NM III unit 2: SCI compensatory treatment strategies in supine and sitting

what ASIA grades typically rely on compensatory rehab

ASIA A or B

what ASIA classifications typically use restorative rehab

ASIA C or D

what is a key compensatory strategy used in SCI

stabilizing distal body parts to gain proximal control

what is an example of stabilizing distal body parts to enhance proximal control as a compensatory strategy

externally rotating the arm to allow elbow extension if the triceps are paralyzed

what allows a pt with a SCI to shift their weight

the head hip ration

how can pts with SCI build force for movement

using momentum

what is rhythmic rocking used for in SCI

it helps overcome inertia and enable a movement that otherwise wouldn't be possible

what is tenodesis

a functional grasp created when wrist extension leads to passive finger flexion

how can tenodesis be preserved in SCI

avoid overstretching the finger flexors

why is mild tightness in the lumbar extensors beneficial in pts with SCI

it helps to support upright sitting posture and improves balance

how can tight lumbar extensors be preserved in rehav

prioritize hamstring flexibility before starting long sitting activity to avoid overstretching the low back

what is muscle substitution

where preserved muscles are used to replicated lost function in other muscles

what is an example of muscle substitution

using the shoulder extensors to substitute for the triceps to lock out the elbow

what is the foundation of SCI rehab

bed mobility

what frequency is bed mobility training done for SCI

high frequency and high repetition often multiple times a day

what can be used to simplify bed mobility movements(3)

wedges

loop straps

friction reducing sheets

how should the surface be progressed for bed mobility

start on a firm mat then progress to the pts bed at home

what is a useful strategy used in bed mobility for SCI

part task practice

what is included in bed mobility (5)

rolling

bridging

prone on elbows

supine on elbows

transitioning to sitting

how does a pt with SCI perform supine to prone

pt flexes the head and neck with rotation and arms in the direction of move

how can momentum be generated for supine to prone

the pt rhythmically rocks the outstretched arms and head from side to side then forcefully tosses them synchronously to the side of rolling

what can be used to increased kinesthetic awareness and momentum with rolling

2-3 lb cuff weights

how can the feet be positioned to help facilitate rolling

crossing the ankles or legs so the upper limb is toward the direction of the roll (right over left to roll left)

what device can be used to assist with initial rotation

a pillow or wedge under the pelvis or scap

how does a pt with a SCI roll from prone to supine

extending the head and neck with rotation and swinging the UE

what is the prone on elbows position useful for

it helps build upper trunk and scapular control

how is the prone on elbows technique achieved from prone

the shoulders can be either abducted or adducted as the pt weight shifts from side to side to move the unweighted arm underneath the shoulder joints

how can a pt with a SCI assume prone on elbows from sielying

the pt pushed the elbow that is on the mat down by extending the shoulder then swinging the top arm forward while rolling so the elbow comes onto the mat in prone on elbows

what can be done to further facilitate co-contraction in prone on elbows

performing unilateral weight bearing in prone on elbows

how can a pt move in prone on elbows

by walking on the elbows

what exercises is useful for strengthening the serratus and other scap muscles in prone on elbows (2)

prone on elbows push ups

weight shifting

how are prone on elbow pushups performed

the pt pushed the elbow down into the mat and tucks the chin while lifting and rounding the shoulders and upper thorax

how can a pt perform supine on elbows with good abdominal control

the pt wedges the hands under the hips or hooks the thumbs into pockets or belt loops and contracts the biceps and/or wrist extensors to pull up partially then weight shifting to position the elbows under the shoulders

how can a pt assume supine on elbows from sidelying

the pt positions the lower arm and pushes into the mat to roll towards supine quickly extending the upper arm and landing on the elbow

what can supine on elbows strengthen

the shoulder extensors and adductors

what does lateral weight shifting in supine on elbows enhance

it enhances the pts ability to align the trunk with the LE when in bed or in preparation for positional changes

what is a precaution to be aware of for the supine on elbows position

be cautious of anterior shoulder pain due to pressure on the anterior capsule from shoulder extension

how can a pt perform supine to long sitting from prone

in prone the pt walks on elbows toward one side in a C position

the pt then unweights the elbow closest to the leg to hook around the knee pulling the trunk towards the legs

then pt can then shift off the weight bearing elbow to the palm and push with one arm while pulling with the other into a long sit

what is required to assume supine to long sitting from prone

strong elbow flexors and wrist extensors

what is required to perform supine to long sit

more than normal shoulder extension range

string elbow flexors and wrist extensors

how is supine to long sit performed

in supine on elbows the pt unweights one side throwing the opposite UE into hyperextension and external rotation with elbow extended and palm down

the pt then rotates the upper trunk onto the palm down UE to unweight the opposite side throwing it into hyperextension and ER onto the palm

the pt the walks up with the hands into long sitting

how can tenodesis be used for LE management

the pt can hook the wrist under their leg and use wrist extension to lift

what are leg loops or straps used to do

to help lift and reposition the LE

what practice type should be used when first performing bed mobility in SCI

blocked repetitive practice then shift to random variable practice

how should feedback be used in bed mobility with SCI

start with more external feedback transitioning to faded

why does bed mobility handling matter (3)

prevents injury to the pt and PT

promotes motor learning

helps pt transition from total dependence to graded independence

what is the key of handling

the hands should be used to guide and facilitate movement not replace the pts effort

how does a PT assist with rolling in SCI

one hand is at the scapula with the other at the pelvis and guide the pt through the motion

how can a PT assist with supine to short sitting getting to a C position with a C6 level injury

PT is positioned diagonally to pts head and side with one hand proximal to moving elbow and other hand stabilizing the trunk or assisting with pelvic alignment

as the pt unweights one arm use tactile cues on the scap or lateral humerus to guide motion

what motion can be used to assist supine to sit with the moving elbow when getting to a C position

a forward and upward motion to help clear the elbow to place it by the knees to allow them to hook their leg and get into long sitting

what should always be done after assisting a pt

demonstrate the techniques for the caregivers allowing practice

why is decreased cerebral perfusion and postural hypotension common in SCI

due to reduced venous return from bilateral LE and their abdomen leading to reduced filling and decreased cardiac output

what needs to be done if a pt is experiencing S/S of postural/orthostatic hypotension

their BP and HR should be measured and they should be laid down with the legs elevated

how is postural hypotension assessed

measure BP after a minute and then again at three minutes of sitting up

what indicated postural hypotension from the assessment

a drop of 20 mmHg SBP or 10 mmHg DBP within 3 minutes of sitting

or

HR greater than or equal to 30 BPM increase

what SCI levels are at higher risk for orthostatic/postural hypotension

cervical and thoracic

what compression devices are used for orthostatic/postural hypotension for pts who had a SCI (3)

compression stockings thigh high

abdominal binder

sequential compression devices

what compression should compression stocking be to help with hypotension

30-40 mmHg

what dietary recommendations can help with hypotension

ensuring enough fluid intake to increased venous return and CO

what temperature is best for managing hypotension

colder

what is the foundation for functional tasks

sitting balance

what posture is usually seen in pts with low thoracic or lumbar SCI

often fairly normal in long sitting or shirt sitting

what sitting posture is often observed in pts with higher thoracic and cervical SCI

stooped forward with kyphosis

head very far forward

both UE used for support

what needs to be relearned for pts to help sitting balance

where their center of balance is

what is the first intervention used for sitting balance in SCI

assisting them into a balanced sitting position so they can feel what the body is doing

how can low back tension be reduced in long sitting

sitting with slight ER and abduction of the hips

if a pt has tenodesis how should their hand be positioned when sitting with support

in the tenodesis grip avoiding extending the fingers and stretching the flexors

how can elbow extension be maintained in sitting with an upper cervical SCI

sitting in shoulder extension and external rotation

how can pts with SCI use their shoulders to get to elbow extension

using the anterior delt in closed chain

what is seen in sitting balance at a C1-C4 SCI

complete dependence in static and dynamic balance due to absent trunk control and no UE or LE support

what can be used for pts with C1-C4 SCI to support balance

head of bead controls and wheelchairs with lilt functions

how can dynamic movement in sitting be initiated in C1-C4 SCI

start with basic visual scanning and supported head movements progressing to dynamic head motions to help use controls on AD and create momentum for movement

what should be practiced to assist with repositioning in a C4 SCI

shoulder shrugs to help reposition the arms when sitting

how should a PT assist a pt with C1-C4 SCI

they should sit in front of the pt with both hands guarding the head for support and tactile cues for controlled head movement

what is preserved in a C5 SCI

preserved bicep function and deltoid function

what is seen in static and dynamic sitting balance in a C5 SCI

they require assistance using propping techniques

what is posterior propping

the UE are put behind the pt for support

what is anterior propping

the UE are positioned in front of the pt for support

how is posterior propping achieved with a C5 SCI

using momentum to swing the arms posteriorly landing in passive elbow and wrist extension maintained with shoulder ER

what position should static sitting balance be initiated in for a C5 SCI (2)

posterior propping then progressing to anterior prop sitting

long sitting with mote stability progressing to short sitting

what interventions can be done for dynamic sitting balance for a C5 SCI (5)

lateral weight shifts in posterior and anterior prop positions

assisted movement between posterior and anterior prop sitting starting with trunk support

head movements to prepare for activity

reaching

hooking on the armrest

what does a pt with a C5 SCI rely on in dynamic sitting balance

their head or postural righting reactions and center of gravity

where is the PT positioned when performing static posterior propping

behind or at the side of the pt using their hands to stabilize an grasp the shoulders or one hand anteriorly on chest and posteriorly on upper back

where is the PT positioned for anterior prop static sitting balance

in front of the pt with support to both shoulders with the pts thighs between the legs to prevent anterior tibial translation

how is the pt stabilized in anterior prop dynamic sitting balance

when the pt reaches stabilize the opposite side at the elbow or the trunk to prevent collapse

why does a C6 SCI have good potential for independence in static sitting

due to stronger biceps and shoulder with the addition of wrist extension and sensation into the thumb

what is seen in static and dynamic sitting with a C6 SCI

some pts can progress from assisted to independent static and potentially dynamic sitting balance

what allows a C6 SCI pt to lift the body for scooting

the use of serratus anterior in an anterior prop sitting allowing the shoulder to depress to lift the body and scoot

what can be done if a pt with a C6 SCI has difficulty with hamstring length for long sitting

you can initially do partial long sitting with the feet off the edge of the bed to allow some knee flexion

what allows pts with C6 SCI to have functional grasp

wrist extension function

what dynamic sitting balance interventions can be done with a pt with a C6 SCI (3)

hand walking to shift between prop positions

weight shifting in supported sitting

scooting

how can a pt with a C6 SCI perform scooting in sitting

the pt swings their head down and away from the direction they want their hips to move then depressed the shoulders to lift and scoot

how can the PT support transitioning from posterior to anterior prop sitting in long sitting

they should sit or stand perpendicular to the pt at their trunk with one hand on the chest and one on the upper back giving room for the pt to swing their arms and blocking the hips and knees

how can the PT support transitioning from posterior to anterior prop sitting in short sitting

they should sit anterior lateral to the pt to avoid falling forward off a table or bed with one hand on the chest and one on the upper back giving room for the pt to swing their arms and blocking the hips and knees

what is seen in static and dynamic sitting balance, transfers, and most ADLs for a pt with a C7 SCI

independence due to preserved tricep function

what muscles are still intact in a C7 SCI (3)

triceps

lats

wrist flexors

what can lateral weight shifting be used to do for pts with a C7 SCI

to help dress and move up the legs

how should the PT be positioned during scooting wit a pt with a C7-C8 SCI

in front of the pt and place the hands low on the hips to help unweight and lift the hips

what is seen in SCI above T2 in function

more independence with sitting balance, ADLs, and transfers

what provides more stability in sitting balance with a T1-T6 SCI

preserved intercostal and upper back extensor function