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Chapter 20: SCI (Neurological Complications and Associated Conditions…

- - - - ASIA Impairment Scale Table 20.1 (A-E)
  - - - Paralysis and sensory loss of ipsilateral side
      - Loss of pain and temperature on contralateral side
    - - Usually flexion injuries of cervical region; damage to anterior spinal artery
        
        Loss of motor and pain/temp below level of lesion
    - - Usually hyperextension injuries in cervical region; MOST COMMON
        
        More involvement in UE's than LE's; sensory impairments less severe than motor deficits
        
        Usually recover ability to ambulate, but deficits in fine motor control may remain, which may affect functional tasks
    - - Areflexic bowl/bladder anesthesia
      - Peripheral nerve injury/LMN injury
        
        However, full return of innervation is uncommon
- - - - Motor level, age, concomitant injury, preexisting health conditions, secondary complications, body type, psychosocial support
    - - Functional expectations for SCI based on level of injury
    - - Asia A not likely to regain required LE strength; preservation prinprick sensation is prognositc indicator in ASIA B; ASIA C and D will regain some ability to walk
  - - - BP, integumentray, fracutre site, fall risk, overstretching, overuse
    - - Strategies for rolling: crossing feet, flexing head/neck to get from supine to prone, bilateral UE rocking
      - Sitting to sitting to supine: 1)Walking onto elbows from prone or SL, 2)coming straight up from supine
      - Sitting balance
        
        start in long-sitting or short sitting position with WB through UE's
      - Transfers
        
        Head-hips relationship: hips will move in opposite direction of head movement
        
        Hands should be forward of hips to perform tripod with buttocks
        
        Emphasize lifting + shifting laterally, rather than sliding to avoid skin damage
    - - Complete SCI
        
        Even if won't be functional ambulators, give option for training - standing itself is beneficial to pt
        
        Full hip extension is necessary for balance in standing
        
        Endurance is more important of a factor
        
        Often use orthotics with swing-through or 4 point gait pattern
      - Incomplete SCI
        
        Body weight-supported treadmill training with manual support
        
        Followed by overground training, then ability to integrate skills in community
        
        Shown in literature to improve balance, gait speed, endurance, stair-climbing, and independence
        
        "Train like you walk"
        
        LE's maximally loaded for WB
        
        Sensory cues to facilitate "normal" walking characteristics
        
        Posture, trunk, pelvis, and limb kinematics are specific to task of walking
        
        Minimized compensatory strategies, ie. hip hiking, lateral trunk lean
- - - - Functional cough (1-2 per exhalation) vs weak functional cough (1 per exhalation) vs nonfunctional cough
    - - Braden scale
    - - ie. rolling, supine to sitting transfer
  - - - Improve cough effectivness, prevention of chest tightness
      - Deep breathing exercises (diaphragmatic breathing), Glossopharyngeal breathing for pts on ventilator
      - Air shift maneuver
      - Respiratory muscle strengthening
      - Abdominal binder
      - Manual stretching
    - - Positioning
        
        repositioned every 2 hours
        
        Pelvis in neutral or slightly anteriorly tilted
        
        Pt should perform pressure relief maneuver every 15 min
    - - Pelvis in neutral during LE ROM
      - Certain hip and trunk movements may be contraindicated depending on location of spinal cord injury
      - For SCI pts, ROM not required in all joints; in fact, may be beneficial for certain joints to be tight to enhance function, ie. trunk to improve postural stability
        
        Selective stretching (understretching some muscles, normal stretching to others)