Adult Process Weeks 1-3

Complete SCI

Total absence of sensation in the dermatomes below the level of lesion

Incomplete SCI

Partial Preservation of sensory and/or motor function below the neurological level and includes sacral segments

Central Cord Syndrome

Incomplete spinal cord injury that occurs when there is damage or pathology in the central portion of the spinal cord

Loss of pain and temperature sensation below the level of the lesion and more impairments in the UE, including the shoulder subluxation

What does central cord syndrome cause?

Brown-Sequard

Result of an asymmetric or "one-sided" cord injury. It produces a unique sensory and motor pattern.

Loss of touch, vibration, and proprioception

Brown-Sequard Ipsilateral Loss

Loss of pain and temperature sensation

Brown-Sequard Contralateral Loss

Cauda Equina Syndrome

compression of nerve roots at the base of the spine causing sudden severe back pain, bladder/bowel dysfunction, and saddle anesthesia

C5

shoulder flexion, elbow flexion, shoulder abduction

C6

wrist extension, supination

C7

pronation, elbow extension, wrist flexion

C8

gross motor movement of the finger

pressure ulcer prevention

Use cushions/mattresses, weight-shifting schedules, teach independent skin checks, caregiver education

Autonomic Dysreflexia prevention

Educate on signs, identify and remove triggers (drain bladder, remove tight or restrictive clothing, address skin irritation, pressure ulcers, DVTs, injuries)

autonomic dysreflexia

Medical emergency causing a sudden, dangerous rise in blood pressure, typically occurring in individuals with spinal cord injuries at or above T6. Triggered by noxious stimuli below the injury, it causes severe headaches, sweating, and flushing above the injury level

Causes of autonomic dysreflexia

full bladder, tight closes, skin breakdown

respiratory problem prevention

Promote upright wheelchair posture for lung expansion.

Spasticity/Contractures prevention

ROM/PROM exercises to maintain joint integrity, positioning, pharmacological

Spasticity/Contractures

Experienced when the initial period of spinal shock subsides and there is an increase in transmission within the synaptic stretch reflex

Spasms

Triggered by sensory stimulation (touch, infection, irritation)

Orthostatic Hypotension

Extreme drop in BP causing light headedness, feeling faint, blurred vision

Heterotrophic ossification

abnormal bone grown, connective tissue calcifies around joint

Poor thermoregulation prevention

Reduced sweating in response to increased ambient temperature

Tests for spinal cord injury

Cognition, self-care, sensory, touch & pin prick, ROM, MMT, grip & pinch strength, Modified Ashworth Scale (MAS)

Tenodesis grasp

functional, passive hand-closing mechanism used by individuals with certain levels of spinal cord injury (SCI), most notably at the C6 level, where active wrist extension is preserved but active finger control is lost.

Specific Ranging Protocols for tenodesis

To preserve this tightness, therapists must ensure finger flexors or extensors are never fully stretched over all the joints they cross at the same time

Splinting for tenodesis

Short opponens splints are often used to maintain the thumb web space and keep the thumb in an opposed position, ensuring it is properly aligned to meet the index and middle fingers during the grasp

Light Touch Screen

Use a cotton swab or fingertip to lightly stroke the skin in specific dermatome regions,.

Pain Awareness Screen

Randomly apply the sharp and dull ends of a safety pin or paper clip to the skin,.

Temperature Awareness Screen

Apply test tubes containing hot (115°F-120°F) and cold (40°F) water to the skin,.

Proprioception Screen

Move a joint into a position (holding only the lateral aspects) and ask the patient to state the position or replicate it with the other limb

2-Point Discrimination screen

Use an aesthesiometer to find the smallest distance at which the patient can still perceive two distinct points.

Stereognosis screen

Place familiar objects in the patient's hand for manipulation and identification while their vision is occluded.

Stereognosis

the ability to identify 3D objects using only tactile information—such as texture, size, and spatial properties—without visual or auditory input

Graphesthesia screen

Draw five letters or numbers on the patient's palm with a blunt object for identification.

ASIA Impairment Scale

Standard for the neurological classification of spinal cord injury (SCI) to provide a thorough and consistent method for clinicians to quantify the severity of an injury and track neurological recovery

Neurological level of injury

lowest/most caudal segment of the spinal cord where sensory and motor function are intact

3/5

MMT score for the muscle to be cosidered "working" for ASIA impairment scale?

Tests key sensory points for each dermatome and test motor function for key muscles from C5-T1 and L2-S1

Process of ASIA impairment scale

Zone of Partial Preservation

Dermatomes and myotomes below the neurological level of injury that remain partially innervated in complete SCI

ASIA A

Complete SCI with total absence of sensory and motor function in the lowest sacral segments

ASIA B

Incomplete SCI with sensory function preserved below the neurological level of injury including S4-S5; motor function is not preserved, and no motor function is preserved on either side more than 3 levels below the NLI; usually won't walk

ASIA C

Incomplete SCI where motor function is preserved below the NLI, and more than half of key muscles below the NLI have a grade below 3; the person may walk

ASIA D

Incomplete SCI where motor function is preserved below the NLI, and more than half of key muscles below the NLI have a grade greater than 3; will likely walk

ASIA E

Normal; given to someone with prior deficits

Sacral sparing

reservation of sensory or motor function in the lowest sacral segments (S4-S5)

Biceps

Muscle to test for C5

Wrist extensors

Muscle to test for C6

Triceps

Muscle to test for C7

Finger flexors

Muscle to test for C8

small finger abductors

Muscle to test for T1

Acute Care average length

Short term, usually 1-2 week or less

Acute care

safety assessment, assessment of clients' abilities, roles, and routines. ADLs include eating, grooming, bathing, and functional mobility. Discharge planning

Skilled nusing average length

Short term is not to exceed 100 days; Long term is indefinite or as needed

Skilled nursing

Bridges the gap between levels of care. Short-term care is more intensive with specified frequency; Long-term care is by consultation

ADLs, including eating, grooming, dressing, bathing, and toileting; Mobility like transfers between bed, chair, wheelchair, toilet, and tub/shower

inpatient rehab average length

2-4 weeks

Inpatient rehab requirements

Must be able to tolerate therapy for at least 3 hours a day, 5-7 days a week, need care from at least 2 disciplines

day rehab average length

3 months

day rehab requirements

must be able to discharge home, medically stabel, require care of at least 2 disciplines

day rehab

Maximising independence with ADLS, Complex IADLs, independence with meal prep, home management, medication management, grocery shopping, and leisure activities, Return to work

outpatient average length

Number of visits depends on skilled need

outpatient

Mobility skills such as transfers, Home management, community skills, work skills, driving

Social participation as a student, worker, or caregiver, Therapeutic activities to remediate body structure/function impairments

Less than 5000 - Leukopenia

defer therapy or don mask and gloves

Greater than 11000 - Leukocytosis

sign of infection, follow standard protocol

12-18

Normal hemoglobin

Less than 50,000 platelets

ncreased risk of bleeding, no resistive exercises, teeth brushing, straining for BM, or gaitbelts

Progress Report

Summary of the client's progress toward achieving functional goals, interventions chosen, updated goals, and revised/updated treatment plan

ICD-10 codes

coding system used to differentiate diagnosis and procedures in virtually all treatment settings

CPT codes

Current Procedural Terminology that standardize the reporting of medical services, procedures, and surgeries, essential for medical billing, insurance reimbursement, and tracking healthcare utilization

therapeutic exercises

CPT to develop strength and endurance, range of motion, and flexibility

neuromuscular reeducation

CPT for movement, balance, coordination, kinesthetic sense, posture, or proprioception for sitting or standing activities

therapeutic activities

CPT for direct patient contact using dynamic activities to include functional performance

self care/homemanagement training

CPT for teaching of ADLs, applying compensatory strategies, meal preparation, safety procedures and instructions in use of assistive technology devices

0 units

1-7 minutes

1 unit

8-22 minutes

2 units

23-27 minutes

3 units

38-52 minutes

Low complexity

assessments that identify 1-3 performance deficits that result in activity or participation limitations and a brief history review; no comorbidities that affect performance, modification of tasks or assistance is not necessary to enable evaluation

moderate complexity

assessments that identify 3-5 performance deficits that result in activity or participation limitations and expanded review of medical records

high complexity

Assessments that identify 5 or more performance deficits that result in activity or participation limitations and extensive additional review of physical, cognitive, and psychosocial history; Clinical decision-making is of high analytic complexity. Patient presents with comorbidities, and significant modification of tasks or assistance is needed to complete the evaluation

60-100bpm

Normal HR

95-100%

Normal Blood O2

88-92%

Normal Blood O2 with COPD

<120/<80

Normal Blood Pressure

120-129/<80

Elevated BP

130-139/80-89

Stage 1 Hypertension

>140/>90

Stage 2 Hypertension

systolic >180 and/or diastolic >120

Hyperensive Crisis

Acute care and inpatient rehab

Which two settings are OTs most involved in discharge planning?

day rehab and outpatient

Which of the following settings are OTs most likely to address a patient's IADLs?

Inpatient rehab and day rehab

Which rehabilitation settings require that patients must receive and tolerate a combination of at least two disciplines?

Skilled Nursing

After 2 weeks of acute care, Bob's interdisciplinary team was uncertain whether he could tolerate 3 hours of therapy per day and recommended:

Parallel Processing

Multiple brain regions simultaneously process signals.

Motor control

a process where the brain organizes and regulates action of the muscular and skeletal systems

Motor learning

the acquisition of modification of motor skills resulting from practice

Basal Ganglia

Responsible for stereotypic and automated movement patterns. They also play a role in movement initiation, termination, and error correction.

Cerebellum

Coordinates gross and fine motor skills and regulates equilibrium

Plasticity

capacity of the CNS to adapt to functional demands and therefore to the system's capacity to reorganize

Neuroplasticity

the ability of neurons to change their function, chemical profile, or structure

Praresis

Weakness of a group of muscles