Physiotherapeutic practice for neurological rehabi
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Summary physioth. practice: SCI
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Physiotherapeutic practice for neurological rehabi
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the SCI practical lesson given by prof. K. Bruyninckx of the physiotherapeutic practice course. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as possible. It is therefore a mi...
Physiotherapeutic practice for neurological rehabi
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Phys. Practice: SCI
STATION 1 – JOINT MOBILITY AND MUSCLE LENGTH
1. COMPLICATIONS – CONTRACTURES
6 Causes
- Immobilization
- Not using full ROM
- Muscle imbalance
- Posture
- Spasticity
- Pain
Try to predict !
2. IMMOBILISATION
Which muscles will have the tendency to shorten?
- iliopsoas m. hamstrings m. gastrocnemius
3. NOT USING FULL ROM
Not enough strength to counteract gravity
What muscles do you need to reach above your head?
- RC,
- biceps,
- deltoideus,
- serratus anterior
- triceps brachi??
At what root are they innervated?
- C5-C6
- C4: deltoideus
Door niet te kunnen reiken boven hoofd= ROM verliezen in schouder
- Schouder is niet het probleem maar elleboog wel
- Boven hoofd reiken is vaak niet functioneel meer
4. MUSCLE IMBALANCE
Find 3 pairs of agonist/antagonists innervated by different myotomes
- Biceps (C5) vs triceps (C7)
- DF (C6) vs PF (C7)
- Pronation (C6) vs supinaton (C5 – biceps)
- Deltoideus (C5-6) vs latissimus dorsi (C6-8)
- Flexor carpi ulnaris vs extensor capri ulnaris
- Flexor carpi ulnaris vs flexor carpi radialis
Can you predict problems depending on lesion height?
- Indien ene spier wel werken en andere niet
- Eccentrische functie gaat weg àcontrole wat weg
Vb geen BB meer en elleboog strekken= arm gaat
gewoon naar extensie vallen
- Ene spier gaat verkorten
Can you deduct the lesion height from this picture?
- C6; passive DF (ze hangt in haar pols gewricht)
- C5 is nog wel goed -> biceps
- Tenodese greep gebruiken à C5-6
Pols DF niet geweten
Passief in DF en supinatie
What happens when she is lying down in bed?What position will her arms be in?
- Blijft met armen in flexie tegen lichaam na het krabben
- Kan niet terug strekken van arm
- Orthese geven voor snachts aan 1 kant
Nala Melis Pagina 1
, Phys. Practice: SCI
5. SPASTICITY
Patterns can differ in different patients.
Optimal management and knowledge of your patient are key!
6. PAIN
What influence can pain have on these factors?
- Immobilisation
Will get worse
- Not using full ROM
Even less ROM will be used
- Muscle imbalance
Will increase
- Spasticity / tone
There will be an increase
- Posture
Antalgic posture
7. TREATMENT
How can you minimize the need for daily physiotherapy?
- Multidisciplinary therapy
- Self exercises and mobilisations
- Zelf mobilisatie & stretching
7.1. PASSIVE MOBILISATION
Detection of possible problems
Treat problem areas
Lower tone
Increase flexibility
→ Preparation for therapy
7.2. SELF MOBILISATION
Nala Melis Pagina 2
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