Spinal Cord Injury and Occupational Therapy – Flashcards
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___________________ is currently the most frequent neurological category followed by ____________________, _______________________, and ____________________________________.
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Incomplete tetraplegia is currently the most frequent neurological category followed by incomplete paraplegia, complete paraplegia, and complete tetraplegia.
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In the 70's, common SCI causes of death were things like
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sepsis from UTI or wounds.
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What level innervates most of the breathing
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C4
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If someone's level is a X, that is the level that
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WORKS. THIS IS SUPER IMPORTANT.
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C4: Key muscles and functions
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Diaphragm, trapezius: Respiration;
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C5: Key muscles and functions
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Biceps: Elbow Flexion; Deltoids
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C6: Key muscles and functions
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Radial wrist extensors: Wrist extension; tenodesis after time and therapy
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Early in therapy with a C6 injury . . .
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you might use a universal cuff or hook something to the hand, because they do have the wrist extension. They haven't developed tenodesis grasp yet, which takes a lot of time and effort.
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C7: Key muscles and functions
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Triceps, elbow extension
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______ is a great activity for C7 SCI, because ______
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transfers! They have tricep extension and can work on scooting themselves over (versus just locking their elbows)
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C8: Key muscles and functions
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Flexor digitorum: Finger flexion (makes a claw hand)
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L2: key muscles and functions
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Psoas Major: Hip Flexion
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L3: Key muscles and functions
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Quadriceps : Knee extension
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L4: Key muscles and functions
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Tibialis Anterior: Ankle Flexion
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S1: Key muscles and Functions
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Gastroc: Plantarflexion
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S3-S5: key muscles and functions
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Bowel & bladder
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In AIS A
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Complete: No motor or sensory function is preserved S4-S5
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In AIS B
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Incomplete: Sensory function is preserved below level of injury (including S4-5)
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In Ais C
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Incomplete: At least ½ key muscles below level of injury <3/5
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In Ais D
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Incomplete: At least ½ key muscles below level of injury >3/5
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In Ais E
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Normal: Motor and sensory function is normal
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A c5 asia D is most likely
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a central cord patient -> arms don't work, legs do!
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What are common precautions and complications of SCI?
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Fracture Respiration Spasticity Thrombus Decubiti Orthostatic Hypotension Autonomic Dysreflexia Heterotrophic Ossification Neurogenic Bowel & Bladder
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When do you hold therapy s/p fracture?
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Surgical consult pending Radiological tests pending
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After operative repair (rods, screws), you need to be aware of
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Fusion, screws, rods, bone graft Brace Post-op precautions -> don't move them too much!
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If a person has non-operative conservative treatment
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Non-operative "conservative" treatment Immobilize - bedrest Immobilize - brace Spinal precautions Braces don't immobilize the bones completely! They serve mostly as a reminder.
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The biggest clue that a patient should not be bending or twisting is
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a TLSO!
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What is a halo?
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screwed into the head, rests on your shoulders, stabilizes your neck while you heal, makes you top heavy
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With splints and braces, it's important to remember that
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they can impede function
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What is BLTS?
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No bending, lifting, twisting, or sitting without more than 20 mins at a time without changing position
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With lesions C4 and above
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Damage to phrenic nerve Diaphragm weakness May require ventilator or phrenic nerve stimulator
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For lesions from C5-C12 (breathing)
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Weakness of intercostal, lats & abdominal muscles Impaired respiration
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What is quad-cough
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push on abdomen to help them cough
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What treatments are available for impaired breathing in SCI?
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Quad cough" Suction Trunk strengthening Incentive spirometer
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One cause of spasticity that can be temporary is
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Reflex muscle contraction
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What are some advantages of spasticity?
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Warns of problem Decrease atrophy Promotes circulation Use functionally
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What are some disadvantages of spasticity?
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Impairs function Pain Skin breakdown Seating & positioning limitations
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Treatments for spasticity include
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ROM Splints Medication Baclofen
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What are some blood clot risks in SCI?
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Blood clot - decreased circulation Deep Vein Thrombosis (DVT) in extremity or Pulmonary Embolus (PE) in lung
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Symptoms of DVT include
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Warm, swollen, pain
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PE symptoms include
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SOB Decreased O2 saturation Chest pain
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How can we prevent thrombus?
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Anticoagulants Sequential Compression Device (SCD) Compression garments(TEDs) ROM & activity
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What are treatments for thrombus?
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Anticoagulants Inferior Vena Cava Filter (IVCF)
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What are causes of decubitus ulcers
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Decreased circulation Immobility Cell death
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How can you prevent decubitus ulcers?
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Position change Skin check Hygiene
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Stage 1 pressure ulcers
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look like red blisters
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A stage 2 pressure ulcer
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skin opens
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A stage 3 pressure ulcer
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goes into subcutaneous fatty layer
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A stage 4 pressure ulcer
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goes into bone/muscle
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One way to motivate patients that do not want to engage in therapy into doing position changes and hygiene is
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to show them pictures of pressure ulcers . . .
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What is orthostatic hypotension?
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Low blood pressure with change of position
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What is HoTN?
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hypotension
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Symptoms of orthostatic hypotension include
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Lightheaded, dizzy Syncope
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Prevention of orthostatic hypotension include
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Slow position change TED hose, abdominal binder
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Treatment for orthostatic hypotension include
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Lie down / recline Elevate LE Progressive activity tolerance Have them kick their legs, move around -> get blood moving back up
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What is autonomic dysreflexia?
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Serious, life-threatening condition! Sympathetic nervous system responds to a stimulus (interpreted as "noxious")
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Who is at risk of autonomic dysreflexia?
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Injuries at or above T6 are at risk
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What are symptoms of autonomic dysreflexia?
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High blood pressure Pounding headache, blurred vision, decreased heart rate, goose bumps, sweating, flushing skin, nasal stuffiness
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Possible causes of autonomic dysreflexia include
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Full bladder Urinary catheter blocked Stool impaction Infection Pressure sore Tight clothes Ingrown toenail ANYTHING that the body feels is a threat!
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What could happen as a result of autonomic dysreflexia?
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Cerebral vascular hemorrhage (CVA - stroke) Myocardial infarction (MI - heart attack)
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Treatment for autonomic dysreflexia includes?
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Sit patient up, or remain sitting. DO NOT LIE THE PERSON DOWN; IT INCREASES THE BP Find the "noxious stimulus" and fix it Nitro paste if necessary
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Prevention for autonomic dysreflexia includes?
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Follow cathing schedule Successful bowel management program Skin checks
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What is heterotopic ossification?
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Abnormal calcification around a joint
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Where is heterotopic ossification most common?
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Most common at shoulder & hip
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Symptoms of heterotopic ossification include?
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Decreased ROM Warm & swollen Febrile
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Treatment for heterotopic ossification includes
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ROM Medication
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What is neurogenic bowel and bladder?
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Decreased voluntary control of bowel & bladder due to neurological injury
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Bladder management can include
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Indwelling foley catheter Intermittent cath Suprapubic cath
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Bowel management can include
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Diet Medication Bowel training program Ostomy
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How does tenodesis work?
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Technique used with C6 injury Use of wrist extension to elicit "grasp" Strengthen wrist extensors Maintain flexor tension
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At ______ you can usually pronate
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c6
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C6 cannot (extend/flex) the wrist
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flex
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A good thing to work on for ADL's and dressing skills for C6 could be
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substitutions movements to get pants on and off, trunk balance; long sitting in bed
