Week 4.7 Interventions for complete paralysis handout.pdf

DPT 6410 Neuromuscular Practice Therapeutic Interventions for Complete Paralysis Objectives Describe the clinical presentation of someone with more complete/higher level SCI Identify some interventions to best recovery and/or retrain basic mobility functions in person with more complete/higher level...

DPT 6410 Neuromuscular Practice Therapeutic Interventions for Complete Paralysis Objectives Describe the clinical presentation of someone with more complete/higher level SCI Identify some interventions to best recovery and/or retrain basic mobility functions in person with more complete/higher level SCI Expected Functional Outcomes C1-C4: total Assist; capability for powered mobility C5: still requires a great deal of assist C6-C8: more independent, may require some assist T1-9: independent in all basic mobility (may need equipment); gait is variable T10-L1: independent in all basic mobility; gait more likely, still variable L2-S5: independent in all; maybe need orthoses and/or AD Preparatory Interventions With complete and seemingly permanent paralysis, goals become more compensation/substitution Pharm: corticosteroids early; typical low mobility meds – DVT prevention, spasticity management, pain management, bowel and bladder, ED Development of compensatory movement strategies Compensatory Movement Strategies Muscle substitution By synergist, gravity, tension of passive structures, use of close chained mechanics Momentum Linear, angular Head-hips relationship Pivot on arm, using shoulders as fulcrum; head moves one way, buttocks move opposite Preparatory Interventions cont Strengthening Innervated Musculature Strength and endurance beyond a 5/5 Balanced strength around the shoulder Development and preservation of ROM Where do we need a little tightness? Where do we need a little extra ROM? Equipment – vital; make or break for function Therapeutic Techniques All based on the movement strategies necessary Strengthening Fairly typical in many ways How do we strengthen very weak muscles? Equipment? Extra caution strengthening UEs… why? ROM and Stretching Challenge is often how to self-stretch Interventions Applied to Functional Activities Functional training Rolling Transition to sitting Long/short sitting Transfers Basic w/c skills Advanced skills Special Precautions Spine precautions Orthosis, restricted motions, lifting restrictions C spine – avoid strong contractions of shoulder and avoid abd or flex > 90 L spine – avoid strong contraction of hip and avoid flex > 90; restrict SLR to range without vertebral motion Fracture prevention Skin protection Orthostatic hypotension Autonomic dysreflexia Interventions Beyond “Therapy” Patient, family, caregiver education Patient needs to be able to verbally direct all care HEP that focuses on flexibility and strengthening Continued functional practice/training Regular cardiovascular exercise Nutrition