Rehab Techniques Final Review PDF

REHAB TECHNIQUES FINAL REVIEW Tandem stance- When you place the right foot in front of the left foot, directly in front of the other, with the right heel touching the toes of the left foot. Also known as tightrope walking Tandem stance Rombe...

REHAB TECHNIQUES FINAL REVIEW Tandem stance- When you place the right foot in front of the left foot, directly in front of the other, with the right heel touching the toes of the left foot. Also known as tightrope walking Tandem stance Romberg stance-Standing with the feet close together Romberg stance Tandem and Romberg stance are good exercises to help improve balance. Stages of motor development Level I: Mobility (Reciprocal Innervation) o Agonist muscle contracts as antagonist muscle relaxes Level II: Stability (Co-innervation) o Fixes potion of the body so weight bearing can be done Level III: Mobility superimposed on stability with distal segment fixed o Moving the limbs when they are fixed, closed chain Level IV: Skill - Mobility superimposed on stability with distal segment free  o Ability to maintain stable proximal joint while the distal end moves, open chain Rood technique=The developmental approach (sensorimotor therapy=sensory+motor) Rood technique consists of working on normal development Rood technique vital Functions: Food intake, respiration, eventually speech a. inspiration b. Expiration: includes crying, sneezing, coughing (last two are protective) c. Sucking: coordinated with swallowing and breathing d. Swallowing: facilitated by sensory input from the trigeminal distribution (CN 5th) e. Phonation: controlled expiration -- speech development Brunnstrom=Stages of recovery after a stroke NDT=The problem-solving approach (Bobath) Gross Motor skills-motor tasks that use large musculature precision of movement is not as important to accomplish the task Fine Motor skills-motor tasks that use small muscles precision is important to accomplish the task, typically requires eye-hand coordination Stages of motor learning Massed= Practice occurs in a larger block of time with more practice time than rest time. Cramming for an exam the night before 5 hours of studying in one night Distributed= Practice occurs in smaller blocks with breaks equal to or less than rest time. Studying in small chunks every evening 5 hours of studying 1 hour, each day, for 5 days  Constant= Practice is focused on a single activity under the same conditions every time. Practicing a passage of music with the same start and end point each time. Working on walking in the gym with a pre-planned distance in the same hallway, same speed, repeated manner. Variable= Practice occurs under a variety of conditions Practicing the passage of music with different starting and ending points. Vary conditions of the activity: changing location, speed, or surface. This practice ensures the learning is not dependent upon the specific activity starting point but can be adapted under various circumstances. Blocked= Single task performed uninterrupted by the practice of any other task. Training a basketball player to shoot, then dribble Random= Multiple tasks are performed without regard to a particular sequence. Training a basketball player to shoot and dribble throughout game play Guidance= Providing verbal or physical cues for proper performance Facilitation for normal patterns and movement Assisting and cueing throughout the activity Discovery= Allowing the learner to make changes based on their own assessment No feedback provided during the session, learning occurs through trials and self-assessment Error-Driven (Error-based): Allowing the learning to make mistakes throughout practice and make changes based Allowing trials with mistakes that encourages the learner to make  errors and redirect performance based on cues or self-assessment Not NO-DIRECTION, but some direction Walking practice where the learner is directed in the end goal and not the performance of each step Error-Free: Learners are not allowed to make mistakes in practice. Consistent and similar performance encouraged with each repetition Walking with guided foot placement in the same location with each step Whole= Practicing the entire skill from start to finish Part= Practicing components of skills Stages of learning Cognitive Stage: Learning what to do and what is necessary to perform a skill correctly. Developing an understanding of the skill. This stage requires the most attention and cognitive load Associative Stage: Learning how to perform a skill with greater precision and accuracy. Breaking the skill into components. Learning to experience the correct “feel” of a skill. Fine tuning and applying the skill to basic situation Autonomous Stage: The learner has learned the skill and is able to perform it with minimal cognitive monitoring. Spasticity-Contractions of muscles causing stiff and awkward movements (velocity dependent) Rigidity- Resistance to stretch throughout range of movement Muscle tone- overall state of tension in the body Types of muscle tone ▪ Flaccid = no tone ▪ Hypotonia = decreased from normal ▪ Hypertonia = increased from normal ▪ Dystonia = disordered tone (seen with active movement)  Modified Ashworth scale measure what: Spasticity Modified Tardieu scale assesses what: Muscle response to stretch at given velocities ▪ R1 measurement=spasticity ▪ R2 measurement= structural limitation (contracture) Burke-Fahn-Marsden scale measures what: Dystonia  What medicines is used for spasticity: CNS depressants (baclofen, valium dantrolene sodium) o Can also use botox injections to decrease spasticity PNF Facilitation: To free from difficulties or obstacles; to make easier; to assist something to happen. Inhibition: To hold back, repress, depress, slow down, or limit. Quick ice and light touch are good faciliatory techniques to get a muscle contraction In PNF maximal resistance is the amount of resistance used to get an active muscle contraction to get the correct motion you need PNF improves coordination, strength, ROM, and balance Diagonal line of motion is called the groove The completely lengthened state is called the wind up Which diagonal pattern used for chopping: UE D1 extension Which diagonal pattern used for lifting: UE D2 flexion Creeping has both a flexion and extension component Joint approximation is a technique used to help a patient stay stable while sitting upright Shaking is a series of quick stretches o You can use shaking with a rotational component to reduce spasticity Fixing(co-activation)- using muscles in one body area to stabilize or to help move another body part walking on a balance beam 15 feet above the floor child walking with a high guard Balance and coordination Coordination- the ability to use and control multi joints of the body together to help move the body smoothly and efficiently. Nonequilibrium coordination-control of discrete(separate) movements of the extremities  Equilibrium coordination-control of multi-joint movements for posture and gait (includes the trunk) Cerebellum, basal ganglia, and dorsal column are all areas where balance impairments occur in Cerebellum impairments: Hypotonia, dysmetria, dysdiadochokinesis, tremor, dyssynergia, ataxia, dysarthria, asthenia, rebound phenomenon, nystagmus Basal ganglia impairments: Bradykinesia, akinesia, rigidity, tremor, chorea, athetosis, choreoathetosis, hemiballismus, dystonia Dorsal column impairments: Decreased proprioception, kinesthesia, and discriminative touch Cerebellum=intention tremor Basal ganglia=resting tremor Dysdiadochokinesis- Having trouble doing RAM (rapid alternating movements) o Flag wavers and taxi drivers don’t have trouble doing RAM because their hands are stable What exercises are used for ataxic pts- Frenkel's exercises Ankle strategy-small perturbations within LOS, muscle work distal to proximal o What correct a backward sway in order: Tibialis anterior, quadriceps, abdominals Hip Strategy-Large perturbations on narrow BOS, muscle work proximal to distal o What correct a forward sway in order: Abdominals followed by the quadriceps Stepping strategy-Large fast perturbations o Walking in a crowd and get push a little too hard you will use this strategy to not fall down Anticipatory or proactive- Tell pt ahead of time what they will expect for preparation o Helps improve pt confidence because they know what to expect Compensatory or reactive- Don't tell pt ahead of time what to expect. Pt will react to the stimulus provided  Vestibular The labyrinth has no collateral anastomotic network=susceptible to ischemia Otolith organs: utricle and saccule o Detects linear motion acceleration and deceleration Angular head movement coordinates the VOR (vestibular ocular reflex) in semicircular canals VOR- This is when your eyes can stay stable with rapid head movements, so you won’t get dizzy Semicircular canals- where rotary movement is at Otoconia is located in the vestibule o If otoconia travels to the semicircular canals you will get BPPV (Most common cause of vertigo, feels like your world is spinning) Smooth pursuits-eyes remain fixed on a moving object VSR (vestibular-spinal reflex)- balance strategies VCR (vestibulocollic reflex)- Cervical muscles used for head stabilization Strabismus-crossed eye Ptosis-drooping eyes Vertigo-the illusion of spinning Oscillopsia- vision gets blurry with head movements  o You get this when the VOR is absent Migraine vs Meniere’s disease o Migraine ▪ Tinnitus, high pitched ▪ Ear fullness ▪ True vertigo is rare, occur for a few minutes ▪ Short naps helps ▪ Visual auras common ▪ Motion sickness common Meniere’s disease ▪ Tinnitus, low-pitched ▪ Hearing loss ▪ True vertigo is common, occur for hours ▪ Short naps don’t help ▪ Visual auras uncommon ▪ Motion sickness uncommon Meniere disease diagnosis=Low level hearing loss + endolymphatic hydrops (imbalance of fluid) BPPV is treatable ▪ Treat it by doing a vertebral artery screen, Dix-Hallpike, and finish off with canalith repositioning technique Functional assessment and outcome measures Reliability=consistency Validity-accuracy Responsiveness-sensitivity MDC (minimal detectable change)- how much is really change and not an error MCID (minimal clinical important difference)- How much change is important for a specific population Performance based tests- observational only, what the pt do o Tinetti, TUG tests Self-reports- what the pt reports to the PTA o Pain scale from 0-10 Cut-off scores- The true decision for a specific population  o Gait walk test to determine whether it safe for a pt to go home ICF model measures health and disabilty at both individual and population levels, treats pt impairment o Consists of body function and structure, activities, participation, Enviromental and personal factors FEAR OF FALLING IS THE MAIN REASON AN OLDER ADULT IS AT RISK FOR FALLS Stages of arousal  Alert: awake and attentive to normal levels of stimulation Lethargic: appears drowsy and may fall asleep, if not stimulated in some way Obtunded: difficult to arouse from a somnolent (sleepy) state and frequently confused when awake Stupor: responds only to strong, generally noxious stimuli and returns to unconscious when the stimulus is removed Coma: cannot be aroused by any type of stimulation Orthoses=improve Prosthesis=replacement Limb Loss Excessive knee flexion can be d/t o High heels, socket too fair anterior (prosthetic causes) o Flexion contracture, weak quads (anatomic causes) Lateral displacement/abduction o High medial wall, long prosthesis (prosthetic cause) o Adductor weakness (anatomic cause) o Abduction contracture (anatomic cause) o adductor tissue redundancy (adductor roll) (anatomic cause) o Distolateral limb pain (anatomic cause) Circumduction and vaulting (prosthesis causes) o Long prosthesis o Locked knee unit o Loose friction at knee (does not flex as much as it should) o Inadequate suspension (slips down) o Socket is too small (limb does not go on completely, causes a long leg) o Foot plantarflexed Circumduction (anatomic causes) o Abduction contracture o Poor knee control o Patient finds it easier to circumduct than to control the knee unit  PVD or Diabetes (vascular disease) are the main reasons for getting a limb amputated. Massages, limb wrapping, and early weightbearing can help decrease pain in an amputated limb. Phantom Limb Sensation o PRO: An awareness of the missing limb, helps with early prosthetic training o CON: Wake up and fall out of bed because you still think you have your leg= FALL RISK Phantom Limb Pain o CON: Can prevent prosthetic training d/t the pain Total Contact Socket o All surfaces touching, not all surfaces weight bearing, but makes a very nice fit o bearing on tolerant soft tissue areas o Counter pressure assists with venous return o Enhances sensory feedback Patellar Tendon Bearing (most common) o Patellar tendon takes most weight (Provides the weightbearing) o Facilitates quadriceps loading o Prevents recurvatum o Requires socket flexion- 5* TFA-quadrilateral o Can bear weight on the ischial tuberosity TFA- ischial containment o Can bear weight on the glutes and bottom of the limb TFA comfort flex socket is hard not soft  o Reduces socket rotation on the limb Wraps can be replaced with shrinkers once the skin is healed. Following an amputation to help control swelling of the residual limb you use a shrinker DONT WEAR A SHRINKER INSIDE OF A PROSTHESIS, PRESSURE OF THE PROSTHESIS DOES THE SAME JOB AS A SHRINKER. SHRINKER IS WORN ONCE THE WOUND IS HEALED AND THE SUTURES HAVE BEEN REMOVED With an amputated transfemoral limb prone lying helps with hip extension, Hip adduction and hip extension is important. YOU DO NOT WANT HIP ABDUCTION AND FLEXION. With a transtibial amputation if the pt sits in a w/c make sure the KNEE IS PLACED IN EXTENSION The main concern after getting a limb amputated: CONTRACTURES o Contractures are prevented through ROM and frequent positioning o DO NOT REST LIMBS IN A GRAVITY DEPENDENT POSITION=CONTRACTURES Main rules for limb wrapping o No tape on the skin o Use a figure 8 style o Wrap on a diagonal, never circumferential, wrapping circumferential will decrease circulation in the limb which causes ischemia o No stirrups o Even Pressures o Cover all holes and windows o Should feel tight o Maintain upward pressure gradient o Pressure is greater distally than proximally o Pull on the up, not down phase o Anchor with 2 layers of minimal stretch to hold in place  o May use tape to secure top layers, but no pins o Leave space for hygiene o Watch out for wrap sizes so you won’t create a tourniquet. Ex: if you start the limb wrap with 2-inch bandages, the next bandage you use is a 2- inch or higher. Never go smaller because it will cause edema in the distal limb. o Wrap in a diagonal to avoid dog ears (stirrups- wraps start in the middle which will cause flaps on both sides=dog ears) Burns Thermal burns – Due to an external heat source that raises the temperature of the skin. Thermal burns can be caused when hot metal, scalding liquid, steam or flames come in contact with the skin. Chemical Burns – Due to strong acids, alkalis, detergents or solvents coming in contact with the skin. Electrical Burns – From an electrical current (alternating current AC or direct current DC). Can be accompanied by flash flame (thermal) burn. Radiation Burn – Due to prolonged exposure to UV rays from the sun or exposure to radiation such as therapeutic cancer treatments or nuclear power plant leaks. Friction Burn – When heat generated by friction causes direct damage to the skin (ex: road rash, rope burn) Eschar- dead tissue Rules of 9’s- the percentage of how much of the body is burned RULE of NINES TBSA 9 head 9 each arm 18 each leg 18 anterior thorax 18 posterior thorax  1 perineal area EX: if the patient burned their entire left leg and right arm what's the TBSA: 18+9=27% EX: if the patient burned half their right arm and half of their left leg what's the TBSA: half of 9=4.5, half of 18=9, 9+4.5=13.5% If a burn patient does not try to move or ambulate what are some complications they can get: Pulmonary complications (pneumonia), or DVT. o It’s very important for a burn patient not to be down. Encourage ambulation so the patient won’t get deconditioned When is it contraindicated to ambulate a burn patient: If the burn patient has a new skin graft or is getting dialysis done every hour Deep burns in the skin can affect the nerve endings in the body which result in tingling in the skin, numbness, weakness, pain, or burning in the body Temporary wound coverings: Xenograft(pigskin), Allografts(cadaver) What’s the difference between a mesh graft and sheet graft: the mesh graft covers way more skin than the sheet graft REMEMBER THE DEEPER THE BURN THE MORE ALTERED THE SENSATION WOULD BE THE POSITION OF COMFORT= THE POSITION OF CONTRACTURE  The optimal position to keep a patient in with burns so they wont get contractures (Important picture) Optimal positions for burns examples o Burns on the anterior neck what position should the head be in to prevent contracture: Neck extension, no neck flexion= comfortable position, which results in a contracture o Burns on the hip what position should the hip be in to prevent contracture: In a straight neutral position, (hip extension), no hip flexion or hip external rotation (frog legs) =comfortable position, which results in a contracture o Burns in the axilla area what position should the arm be to prevent contractures: Shoulder abduction, external rotation and arm supination Never put in shoulder internal rotation, adduction, arm pronation=comfortable position, which results in a contracture o Burns on the foot what position should the foot be to prevent contractures: Dorsiflexion, no plantarflexion=comfortable position, which results in a contracture o Burns on the knee what position should knee be to prevent contractures: Knee extension, no knee flexion=comfortable position, which results in a contracture When is stretching contraindicated for a burn patient: If the skin and tendons are way too dry and fragile= can rip the skin off (BAD) Epithelization- The process of covering the epithelium with new skin o This process does not occur in full thickness burns  Granulation-The development of new tissue and blood vessels in a wound during the healing process (looks like ground beef) Circumferential burns=ischemia (decreased circulation) Burns greater than (>) 25%= organ failure What is an inhalation injury: when someone gets burned in a very tight closed space which can result in pulmonary complications, pt inhaled all the smoke and fumes during the fire Alimentation means nourishment, to feed **Not to keep pt weight up!! Burn patients diet need to consist of a lot of protein and meat so the patient wound can heal faster and to help the patient immune system Escharotomy-full thickness incision through eschar (down to subcutaneousfat) relieve pressure on vasculature from circumferential deep burns Fasciotomy-incision through all skin layers, into muscle compartment to release pressure What’s the main reason a patient with burns could die from: Infection Burn contractures are common in the axilla area Heterograft (xenograft)- A graft from another species (not human, EX: pigskin) Allograft (homograft)- A graft from another human, same species, EX: human cadaver Autograft- skin graft from own person’s body Hypertrophic Scar - an abnormal response to scar development, an over growth of dermal contents that remain within the boundaries of the wound. o How can you control hypertrophic scarring: Laser therapy, steroid injections or pressure therapy Compression Keloid - A scar which extends beyond the boundaries of the wound. Most common in African Americans. Superficial thickness (1st degree burns)- Involves the epidermis, sunburn Partial thickness (2nd degree burns)- Involves the epidermis and some or all of the dermis Full thickness (3rd degree burns)- Involves the entire epidermis and dermis and extends into the hypodermis (subcutaneous tissue) 4th degree full thickness burns- Involves the fascia, muscle, and bone Hypertrophic scar Keloids 1st degree burn  2nd degree burn 3rd degree burn 4th degree burn Debridement-The removal of dead tissue o Burn patient may bleed a lot d/t debridement If a burn patient has an arterial line, make sure you wrap it with an ace wrap before ambulation Local flaps heal faster than free flaps  Local Flap – tissue taken from area adjacent to original wound; tissue remains attached at one end and is nourished by original blood supply Free Flap – tissue is completely detached from one area and transplanted to another, along with its own blood supply, whose circulation is restored after transplantation Environmental and seating, W/C Ramps outside on snow and ice what measures are for the ramp to be modified- 1:20 What the difference between accessible designs and universal designs: Accessible designs are for people with disability, universal design is for all people Lever type handles are good for people who have limited grip/or strength in the hands. EX: people with MS, arthritis, brachial plexus syndrome, or Parkinson's Width of a wheelchair: 18-25 inches What’s the standard width for a door to let a standard w/c get through: 32-34 inches Tilt in space w/c- facilitate feeding and respiratory function, reduce pressure beneath the pelvis, and improve visual alignment by holding the head upright. ▪ Used for pts who will be moving around all day Make sure the wheelchair width size fits the patient so the patient can propel their wheelchair in the community properly A patient with extensor tone what kind of w/c is suitable: A chair that 90 degrees at the hip, knees, and ankles The height of stairs should never go pass 7 inches, and handrails should be at least 34 inches high Cambers on wheelchairs help with turning the wheel faster and easier. Mostly seen on sports w/c  Camber w/c used for sports Handrails length should about 12 inches with a grip of 1.25 inches and a wall clearance of 1.5 inches To propel in a wheelchair, you must have strong stable proximal joints Never use abductor cushions to keep a patient stable and from falling out of the wheelchair. Long-term use can cause future pressure injuries A k5 w/c have rigid foldable frames Maximum rise of a ramp-30 inches Maximum width of a ramp-36 inches Closets bar height-52 inches Kitchen for w/c counter height-no greater than 31 inches, knee clearance height-27.5-30 inches, and depth-at least 24 inches Bathroom grab bars:33-36 inches, length side wall-42 to 54 inches, length back wall-24 and 36 inches Roho cushion uses air cells for support and comfort Orthoses What is the most stable cervical (neck) brace: HALO o This prevents the head and neck from moving o No neck flexion, extension, sidebending, or rotation  Halo brace (CTO, CTLSO) Minerva brace (CTLSO) Limits flexion, extension, sidebending, and rotation Philadelphia collar (CO) What's an advantage of a Philadelphia collar: Can take a bath or shower in it. It can get wet. Limits flexion, extension, sidebending, and rotation Soft cervical collar (CO) This brace limits flexion, extension, and sidebending Knight taylor brace (TLSO) This brace limits flexion, extension, and sidebending  Somi brace (CO) The somi brace consists of an occipital and mandibular plate to keep the head and neck stable Body jacket brace (LSO or TLSO) Limits flexion, extension, sidebending, and rotation  Miami J collar (CO) Braces abbreviations CO-cervical orthoses CTO-cervical thoracic orthoses CTLSO- cervical-thoracolumbosacral orthoses LSO-lumbosacral orthoses TLSO-thoracolumbarsacral orthoses foot orthosis = FO ankle-foot orthosis = AFO knee-ankle-foot orthosis = KAFO hip-knee-ankle-foot orthosis (HKAFO) trunk-hip-knee-ankle-foot orthosis (THKAFO) The difference b/t springs and trimlines: o Trimlines-restrict or allow the motion at the joints o Springs-Used to help assist motion at the joints SCI  In SCI patients, if you're working on dynamic balance the patient should always be positioned at the edge of the mat with the feet planted on the ground. Parastance- an extension moment is created at the hips that prevents the individual from folding forward, starts at T12, feet set in 5-15 degrees of DF to get the patient stable, pt leans on Y ligaments If pt loses para-stance position what will happen: pt will jack-knife (lean forward aggressively) The patient cannot make decisions on when they think they don’t have to wear the orthosis anymore. Get it cleared with the orthotist. Educate patient and family in donning, doffing, positioning, functional training, skin protection, wearing schedules, and maintenance (care) of the orthosis Myotomes C5 = elbow flexors C6 = wrist extensors (pt gains tenodesis) C7 = elbow extensors C8 = finger flexors T1 = little finger abductors T6-12 = trunk flexors L2 = hip flexors L3 = knee extensors L4 = ankle dorsiflexors L5 = long toe extensors S1 = ankle plantar flexors S2,3,4 = bowel and bladder In SCI patients what are some reasons for getting increased spasticity: neurogenic bladder is not a fever, infection, stress, constipation, position, fatigue, environmental reason. conditions, catheter and or bowel blockage, and cutaneous stimulation SCI patients need good hamstrings length to help function properly and sit upright o L2 ASIA A SCI (pt has hip flexors) patient can benefit from good hamstring length because they can do activities like reaching from something at an angle or reaching to tie their shoes in sitting position  SCI patients are at risk for getting pulmonary complications like pneumonia, DVT, osteoporosis, heterotopic bone formation, pressure sores, and contractures o Make sure their getting up and doing some type of movement to prevent that For sliding board transfers from w/c to mat. If you're transferring pt to the right, what can you do to make it a successful transfer: make sure pt uses their momentum and whip their head and shoulders to the left to get on the mat. Remember to ask the pt to use their momentum the opposite way they are moving to get a successful transfer, pt transferring to the right whip their to the left and vice versa. ASIA A spinal injuries what highest level you can begin ambulating with AFOs- L13 C6 ASIA A pt scooting back and forward on the mat are you what motions at the shoulder: Shoulder extension, external rotation, and adduction Key muscles at motor level for SCI C1, C2, C3, C4 ▪ Face and neck muscles, diaphragm at C3 and C4 C5 o Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, ands supinator C6 o Extensor carpi radialis, Infraspinatus, Latissimus dorsi, pec major (clavicular portion), pronator teres, serratus anterior, teres minor C7 o Extensor pollicis longus and brevis, extrinsic finger extensors, flexor carpi radialis, triceps C8 o Extrinsic finger flexors, flexor carpi ulnaris, flexor pollicis longus and brevis, intrinsic finger flexors T1 to T12 o Intercostals, long muscles of back (sacrospinalis and semispinalis), abdominal musculature (T7 and below) L1, L2, L3  o Gracilis, iliopsoas, quadratus lumborum, rectus femoris, sartorius L4, L5, S1 o Quadriceps (L4), anterior tibialis (L5), hamstrings (L5-S1), Gastrocnemius (S1), Gluteus medius and maximus (L5-S1), Extensor digitorum, posterior tibialis, peroneals, flexor digitorum (L5,S1) Autonomic dysreflexia (hyperreflexia) o Occurs with lesions above T6, but seen at levels close to T6 o S/S: hypertension, headache, sweating, increased spasticity, goosebumps, may turn pale ▪ As a PTA what do you do: lay the patient down SCI patients are also at risk for getting orthostatic (postural) hypotension o As a PTA what do you do: Don ace wraps or abdominal binder, get lab work (may be anemic (HGB and HCT)) SCI patients at C6, C7, C8 and down can do their pressure reliefs independently Pressure relief in w/c for the butt= unweighting the ischial tuberosities When having the pt learn the prone on elbows exercise on the mat if the pt has a hard time doing it what muscle can apply pressure on to get them to come up: Pec major Designation of levels ▪ Skeletal level – Level at which the greatest vertebral damage has occurred ▪ Sensory level – The most caudal segment of the spinal cord with normal sensory functions as determined by testing the 28 dermatomes on each side of body. ▪ Motor level – The most caudal segment of the spinal cord with normal motor function as determined by testing 10 myotomes on each side of the body.  ▪ Neurological level – The most caudal segment of the spinal cord with normal sensory and motor function. C1-C5=dependent transfers C6=dependent at first, but can become independent C7-S1= independent transfers Pressure sores in SCI patients can always be prevented. If a pt with SCI is always sitting in a w/c always think they can get a pressure sore. How do C1-C4 SCI patient move their w/c: they use the sip-and-puff mechanism to move the w/c around Wheelies in w/c- When you lean backwards in the w/c with the leg rests off the ground and try to balance on the wheels SCI patients can have bladder problems. o Urinary catheter is used for urinary output SCI patients can still have children, but may have sexual dysfunction (Men) UMN – greater erectile capacity erections are reflexogenic more difficulty with ejaculation (Men) LMN - difficulty getting an erection dependent on psychogenic stim can ejaculate with more ease FEMALE – sexual dysfunction basically not impaired- menstruation initially delayed a few months, conception not impaired To increase functional movement in a SCI patient what relationship do you use: Head/Hip relationship What also do you need for a successful transfer in SCI pts: Velocity/momentum, leverage, and timing  o You do not need strength o Pt is not a piece of meat Spinal shock happens right after the cord insult (car accident, GSW, etc) o S/S: areflexia, flaccidity, loss of sensation below level of lesion o Bulbospongiosus reflex is absent When the bulbospongiosus is present, spinal shock is over and the pt will eventually become spastic UMN=central nervous system LMN=peripheral nervous system Weighted vests are good for SCI pts to wear because it increases their proprioception ASIA scale A- complete: no sensory or motor below the level of the lesion No Sacral sparing (S4-S5) B- incomplete: sensory preserved through S4-S5, no motor C – incomplete: some motor below the neurological level Majority of key muscles < muscle grade 3 D – incomplete: some motor below the neurological level Majority of key muscles > muscle grade 3 E - Normal Cord syndromes Brown- Sequard ▪ damage on one side of the spine due to stabbings and GSW ▪ presentations vary some – lesion is irregular, usually not complete hemisection ▪ Ipsilateral weakness - lateral column damage  ▪ Ipsilateral spasticity in muscles innervated below the lesion ▪ Ipsilateral loss of proprioception, kinesthesia, vibration ▪ Contralateral pain and temp loss Contralateral motor starting a few levels below the lesion Anterior Cord Syndrome ▪ Associated with flexion injury ▪ Often result of loss of supply of anterior spinal artery ▪ Bilateral loss of motor function, pain and temp Posterior Cord Syndrome o Rare o Injury to posterior (dorsal) columns o Loss of proprioception o Pain, temp, sensation, and motor function below level remains intact Central Cord Syndrome o hyperextension injury- cervical area o UE deficits > LE deficits o B&B intact o Most common of the incomplete syndromes CONUS MEDULLARIS SYNDROME o UMN vs LMN ?combo o Likely to be bilateral o Hyperreflexia vs areflexia bladder - CAUDA EQUINA SYNDROME o Below Conus Medullaris o LMN o frequently incomplete o potential to regenerate  WC matching C5- assisted with sliding board transfer C6-power WC in community C7- WC with plastic rim C8-Independentvtransfer from floor to WC Pressure sores are NOT unpredictable Fasting blood count is not a top priority during testing Selective strengthening what muscle for a SCI L2 pt- Hip flexors What type of door should a WC avoid? Offset hinge 12 X12=144 Central cord- UE>LE Anterior cord syndrome- Loss of motor and sensory A word to describe PNF- modulate For tendonesis you want to strengthen wrist extensors Which is not a motor learning concept- combined Supine to prone for T6- chopping D1 extension Pnf for ataxia is- D1 D2 pattern C4 transfer- dependent and p driven C6 when they are prone on elbows what are they strengthening- serratus Dysdiadochokinesis- stocking boxes in a warehouse C6 if they cannot get on prone what muscle do you facilitate? Seratus 55% burned- organ failure Tone inhibition- All **Xenograft will be replaced** **Leather= eschar** Position for distal burns on distal UE- elevate limb to avoid edema If pt is pale, lay them down. 3 different pt with weak LE what should you do- Initiate weight bearing activities What part of the brain will be least affected by ataxia- Frontal lobe Which does not help with limb pain-independent position C2 Asia D can breath room air Help a SCI cough- hand placement between xiphoid and umbilicus.. Vertigo CN:8 Short sitting- edge of mat ** Co-innervated skilled- skill well integrated How do you lessen proprioception- Put pt in water Which is not a type of motor learning- Combined Bun position: Neck-Extension Shoulder- Abduction, horizontal abduction Knee- Extension Posterior elbow- Flexion Ankle- Dorsiflexion SCI Journal- One ? pertaining to school another ? pertaining to near drowning Deep partial burns painful- nerve ending exposed Burn predictions are based on- the depth of the burn Midpoint WC- turning radius -Halo Fest Springs on AFO help with dorsiflexion that helps assist with swing Prone to prone- Next activity prone to supine Oldest part of the brain- Vestibul Most stable orthosis with the least weight- KAFO Cuauda equina- Peripheral