
- Manual W/C with standard hand rims
- Independent transfers
- Driving with hand controls
What are functional expectations of someone with a SCI T4-T6?
Physiological standing - not practical for functional ambulation
What are functional expectations of someone with a SCI T9-T12?
- Household ambulation
- Bilateral HKAFO’s and crutches
- High energy consumption
- Wheelchair used for energy conservation
What are functional expectations of someone with a SCI L2-L4?
- Functional community ambulation
- Bilateral KAFO’s and crutches
- Wheelchair for convenience and energy conservation
What are functional expectations of someone with a SCI L4-L5?
- Functional community ambulation
- Bilateral KAFOs or AFOs and crutches
- Many patients still use wheelchair for convenience and energy conservation
What are prognostic indicators for SCI?
- Level of injury
- 2Age
- Motivation
- Comorbidities
- Weight
- Baseline level of fitness/ endurance
- Support
What are thing to consider in custom W/C prescription?
- Seat depth
- Floor to seat height (include cushion)
- Back height
- Seat width - consider coats during winter, stable weight (?)
- Heel loops (spasticity), pelvic belt, etc.
- Arm rests and foot rests
- Cushion type
- Power options - Tilt, Switches
Cushion type: Lightweight, inexpensive; Least effective pressure distribution, cannot be washed, heat buildup, wears out faster
Contoured foam
- temporary, for someone not with SCI
