Spinal Cord Injury (SCI) Gait and Respiration Flashcards

Flashcards covering compensatory gait strategies, respiratory anatomy and dysfunction, and physical therapy assessments/interventions for spinal cord injury patients as discussed in the lecture.

Reverse C position

A compensatory strategy for standing balance in patients with thoracic level lesions using KAFOs, achieved by hanging on the Y ligaments with the head back and hips forward.

KAFO

Knee Ankle Foot Orthosis; a brace that locks the knees into extension and the ankles into neutral or dorsiflexion, used for gait in patients without hip control.

Jackknife

A phenomenon where a patient suddenly flexes forward at the hips and falls because they fail to maintain a reverse C position and hip extension.

Head-Hips Relationship

A physical principle used in SCI mobility where moving the head in one direction causes the hips to move in the opposite direction; used to achieve hip extension by throwing the head back.

Swing-through gait

The safest and most stable gait pattern for individuals with thoracic level lesions using KAFOs and an assistive device.

Mary Massery

A famous physical therapist and researcher who specialized in respiration, known for the saying, 'If you can't breathe, you can't function.'

Primary respiratory dysfunction

A direct interruption in the neural drive for respiration caused by conditions like SCI above $C4$, ALS, or Guillain-Barre Syndrome (GBS).

Secondary respiratory dysfunction

Respiratory impairment resulting from postural changes, rigidity, or muscle length-tension issues observed in conditions like Parkinson's disease or Cerebral Palsy.

Diaphragm Innervation

The phrenic nerve, which originates from spinal levels $C3$, $C4$, and $C5$ to control the primary muscle of inspiration.

Forced exhalation muscles

Primarily the abdominal muscles ($T6$ to $L1$) and intercostals, used for actions like coughing.

2:2 Breathing Pattern

A typical or normal breathing ratio where the degree of excursion in the diaphragm (abdomen) matches the excursion in the chest.

4-diaphragm pattern

An atypical breathing pattern where the diaphragm does all the work while the chest remains still, common in patients with intact phrenic nerves but paralyzed intercostals.

2-neck 2-diaphragm pattern

A breathing pattern typical of a $C4$ level injury characterized by partial diaphragm function supplemented by neck accessory muscles with no chest movement.

Paradoxical breathing

An abnormal pattern occurring during the acute spinal shock phase of SCI where the chest and abdomen cave in during inspiration instead of expanding.

Chest Wall Mobility Measurement

A circumferential measurement using a tape measure at the axilla and xiphoid levels; normal expansion is typically $2$ to $3\text{ inches}$.

Manual assisted cough

An intervention where the therapist applies a quick, upward and inward force below the xiphoid process or lateral ribs during exhalation to compensate for paralyzed abdominals.

Tenodesis

A passive functional grip used by patients with $C6$ level injuries that must be preserved by avoiding finger extension while the wrist is extended during mobility tasks.

Neuroplastic principles for motor learning

Key concepts including repetition, task specificity, intensity, and focused attention used to promote change in the nervous system when learning new skills.