Neuro PM: SCI research/advancements + psychosocial

neuromodulation definition

use of electric impulses or chemicals to alter neuronal activitiy

SCI examples of neuromodulation

FES, TMS, intrathecal baclofen, transcutaneous SC stim, epidural SC stim

FES with SCI: used to enhance contraction of _______________ nerves

peripheral

FES with SCI can promote _____________ and prevent _________________

strengthening, atrophy

true of false: FES can aid in neuroplasticity

true, used with task-oriented approach!

FES with cycling

true of false: FES can NOT be used to enhance respiratory and bladder function

false

transcutaneous spinal cord stimulation (TSCS) uses electrodes over the ______________ segments

spinal cord

TSCS: previously established that this could alter ______________ ____________, activate ______ ________ ____________, and reduce ______________

LE reflexes, central pattern generators, spasticity

TSCS has UMN or LMN influence?

LMN

true or false: TSCS in combination with repetitive, task specific training and/or medications may reengage diminished neural connections and can meaningfully improve voluntary motor activation at an UMN level

true

TSCS often targets ________________ enlargement

lumbosacral

TSCS on cervical enlargement helps with ____________ strength

grip

epidural spinal cord stim (ESCS) more or less effective than TSCS?

MORE!

true of false: for ESCS the electrodes are placed on the surface of the skin

no they are implanted

drawbacks of ESCS:

money, invasive, infection

true or false: TSCS and ESCS have been around for centuries and the FDA says everyone should use them

false (experimental and not FDA approved)

what are the important parts of HIGT?

intensity, specificity, and repetition

incomplete SCI locomotor CPG:

brace them up, use harness for safety, and GO

true or false: most SCI patients get plenty of exercise, especially those in a power chair

false

what can counteract the accelerated aging after SCI?

exercise

what types of cells are being used for SC regeneration?

stem

reasons for lack of success with SC regeneration:

scarring from glial cells/astrocytes, proteins secreted by SC which inhibit growth, and inflammation

losses associated with SCI (psychosocial)

physical, functional independence, financial security, social role, personal autonomy/identity

true of false: each person with SCI will experience grief in their own way

true

true or false: level of injury will affect psychosocial adjustment

not necessarily

factors that influence adjustment after a SCI:

personality, values, attitude, psychological, age, education, financial security

early reaction to SCi

may seem confused and disoriented in first days/weeks, followed by a period of denial

why is a period of denial a normal/healthy response

allows reality to sink in and gradual coping skills to develop

why are patients confused/disoriented at first?

sensory deprivation, social isolation, loss of time cues, sleep deprivation, pain, side effects of medications

wide range of emotions associated with grief

sadness, anger, hostility, anxiety, panic, feels of inadequacy, shame, helplessness, vulnerability

greater life satisfaction has been correlated with:

level of injury, length of duration, younger age, higher education, married vs single

at 1 year what were the most positive predictors

gender, employment, perceived health status, social integreation, and mobility

at 2 years what were the strongest predictors

perceived health status, and mobility

access to the _____________ has a critical influence on positive life satisfaction

environment

educate family members because

their roles also change

self-advocacy skills

must become aware of legal protections and rights of disabled individuals

qualities of a therapeutic environment:

promote personal responsibility, be positive yet realistic, active problem solving, let them set goals and determine treatment options

true or false: it is important that our patients can identify, hire, and manage personal attendants

true

group counseling may be beneficial to allow for

exchange of emotions, promote mutual encouragement, role modeling, and problem solving

when is individual counseling indicated?

person is overwhelming or grieving process is pathologic

WISCI II (walking index for SCI)

used to determine amount of assistance and reliance on aids for walking in SCI (scored 0-20 with higher score indicating less severely impaired) (activity level)

Sickness impact profile

measure of quality of life, used to assess impact of disease on physical and emotional function, pt fills out (participation)

medical council short form 36

participation level, any neuro patient, how their life is affected

satisfaction with life scale

- In most ways my life is close to my ideal

- The conditions of my life are excellent

- I am satisfied with my life

- So far I have gotten the important things I want in life

- If I could live my life over, I would change almost nothing

satisfaction with life scale what part of ICF?

participation

spinal cord independence measure (SCIM)

-measures ADL performance, sphincter control, respiration and mobility

SCIM ICF level

activity

capability of upper extremity instrument ICF level

activity

Capability of upper extremity instrument

measures functional limitation with specific actions of arm

Penn Spasm frequency scale

Self-report measure that assesses a pt's perception of spasticity frequency and severity following an SCI

Penn spasm frequency scale ICF domain?

body function

craig handicap assessment and reporting technique (CHART)

big picture look at mobility, patient reported, multiple domains

CHART what domain ICF?

participation

Multidimension pain inventory (SCI version)

comprehensive about pain, specialized for pt with SCI