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SCI4 (complications of SCI (quiz (q. Pt will 3 yr old case of complete SCI…
SCI4
complications of SCI
quiz
q. Pt will 3 yr old case of complete SCI with T6 neurological level was recently admitted to hospital with pneumonia(폐렴). after the discharge from hospital, pt was taking short term rehab in as SNF. during the physical therapy treatment pt experiencing decrease cough effectivenesss and decreased secretion clearance. this decrease in effectiveness of cough is due to - a)partial innervations of Diaphragm. b)decrease forced expiratory volume. c) decrease tidal volume d) decreased forced inspiratory volume
internal intercostal- help forceful expiration,(T1-T11), external intercostal-forceful inspiration(T1-T11), abdominals-forceful expiration(T6-T10/T12) /// 표로 만들어!
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cough
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insuff
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passive insuff 
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Q. during the long term rehab of a pt with comlete transection of spinal cords with C6 neurological level. in order to teach the pt grasping to carry out ADL and to use adaptive utensil, the therapist will teach pt- 1)grasp by the active flexion of wrist and finger flexors 2)by compensating by active insufficiency of wrist flexors 3) compensatory grasp by doing active wrist extension 4) pt with C6 injury will not be able to use adaptive utensil
functional position of hand
- 2 more items...
actively contracting
- 1 more item...
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diagphram 내려간 상태임 기침하기 위해선 가로막을 올려야 함 이때 force expiratory volume 이 매우 낮은상태이기 때문에 abdominal corrset일하게 해야해
1)abdominal 이 위로 올리고2) force expiratory volume을 위해 copping한다
homework
2) how the ability of cough and secretion clearance will be affected during above mentioned levels of spinal cord injuries?
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quiz. during the SCI rehab pt upright/vertical progression should proceed gradually as elevation of head bed, progress to reclining wheel chair with elevating leg rest and then use of tilt table. this pattern of gradual progress is followed in order to - )to prevent any further injury to spine. b) to prevent lower extremities from weight bearing c) to prevent sudden blood pressure drop. 4) to conserve energy
autonomic hypertension이므로 주의해야 한다. 무엇을? 4wk동안? 무엇을? blood pressure 를 주의해야 한다. SCI뿐만 아니라 모든 long term bed 환자는
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during sudden sit to stand transfer in parallel bar, pt complained about blurred vision, ringin in the ears, light headache, the therapist suspect this as episode of orthostatic hypotension. how this kind of incidnets can be minimize 1)slow progression to standing position2)use of compressive stocking 3)use of abdominal binder 4)all of the above
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abdominal binder
primary complications
spinal shock, autonomic dysreflexia, spastic hypertonia, CV complications, bldders and bowel dysfunctions
secondary complication
pressure sores, pneumonia , DVT, pain, heterotrophic ossification, fx
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SCI ADL
bed mobility
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Rolling
+littile assist, pt can rolling
C7-8
need assistance with adaptvie equipment for lower extremity positioning, inefficient due to high energy requirement for trunk and LE positioning
C5(biceps)
assisted to dependent, use bed rails and leg loop with the help of elbow flexors and shoulder abductors. but need assistance from care givers
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T1-12
more efficient due to more trunk control as SCI goes caudally. Pt uses arm swing maneuver for rolling
C6(wrist extensor)
need assistacne and adaptive equipment like bed rails, leg loops
leg loop(발에 거는 루프로 LE사용 못하는 SCI환자위한것)
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transfer
C1-4 ; dependent with mechanical lift(sling같은거)
C5; mechanical lift or assisted transfer with sliding board
C6; independent to some assistance with sliding board transfer
C7; independent with sliding board but require assistance for uneven surfaces(complete independent!)
C8; independent, may transfer from floor to chair
C6에서 arm rest를 휠체어에 기대서 trunk muscle이 없음에도 불구하고 버틸수 있게 했음
slide board를 이용해서 이동할수 있음 elbow를 lock해서 triceps를 쓰지 못함에도 불구하고 팔을 걸어 이동가능 심지어 slideboard없이도 이동하네; 사람에 따라 다르다고?
scapulothoralcic depressor=lower trapezius, latissmus doris
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head- hip principle for transfer-> moving the head and upper trunk in one direction causes the lower trunk and buttocks to move in the opposite direction. hip towards the transferring surface
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quiz
Q. during the functional rehab. of supine to long sitting and tranfer training of a pt with ASIA A C6 level, PT can teach compensation of triceps by 1)contraction of posterior shoulder muscle in open kinetic chain 2)contraction of anterior shoulder muscles in close kinetic chain 3)contractions of posterior shoulder muscles in close kinetic chain 4) contractions of anterior shoulder muscles in open kinetic chain
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brainstorming
in order to improve shoulder ROM in a SCI pt with C7-T4 fx precaution should be taken in early stages of rehab to not to abduct more than 90 degree. why?
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