ASIA impairment scale (AIS)

Transcription

1 Physiotherapy management of people with SCI: the essentials Lisa Harvey ASIA impairment scale (AIS) COMPLETE: No motor or sensory in S4-S5 segments Moorong Spinal Unit Royal Rehabilitation Centre Sydney INCOMPLETE : Some motor or sensory in S4-S5 segments Rehabilitation University of Sydney Health condition Impairment Activity ty Participation re- Environment factors Personal factors 1

2 Assess - participation restrictions Assess - activity limitations recreation ability to push a W/C ability to use the hands family and friends Assess - activity limitations Assess - impairments Most widely used ments: 1. Spinal Cord Independence Measure (SCIM) 2. Walking Index for Spinal Cord Injury (WISCI) 3. Wheelchair Skills Test (WST) 4. Grasp and Release Test (GRT) Joint range of motion strength re- Partnership between p patient and therapist. 2

3 C5 level of lesion C3 diaphragm C4 rhomboids C5 - deltoids biceps Hand-to-mouth activities C6 level of lesion C6 level of lesion C3 diaphragm C4 rhomboids Implications of latissimus dorsi: C5 - deltoids biceps C6 - pectoralis latissimus dorsi serratus anterior wrist extensor Everything! C6 level of lesion C6 level of lesion Implications of latissimus dorsi: Implications of latissimus dorsi: 1. sitting unsupported 1. sitting unsupported 2. lifting 3

4 Understand movement re- Thoracic paraplegia - walking with orthoses Copied with permission Understand movement C6 quadriplegia horizontal transfer Copied with permission re- Source: Harvey L (2001) Phys Ther Res Int 6:

5 Steps Observe 1. Move to the front edge of the chair YES 2. Position the hands YES 3. Lift and shift the body NO re- Steps Observe WHY Evidence based practice 1. Move to the front edge of the chair YES 2. Position the hands YES 3. Lift and shift the body NO?????? Only one thing talks! Key impairments Often prevents performance of motor tasks fully innervated muscles 3. Joint ROM 5

6 Principles of progressive resistance training: repetitions load sessions per week Varied Interesting Motivating [task specific] Strength training for partially-paralysed muscles progressive resistance training OR endless repetition with minimal overload good therapists = good teachers - instructions - demonstrations - feedback - motivation People with SCI need to learn new ways of moving 6

7 Principles: INTENSIVE task and context-specific practice practice similar but simpler 2 RCTs: 1. chronic 2. recent Comparison: 1. usual care 2. intensive training + usual care HANDS OFF Results Mean between-group difference = 64mm 95% CI (20 to 108) favours no intervention favours intensive training Source: Boswell-Ruys C (2010) Spinal Cord 48: Source: Boswell-Ruys C (2010) Spinal Cord 48: Results Interpretation Mean between-group difference = -20mm 95% CI (-64 to 24) The ADL training patients with recent SCI gp receive as part of usual rehabilitation renders additional training redundant favours no intervention favours intensive training Source: Harvey C (2011) Journal of Physiotherapy 57:

8 Treadmill and Lokomat training provide an opportunity for intensive practice. Neural plasticity treadmill training robotic training 3. Joint ROM Other impairments Manual stretches Passive movements 4. CVS fitness 5. Pain 8

9 Impairments re- Joint range of motion strength Activity limitations Participation restrictions ability to push a W/C ability to use the hands recreation family and friends And what really matters L Harvey 2008 Management of Spinal Cord Injuries: a guide for physiotherapists. Elsevier, London. To order: To order: 9