c-spine and t-spine management

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Author:
hgienau
ID:
111588
Filename:
c-spine and t-spine management
Updated:
2011-10-23 20:55:40
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Ortho Fall 2011
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hg
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  1. Red Flags for a Spinal Cord Evaluation
    • Spinal Cord Symptoms
    • Recent trauma where spinal fracture or instabilities have not been rules out
    • Serious Pain unremitting (pain all the time), night pain that wakes pt (cander), can not be explained mechanically
    • Numbness or tingling bilateral (posterior disc buldge)
    • Bowl and bladder issues
  2. Acute Phase With Inflammation
    • Pt experiences constant pain (pain changes)
    • Signs of inflammation
    • NO poistion or movement completely relieves the symptoms
    • Medical intervection with anti-inflammatory medication si warranted
  3. Acute Phase No inflammation
    • Symptoms are intermittent and related to mechanical deformation
    • signs of nerve root irritability when compressed or stretched
    • Pt can be categorized into extension, flexion, or non-weight bearing bias, based on presenting posture, movement impairment or positions of symptoms relief
  4. Delitto and Associates Classification for no Inflammation
    • cant stand longer than 15mins
    • Can't sit for more than 30mins
    • cant walk more than 1/4 of a mile
  5. Subacute Phase
    • Certain postures with some ADL's still provoke symptoms so that a basic life style cannot fully be resumed
    • Lifting vacumming, gardening, other activities that require repetitive movements of loads
  6. Chronic and Stage (return to function)
    • Pain only when excessive repetitive or sustained stress is placed on vulnerable tissue for prolonged periods
    • Emphasis is placed on returing pt to high level demand activities that require handling prolonged period of time
  7. What are the general guidelines for managing acute spinal problems
    • 1. estabilish a position of relief or comfort
    • 2. Pt may have a bias - bias can be dictatec by the pt or the condition / spinal biomechanics
    • 3. Teach awareness of safe postures and effects of movement
    • 4. Teach basic Stabilization
    • 5. Teach badic functional movements
  8. Extension Bias
    • The pt symptoms are lessened in positions of ext
    • Standing,
    • Prone,
    • Anterior pevlic tilt
  9. Flexion Bias
    • Pt symptoms are lessened in positions of flexion
    • Posterior pelvic tilt
  10. Non- Weightbearing Bias
    • Pts symptoms are lessened when in nonweightbearing positions
    • Move before the Pain comes
  11. How to teach awareness of safe postures and effects of movement
    • Teach the pt to identify and assume the spinal position that is most comfortable and reduces the symptoms
    • Pelvic Tilts
    • Passive Positioning - Supine: hook lying flexes the spine, legs extended exends the spine, Prone pillow under abdomen flexes spine, no pillow ext spine, Sitting, feet are propped up on stool to achieve flexion, a lumbar pillow of towel roll is used for ext, Standing: flexion if achieved by placing on foot on a stool
  12. Acute Plan of Care/Goals
    • Learn Self Management
    • Devrease acture symptoms
    • Demonstrate awareness of pelvic position and movement
    • Demonstrate safe postures
    • Initiate work for stabilizing muscles
    • Safely perform basic ADLs
  13. Acute Care Interventions
    • modalities
    • Kinesthetic training - pelvic tilits, neurtal spine
    • Provide passice support or bracing if needed
    • Basic stabilization exercises
    • Roll, Sit, stand and walk with safe postures
  14. Subacute care Care/ Goals
    • Learn self management and ecrease episodes of pina
    • progress awerness and control of spinal alignment
    • Increase mobility in tight muscle/joint/fascia
    • develop neuromusclar control, strength and endurance in stabilizing muscles
    • Increase trunk and extremity stength
    • Learn safe body mechanics
  15. Subacute Interventions
    • Ergonomic adaptation of work or home evnironment
    • Joint mobilizations, self stretching
    • Progress stabilization exercises
    • Increase repetitions and challenges
    • Tell me about your chair at work
  16. Chronic Plan of care/goals
    • Learn spinal control in high intensity and repetitvie activities
    • Increase Trunk and extremity strngth
    • Return to high level/high intensity activities for prolonged periods of time without exacerbating symptoms
    • Develop healthy exercise habits for self-maintenace
  17. Chronic Interventions
    • Joint Mobilization and self stretching
    • Progress trunk and extermity resistance exercises emphasizing funtional goals
    • Progress intensity of aerobic exercises
    • Progressive practice uing activity - specific training emphasizing spinal control, endurance timing and speed
  18. Acute Treatment Options
    • Position for symptom relief
    • Determine pt bias
    • Teach awarness of safe postures and movement
    • Passive positioning
    • Teach bias basic stabilization exercises
    • Teach Bias functional movements
    • Modalities
    • Kinesthetic training
    • Passive support
  19. Subactue Treatment Options
    • Ergonomic adaptation
    • Practice Spinal movement in pain free ROM
    • Joint MObs
    • Self stretching
    • Progress stabilization exercises
    • Low intensity aerobic functional exercises
    • Modailities if needed
    • Posture correction
  20. Chronic Treatment Options
    • Increase intensity of aerobic exercises
    • Teac spinal control in transitional positions
    • Increase resistacne to exercise
    • Increase reps and intensity of functional activites

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