SCI Rehabilitation: Compensation, Recovery, and Sensory Management Questions with 100% correct answers + detailed rationales

Compensation

Using new movement strategies to complete a task because normal movement is no longer possible after SCI.

Recovery of function

Performing a motor task the same way as before the injury because the neuromuscular system has improved.

Main goal of SCI rehab

To help the patient become as independent as possible.

Two phases of PT management in SCI

Acute phase and rehab phase.

Tenodesis grasp

Passive finger flexion created by wrist extension that allows grasp in patients with weak or paralyzed finger flexors.

Example of compensation in SCI

Using tenodesis grasp or KAFOs to stand.

Example of recovery of function in SCI

Body-weight supported treadmill training (BWSTT).

BWSTT

Body-weight supported treadmill training used to promote recovery of function.

Contraindication in acute tetraplegia: head/neck

Motion of the head and neck is contraindicated until orthopedic clearance.

Contraindication in acute tetraplegia: shoulder ROM

Shoulder flexion and abduction beyond 90 degrees are avoided until the spine is healed and stable.

Contraindication in acute tetraplegia: resistance

Avoid scapular and shoulder resistance exercises.

Why avoid excessive cervical and shoulder motion in acute tetraplegia?

To protect the healing cervical spine.

Helpful tightness in tetraplegia: finger flexors

Tight long finger flexors can improve tenodesis grasp.

Helpful tightness in tetraplegia: lower trunk

Tight lower trunk muscles may improve sitting posture and prevent vertebral telescoping.

Intrinsic-plus splint

A splint used to help preserve hand positioning and support function in tetraplegia.

Contraindication in acute paraplegia: trunk/pelvis resistance

Avoid pelvis and trunk resistance exercises.

Pelvis position during LE ROM in paraplegia

Pelvis should remain in neutral.

Contraindication in acute paraplegia: SLR

Avoid straight leg raise greater than 60 degrees.

Contraindication in acute paraplegia: hip flexion

Avoid hip flexion greater than 90 degrees with the knee flexed.

Hamstring ROM needed later in paraplegia

100 to 110 degrees SLR for long sitting and independent dressing.

Selective stretching

Stretching some muscles fully while intentionally understretching others to improve function.

Bed mobility

Rolling, supine to prone, prone to supine, and supine to sit activities needed for independence.

Why is bed mobility important in SCI?

It is needed for dressing, positioning, skin inspection, and independence.

Momentum in bed mobility

Using force and speed to help move denervated body parts.

Transfers in SCI

Moving between surfaces such as bed, wheelchair, car, toilet, shower, or floor.

Examples of transfers in SCI

Bed to wheelchair, floor to wheelchair, wheelchair to car, toilet transfer, shower transfer.

Primary means of mobility for many SCI patients

Wheelchair.

Why is wheelchair positioning important?

It affects posture, bowel/bladder function, respiratory function, skin integrity, and mobility.

Pressure relief frequency

Every 15 minutes.

Pressure relief duration

About 2 minutes.

Pressure relief methods

Wheelchair push-up, side lean, forward lean, or tilt wheelchair.

Why is pressure relief important?

To prevent pressure injuries and protect skin integrity.

Bladder care in SCI

Needed to prevent UTIs, hydronephrosis, and other secondary complications.

Bowel care in SCI

Needed to prevent bowel dysfunction, colorectal damage, and skin problems.

Self-feeding independence level

Often possible at C6 tetraplegia with adaptive equipment.

Shoulder extension ROM needed

60 degrees.

Shoulder external rotation ROM needed

90 degrees.

Elbow extension ROM needed

Full.

Forearm pronation ROM needed

Full.

Forearm supination ROM needed

Full.

Wrist extension ROM needed

90 degrees.

Hip flexion ROM needed

100 degrees.

Hip extension ROM needed

10 degrees.

Hip external rotation ROM needed

45 degrees.

Passive SLR ROM needed

110 degrees.

Knee extension ROM needed

Full.

Ankle dorsiflexion ROM needed

Neutral.

Why is wrist extension important in SCI?

It helps create tenodesis grasp.

Why is SLR important in paraplegia?

It helps with long sitting and dressing.

Self-ROM exercises for paraplegia

Hamstring stretch, glute max stretch, hip rotator stretch, and ankle plantarflexor stretch.

Therapeutic exercise goal in SCI

Strengthen all remaining innervated muscles.

Important UE muscles to strengthen in SCI

Serratus anterior, latissimus dorsi, pectoralis major, SITS muscles, and triceps.

Why are UE muscles strengthened in SCI?

To improve transfers, wheelchair propulsion, posture, and pressure relief.

Cardiovascular/endurance training in SCI

Improves tolerance for wheelchair mobility, exercise, and gait training.

Respiratory muscle training

Training to improve breathing and cough effectiveness in SCI patients.

Examples of respiratory interventions in SCI

Inspiratory muscle training, functional cough, assisted cough, glossopharyngeal breathing, chest wall expansion, and chest wall stretching.

Cervical orthoses for SCI

Halo, Minerva, SOMI, Philadelphia collar, Miami J, and Aspen.

TLSO

Thoracolumbosacral orthosis.

Lower-extremity orthoses used in SCI

RGO, HKAFO, KAFO, and AFO.

Abdominal binder

Used to provide trunk support and assist circulation in SCI.

Multi-podus boot

A boot used for positioning and prevention of contracture or pressure problems.

Hoyer lift

Mechanical lift often used for high-level SCI such as C1-C4.

Useful bed equipment in SCI

Bed rails, loops, and ropes.

Wheelchair types for SCI

Power wheelchair or manual wheelchair depending on level of injury.

Important wheelchair features

Recline systems, tilt systems, and plastic-coated hand rims.

Adaptive equipment examples

Long-handled devices for eating, bathing, dressing, and wheelchair locks.

Standing/ambulation assistive devices in SCI

Forearm crutches and canes.

Benefits of weight bearing

Improved circulation, prevention of bone mineral density loss, better skin integrity, improved bowel/bladder function, better sleep, and improved sense of well-being.

Sliding board transfer

A transfer that uses a board to bridge two surfaces.

Prone-on-elbow transfer

A transfer strategy using upper body and elbow support.

Lateral push-up transfer

A transfer using upper extremity push to lift and move laterally.

Modified stand-pivot transfer

A pivot transfer modified to fit patient ability.

Airlift or quad transfer

A transfer requiring high assistance, often by multiple helpers.

Dependent transfer examples

Two-person lift, sit-pivot, and mechanical lift.

Three phases of transfers

Preparatory phase, lift phase, and descent phase.

Head-hips relationship

Moving the head in one direction causes the hips to move in the opposite direction.

Why is head-hips relationship important?

It helps improve transfers and body movement.

Factors restricting ambulation in SCI

Knee flexion contracture, ankle plantarflexion contracture, severe spasticity, loss of proprioception, pain, obesity, secondary complications, and low motivation.

Examples of secondary complications restricting ambulation

Heterotopic bone formation, decubitus ulcers, and deformity.

Essential elements for paraplegic ambulation

Full hip extension ROM and cardiovascular endurance.

AIS D gait outcome

Independent ambulation is expected.

AIS C gait outcome

About 75 percent recover ambulation.

AIS C age effect

Better walking outcome if under 50 years old.

AIS B gait outcome

About 33 percent recover ambulation.

AIS A gait outcome

Very limited ambulation potential.

T11-T12 gait outcome

Therapeutic standing or assisted ambulation.

T12-L2 gait outcome

Household ambulation.

L3 and below gait outcome

Community ambulation may be possible.

Compensatory training goal

Teach movement using available musculature and motor control.

Momentum

Using force times velocity to move body segments.

Muscle substitution

Using intact muscles to replace muscles that are weak or lost.

Task modification

Making a task easier to allow progression.

Working in task

Practicing the actual functional task.

Working out of task

Practicing impairments that improve the task.

C1-C4 ADL status

Dependent.

C1-C4 bowel/bladder

Dependent but can direct care.

C1-C4 wheelchair mobility

Independent with power wheelchair, dependent for positioning.

C1-C4 bed mobility

Dependent.

C1-C4 transfers

Dependent.

C1-C4 ambulation and driving

Unable.