1
Q
whats tetraplegia
A
function impairment of arm, trunk, legs (tetra=four) - Motor and sensory impairment of cervical segments
2
Q
whats quadriplegia
A
motor and sensory impairment of thoracic lumbar and sacral spinal segments
3
Q
whats a complete injury
A
absence of sensory or motor function in the lowest sacral segments
4
Q
whats an incomplete injury
A
only used when there is partial preservation of sensory or motor function below the neurological level and including the sacral segment
5
Q
central cord syndrome
A
incomplete injury, centre of cord damage, more weakness in upper limbs than lower limbs
6
Q
whats brown squared syndrome
A
half of cord damaged causing ipsilateral loss of proprioception (covered in sensory prac) and motor function: contralateral loss of pain and temperature.
7
Q
whats anterior cord syndrome
A
front of cord damaged resulting in variable loss of motor and sensory function, preservation of proprioception
8
Q
whats conus medullar is syndrome
A
damage to sacral cord and lumbar nerve roots, impaired bladder, bowel and lower limb function (results from falling from high place)
9
Q
whats caudal equine syndrome
A
: lower motor neurone injury to lumbar sacral nerve roots, impaired bladder, bowel & lower limb function (results from falling from a high place)
10
Q
whats secondary health conditions from spinal cord injuries
A
- Muscle spasm (spasticity)
- Joint and muscle pain
- Circulatory problems eg swelling, oedema, hypo/hypertension
- Chronic pain
- Bladder and bowel dysfunction
- Sexual dysfunction
- Temperature regulation dysfunction (can over heat easily)
- Fatigue
- Deep veins thrombosis
- Heterotopic ossification (connective tissue calcifies around the joint)
- UTI
- respitaroy injection
- due to lack of movement
11
Q
whats autonomic dysreflexia
A
- Happens to injuries at T6 or above
- Lack of autonomic system control
- If a person burns self, touches something sharp
- Leads to dangerously high blood pressure in response to noxious stimulus
- Can cause stroke or death
- Symptoms including pounding headache, flushed skin and sweating
- Requires immediate attention
12
Q
whats postural hypotension
A
- Common people with high injury
- Dangerous low blood pressure as a result of going from lying down to upright too quickly
- Symptoms include light headaches, fainting, pallor (going white)
- Requires immediate attention
13
Q
whats pressure sores
A
- Caused by constant pressure due to immobilisation
- Required pressure life/pressure relieving cushions/beds
14
Q
whats spasticity and spasm
A
- Hyperactive stretch reflex
- Spasms trigger by sensory stimuli such as sudden touch, movement etc
- Can hinder function significantly
- Treated by medication
15
Q
pain with spinal cord injuries?
A
- Most people with SCI suffer from some pain
- Mechanical (overuse of weak muscles, muscle imbalance)
- Neurological (dependent on where injury occurs difficult to control with medication)
16
Q
psychosocial effects of spinal cord injury
A
- Depression and anxiety
- Loss of productivity roles
- Loss/change to leisure roles
17
Q
whats social and community participation affects from spinal cord injurt
A
- Resources and environmental accessibility impact social participation
- Other people influence community engagement
- Heath issues affect social participation
18
Q
whats barriers for psychosocial
A
- Health professionals help or hinder (over protective)
- More assistance needed for more severe injuries
- Social attitudes can impact
- Depression led to disengagement during transition home (going from the support systems at the hospital to own there on at home)
- Financial resources can demotivate (receiving payment therefore not having motivation to go back to work)
- Environments are inaccessible
19
Q
facitiliations psychosocial effects of spinal cord injury
A
- Adequate financial resources (having enough to get resource and do activities)
- Social support from friends, family and from peer mentors
- The physical environment
- Appropriate transport
- Technology links people with cervical injuries to outside world
- Support is important but not being wrapped in cotton wool
20
Q
define pressure ulcers
A
“lesion(s) caused by unrelieved pressure resulting in damage of underlying tissue”
21
Q
how are ots involves in pressure care
A
Occupational therapists, with their expertise in positioning, seating and pressure management, are involved in both prevention and management of pressure ulcers
22
Q
skeletal level
A
refers to the level of greatest. Vertebral dmage
23
Q
function; area
A
: refers to the lowest segment at which strength of important muscles is graded a 3+ or above on the MMT and sensation is intact
24
Q
when does a person need good and stable positioning
A
- Enabling communication
- Transport from one place to another
- Eating
- Access to technology
- Leisure
- Productive occupations
- Accessing powered mobility To name a few…
25
types of wheelchairs
Manual – self propelling, attendant propelled (looking at these today) (aluminium, titanium, carbon fibre)
Powered or motorised (looking at these next semester)
26
whats a self propelling wheelchair
• These types of wheelchairs are for people who can propel the device by themselves.
27
characteristics of self propelling wheelchairs
Tthe chairs have either
– a fixed or rigid frame
– or ‘folding frame’
• Big wheels at the rear, and small wheels at the front to enable the user to push the chair
• In general, fixed frame chairs are easier to push and more sturdy, but unable to fold, and folding chairs have more apparatus and are heavier to push, but more convenient for storage.
• *require good upper limb strength
• *can alter every component of wheelchair for the specific person.
• *no arm rests are for more active people
28
high performance wheelchairs
* Users with increased level of indoor and outdoor independence
* Standard equipment doesn’t meet lifestyle needs
29
attendent propelled wheelchair
* Used by people who are unable to push themselves, and include buggies or pushchairs for younger users, as well as wheelchairs that are purely for someone else to push.
* This type of chair tends to have small wheels at the back and the front, and is an essential back up if the person uses a powered wheelchair as their main form of independent mobility
30
special types of mobility systems
* Children’s wheelchairs and buggies
* High performance sports wheelchairs
* Bariatric wheelchairs
* Stand up wheelchairs
* Elevating wheelchairs
31
seat angle
* Change by changing height if axle plate
* Changing caster or fork size
* Can add stability to user
* Too little can make person fall forward
* Too much can increase pressure on sacrum
* Too much can make it difficult to bring bottom forward
* **Tilt backwards for someone who finds it difficult to sit up straight against gravity
32
setting up wheelchair
Position of axle affects balance and stability
- When wheels are moved forward of axle, more of the weight is behind the axle, therefore the chair is more tippy, but also more inefficient propulsion
- Whereas if wheels are moved in front of axle, chair more likely to tip person out the front
- Position is process of trial and error, depends on person’s strength and skills
33
key role of pelvis in seating
- Joins spinal column and lower limbs
- Supports body in sitting
- Moves backwards and forwards as we perform activities
```
Normal sitting;
• Pelvis in slight anterior tilt
• Weight taken evenly through both ITs
• Good for function
• Sacrum supports no body weight
```
34
whats posterior pelvic tilt
```
• Sacral sitting’
• Common when sitting for long periods
• Most dangerous
• Associated with sacral, heel & spine pressure ulcers
(arching back head forwards)
```
35
whats pelvic obliquity
* Common when sitting for long period
* Caused by instability of chair or person
* Weight taken through one IT - risk of ulcers
* Associated with scoliosis
36
whats shear force
is parallel or tangential to the face of the material (in this case skin). Shear force causes rubbing of the skin over the bone (think blisters from uncomfortable shoes). This leads to sores, which, combined with compression leads to pressure injuries.
37
factor affecting wheelchair assessment
- Client
- Carer
- Environment
- Personal choice
38
client assessment considerations
- Posture
- Range of movement
- Muscle power
- Diagnosis and prognosis
- Size
- Transfers
- Fatigue
- Pain tolerance
- Pressure relief
- Cognition
- Perception
39
carer assessment considerations
- Physical ability to push, dismantle, assemble and lift chair
- Use in conjunction with other equipment
- Maintenance of safety
- Multiple carers??
40
environment assessment considerations
- Access eg narrow doorways and hallways, steps, stairs, ramps, turning space, worktop heights, height of through floor lift
- Transport of chair
- Terrain – driveway
- Storage
41
personal choice
- Lifestyle, work
- Recreation, hobbies
- Finance
- Aesthetic values
- Personal choice
42
whats the mechanical assessment tool assessment (MAT Tool)
Mechanical Assessment Tool assessment widely considered “good” or “current best” practice
– Provides clinical evidence for decisions
– Provides measurements which form a basis for intervention (product selection, customisation)
Assesses
– Joint ROM, sitting posture, balance, tone, muscle strength, coordination, endurance
– Body / anthropometric measurements (linear & angular) Measurement for seating:
- *Important role of Occupational Therapist
- Correct measurement of chair or wheelchair is essential in order to:
- Provide good positioning
- Provide comfort
- Prevent increased pressure in susceptible areas
43
other integlral parts of mat assessment
```
Sensory Impairments
- Paralysis
- Neuropathy
Developmental/Cognitive Level
- Able to identify sore areas?
Other orthoses, devices that are used
- Do they interfere with position
Nutrition
- Malnourished?
- Bariatric
Risk of Pressure
```
44
basic seating measurements
* A - widest measure across the hips
* B - rear of the buttocks to the inside of the bent knee
* C -Bottom of the heel to the inside of the bent knee
* D - Seat to Scapula
* E - Seat to Top of Shoulder
* F - Seat to Top of Head
45
whats a pressure injury
Pressure injury: is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
46
whats the ASIS scale
used to define and describe the extend an d severity of a patient’s spinal cord injury and help to determine rehabilitation and recovery needs.
47
whats the there main parts of the ASIS test
- Manual Muscling testing
- Light touch sensation
- Pinprick sensation
48
when is the ASIS scale used
It is ideally completed within 72 hours after the initial injury. T
49
mental health affects from spinal cord injury
```
Depression:
- longer hospitalisations
- fewer functional improvements
- greater pressure ulcer occurrence
- poorer subjective health
- higher medical expenses
Anxiety:
- excessive worry
- social anxiety
Post traumatic stress disorder:
- flashbacks/nightmears
```
50
acute care for spinal cord injury
Successful acute care management is dependent upon excellent positioning and extraordinary attention to regular and correct turning.
The primary aim of positioning is to support the injured spine in a good healing position.
Secondarily, the aim is to maintain limbs and joints in a functional position, hence reducing the incidence of spasticity and preventing contractures and deformity.
Other aspects of concerns may include psychological care, range of motion, respiratory care and pressure sore prevention.
51
post discharge rehab therapy spinal cord injury
Functional independence
Self-care tasks
Assistive devices
Re-entering the community
52
recovery for spinal cord injury
Any remaining loss of function present after 12 months is much more likely to become permanent.
53
• Describe the motor and sensory effects of spinal cord injury at the cervical spine
level.
Cervical spinal cord injuries usually cause loss of function in the arms and legs, resulting in tetraplegia
if its C1-4 they may not be able to breath by themselves/ ability to speak can be impaired
C5-8 breathing and speaking normally
*uses automatic wheelchair
54
injury at the Thoracic level of spine
T1-T5 arm and hand function noramal
normally legs affected =paraplegia also affects chest, mid back and abdominal muscles
T6-12 should be able to cough, normal upper body movement
* uses manual wheelchairq
55
injury at the lumbar level of spine
results in some loss of function in legs and hips
| *may need a wheelchair or may be able to walk with a brace
56
injury at sacral level of spine
results in some loss of function in legs and hips
little to no bowel or bladder control
*most likely able to walk
57
list of different sensation assessments
```
pain awareness assessment
temperature assessment
stereognosis assessment
touch threshold assessment
proprioception and kinaesthesia assessment
```
58
which part of the brain damage to usually results in neglect
right middle cerebral artery infarct
59
ASIS scale scores
Grade A
Complete lack of motor and sensory function below the level of injury (including the anal area)
Grade B
Some sensation below the level of the injury (including anal sensation)
Grade C
Some muscle movement is spared below the level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity.
Grade D
Most (more than 50 percent) of the muscles that are spared below the level of injury are strong enough to move against gravity.
Grade E
All neurologic function has returned.
60
screening tool for assessing pressure sores
Braden Scale
61
what nerves are involved in the shoulder, arm and hand
- axillary nerve (shoulder)
- muscultlocanteous nerve
median nerve
ulnar nerve
radial nerve
62
whats damage to dorsal roots lead to
loss of sensation
63
whats damage to ventral roots lead to
paralysis (loss of motor function)
64
whats the two types of paralysis
flaccid paralysis
| spastic paralysis
65
whats flaccid paralysis
- occurs when the lower motor neurones or ventral roots are injured.
- cannot move either voluntarily or involuntarily
66
whats spastic paralysis
-occurs if only the upper motor neurons of the primary motor cortex are damage
- spinal reflex activity continues to stimulate the muscles irregularly (twitch or spasm)
loss of voluntary movement
