fund. of rehab

basic (seating)

good seating balance/neutral posture without support

intermediate (seating)

fair seated balance/trunk with support

complex (seated)

poor seating balance, no neutral posture, needs custom support

seated support goal

optimal trunk/pelvic position

mobility goal

easy movement for caregiver and user

system outcome

provide comfort/support while maintaining maximal independence

sling seat

post. pelvic tilt, add and IR of hips, asymmetrical

too deep seat depth

pressure in popliteal fossa, post. pelvic tilt, kyphosis

too shallow seat depth

decreased support, poor LE alignment

back height (good trunk control)

below to mid scapula

back height (poor trunk control)

acromion level

pelvic positioner optimal angle

45-60

seat width

too big- hard to reach wheels and going in tight spaces. too small- skin breakdown

armrest support

helps trunk posture and shoulder, add 1 inch to armrest

foot supports too low

decreased hip flexion/pelvic slides forward

too high foot support

decreased thigh contact with increase pressure on ischial tubs

elevated leg rests may

put too much stretch on HS

foot support measurement

subtract 1 inch

ideal position for wheelchair propulsion

hands posterior to shoulder girdle and elbow flex 100-120

outdoor frame

larger wheel in back, casters in front

indoor frame

larger wheel in front

comfort cushion

minimal seating needs

pressure relieving foam

mod to significant needs

pressure relieving foam/fluid

mod to significant needs

pressure relieving air

mod to significant, less stable

tilt in space w/c

for poor postural control or abnormal tone

powered mobility

stop/go may be difficult

optimal seated posture

plum line and kendall posture

paralyzed trunk training

teach contra stabilization

aerobic conditioning

where one trains heart to pump more efficiently

chronotropic incompetence

failure of HR to increase with increase workload

HR x stroke volume =

cardiac output

chronic response to aerobic exercise

hypertrophy of cardiac muscles, increased cardiac profusion

BP =

cardiac output x total peripheral resistance

acute coronary syndrome (CAD)

angina, injury (acute MI), infarction (old MI)

unstable angina

pre infarction, happens without exercise, immediate attention

stable angina

happens with exercise or high activity

varient/prinzmetal angina

caused by vasospasms of coronary arteries

evaluation triad of CAD

complaints, ECG changes, cardiac enzymes

Percutaneous Transluminal Coronary Angioplasty, PTCA

catheter into artery, balloon inflated and stent placed. avoid hip flexion and exercise.

coronary artery bypass graft (CABG)

uses donor vessel to bypass artery

MIDCAB

enters in intercostal space

TEDCAB

3 incisions through chest wall

therapy for CABG

ulnar nerve palsy, incision sites, postural education,

CABG precautions

shoulder flex/abd 90, no scapular retraction, use pillow, dont lift more 5-10 lbs

phase 1-level 1 CABG

24 hrs in ICU, bed mobility, ankle pumps, deep breathing

phase 1- level 2

OOB, sit in chair for 30 min, seated marches, knee extension

phase 1-level 3

ambulation

phase 1 levels 4-6

progress ambulation, stairs

phase 2

1 week post op, exercise program 3x week.

MVO2=

HR x SBP (dont exceed 90%)

phase 3

home program or gym, focus on maintenance

COPD

limited airflow from mucus, barrel chest,

asthma

inflammation, wheezing, SOB

cystic fibrosis

affects excretory glands, chronic cough and infections

obstructive diseases

COPD/asthma- air trapped/flow problem

restrictive diseases

cystic fibrosis-hard getting air in/volume problem

obstructive disease tx

slow deep breaths

restrictive disease tx

fast shallow breaths

restictive lung disease

variety of reasons, shallow breathing and digital clubbing

muscles used during difficulty breathing

SCM and scalenes

acute hypoxemia

cyanosis of nail beds

chronic hypoxemia

digital clubbing