treatment
What SCI levels needs an artificial ventilator or phrenic nerve stimulator to assist in breathing?
C1-2
C3-4 need it for acute ventilation but MAY be able to breath on their own
The best way to treat it is to prevent it with ROM exercises, positioning and splinting
What is considered a weak functional cough?
Soft, 1 cough per exhalation, can clear small amounts of secretions and clear throat
Which SCI levels can breathe on their own but may have a weak cough so they need airway clearance assistance?
C5-8
T1 and above still have impaired airway clearance too so they may need assistance with clearance as well
Prevention with ROM and/or pulsed low intensity electromagnetic field, medications, surgery
What is considered a functional cough?
loud, forceful, 2 or more coughs with 1 exhalation, ability to clear respiratory secretions is high
What are the 2 problems with the bladder that can occur with a SCI? What do we do as PTs for bladder management?
1. Failure to store: areflexic sphincter or spastic detrusor muscle
2. Failure to empty: areflexic bladder or sphincter that is unable to relax
As PTs we need to have the knowledge of and participate in bladder management to avoid UTIs
- UMN bladder: foley catheter --> can switch to suprapubic tapping
- LMN bladder: foley catheter --> valsalva maneuver
What should you educate a patient on for nutrition after a SCI?
To maintain their weight they should have a higher caloric intake following their injury and then lower after 1 year once the injury stabilizes.
They should also try to decrease fried foods/high fat snack foods
Refer to dietician if needed
What interventions can you provide to provide a manually assisted cough?
costophrenic assist
anterior chest assist
abdomen thrust
counter rotation assist
What is important to tell a female who wants to know if they can have children after their T2 SCI?
What does the Spinal Cord Independence Measure (SCIIM) outcome measure assess?
Measures self-care, respiration and sphincter management, and mobility after a spinal cord injury
What is the best way position to train respiratory muscles?
Supine position- gravity pushes abdominal contents up, diaphragm sits higher, more efficient breathing pattern, better vital capacity
What is neuropathic pain? What can we do to treat it?
Burning, shooting or sharp pain above the level of lesion
Allodynia and hyperalgesia at or below the level of lesion
Treatment: TENs, massage, acupuncture, mental imagery, medications
What is a home exercise program for a patient after an SCI for aerobic and strengthening exercise?
Aerobic exercise: 3-5 days/week
- 20-60 mins per session
- 50-80% of max HR or RPE 13-17
Resistance exercise: 2-4 days/week
- 8-10 reps
- 60-80% 1RM