Therapy Issues in SCI

1. Therapy Issues in SCI Presented by: Anthony I. Calilung, PT, MS, RN

2. Rehabilitation is The process of helping a person achieve the highest level of function, independence, and quality of life possible. From the Latin "habilitas," which means to make able. To promote functional independence, prevent unnecessary complications, and enhance overall quality of life.

3. PT Physical Therapy is a rehabilitation specialty that is provided by a licensed individual. The Physical Therapist works with an individual to help them regain functional abilities such as walking, getting in/out of bed, strength, balance, gross motor skills, endurance and improve safety skills.

4. OT Occupational Therapy is a rehabilitation specialty that is provided by a licensed individual. The Occupational Therapist works with individuals to help people return to ordinary tasks around home and at work by maximizing physical potential through lifestyle adaptations and possible use of assistive devices. Some of the areas the therapist may help the individual regain function in are self feeding, oral hygiene, dressing/bathing skills, visual/perceptual coordination, splinting and adaptive equipment.

5. KT Kinesiotherapy is a rehabilitation specialty that is provided by a certified individual to help improve their strength, endurance, and mobility. The KT provides therapeutic exercise programs and education to help improve general strength, endurance, joint range of motion, balance, coordination and safety with daily functional activites. KT can also provide aquatic therapy, driver training and cardiac conditioning programs.

6. When do you get Skilled Therapy • Potential to increase/improve function • Functional goals: functional meaning; to have a purpose or outcome; when therapy will improve a persons ability to participate in/perform their daily activities. • Skilled services are those which require the skills of technical or professional personnel (physical and occupational therapists). In order to be deemed "skilled," the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel.  

7. How long do I get therapy? • Dependent upon each person • Generally as long as there continues to be goals • Generally as long as progress continues • What does plateau mean? • Therapy is dependent on: • Medical clearance • Participation • **This can change at any time.

8. ROM • Range Of Motion-The movement in which each joint should/or is capable of moving. • This should be performed every day • This can be done by Therapy (initially) then taught to family and nursing to continue and follow up with • This should be done for every joint; arms and legs

9. ROM cont. It is important to maintain the length of the muscles to prevent contracture, maintain ease of hygiene and keep muscle length within normal limits incase recovery to that muscle occurs to ensure function is not compromised.

10. W/C’s When is a w/c appropriate?: • when there is a good idea of whether a person is appropriate for power or manual mobility –not always in the beginning of therapy • Weight is stable • Which one is correct for you? • Manual • Power

11. Manual • can you push the chair? • does it need to fold? • what does it need to fit your body medically? • What type of activities do you/are you going to perform in your chair? • Where are you going to live?

12. Power • Are you eligible for a power chair? • If so: • Can you drive a power chair • Where are you going to live? • What types of things are you going to do in the chair? • What types of things to you need on the chair medically?

13. 2 wheelchairs? • According to VA policy: • If you have a power chair you are eligible for a backup manual in case your power needs repair. • If you have a manual you are eligible for a backup manual in case your primary manual needs repair.

14. Cushions • Types • Foam • Gel • Air Every person has a cushion that is most appropriate for them. Considerations when choosing a cushion: Age, skin condition, injury, can they care for the cushion, seating ability.

15. Cushions Air Gel Foam

16. Pressure Relief • What is it? • Pressure relief is relieving the pressure off the skin to allow for blood flow back to that area • What constitutes a pressure relief? • Tilt to 60 degrees • Every 15 minutes for a full 2 minutes • Do not stay in your tilt • Other types of pressure relief?

17. Assistive Devices (PT) • Slideboard • Walker • Cane • Canadian crutches • Crutches

18. Assistive Devices (OT) • LH sponge • LH reacher • Sock aid • Shoe horn • Mobile arm support • Universal cuff • Driver training-adaptive equipment for driving..

19. Assistive Devices (OT)

20. Assistive Technology • Hand splints • ECU’s-environmental control units • Are you appropriate? • Computer access

21. HISA Grant • Home Improvement Structural Adaptation • The amount depends on whether or not you are service connected and to what extent. • It is used for structural adaptations of YOUR HOME ONLY to allow you to function better. • EX: widen doorways, install a permanent ramp, kitchen or bathroom adaptations for accessibility.

22. HISA Grant cont. • A consult has to be sent by your doctor or therapist to Prosthetics for you to obtain the form. • You then have to get 3 quotes and return that to prosthetics and reimbursement is addressed by that department. • This is a one time grant. Once you have used it, its gone. If you move you do not get to start over.

23. Safety • Safety is very important during therapy. It is just as important to maintain safety as it is to progress your therapy. • Don’t perform activities that have not been cleared by your doctor or therapist. • Make sure you have the proper supervision. • Do not attempt to try an activity that has not been performed by your therapist.

24. The End! Thanks for your time and attention. Questions?