Yannis Lai

[Audio] Placement 1 Case study presentation: Cervical Spinal Cord Injury Yannis Lai.

[Audio] Patient – Cervical Spinal Cord Injury Name: Weight Lily (pseudonym) kg Past Medical History 2022 subdural hematoma 2021 Depression 2023 Cervical fracture and Spinal Cord Injury Age: Height 63 years m Equipment Walking Frame Equipment : Frame.

[Audio] External physical impact (Fall) Traumatic spinal cord injury 1 ) Damages cells 2 ) Produces the death of neurons and glial cells, ischaemia and inflammation. 3 ) Changes in the organization and structural architecture of the spinal cord, including the formation of a glial scar and cystic cavities. 4 ) Poor endogenous remyelination and axonal regrowth Result : Poor intrinsic recovery potential (Ahuja et al., 2017) Equipment : Frame external physical impact.

[Audio] Timeline STAGE 1 STAGE 2 STAGE 3 STAGE 4 Norfolk and Norwich University Hospital Sheffield Home First Team Community Physiotherapy Surgery Rehabilitation Home visit Improve QoL Support after discharge.

[Audio] International Classification of Functioning, Disability and Health (ICF) Health Condition: Disorder: Cervical Spinal Cord Injury Body Functions & Body Structures Participation Activity Sensory deficit Spasticity in hands Mobility Environmental Factors Personal Factors Living in a bungalow with husband Daughter live next to patient 63 years old (female).

[Audio] Subjective Assessment Mandatory questions : - Medical issues/ Eat or drink/ Continence/ Pressure sore/ Pressure equipment/ safeguarding concern/ Exercise History of Present Condition (HCP) Past Medical History (PMH) Drug History (DH) Family History (FH) Social History (SH) Goals “Accurate history taking will provide 80% of the information required for developing a diagnosis.” (Epstein et al., 2008).

[Audio] International Classification of Functioning, Disability and Health (ICF) Health Condition: Disorder: Cervical Spinal Cord Injury Body Functions & Body Structures Participation Activity Weakness in the lower limb Sensory deficit Spasticity in hands Pain in lower back pain Restricted ADL’s : e.g. make breakfast Mobility: walking, sit-to-stand Work: early retirement Recreational activities Unable to join social gathering Environmental Factors Personal Factors Living in a bungalow with husband Daughter live next to patient High self efficacy: Determined to return to her original route 63 years old (female).

[Audio] Objective Assessment Observation Gait pattern & Hand Proprioception Joint position test ROM Finger and lower limb Strength Lower limb Sensation light touch Fall assessment Tinetti Thirty senior neurological physiotherapists 16 domains Range of movement Muscle spasticity Sensation Postural and balance Gait https://onlinelibrary-wiley-com.uea.idm.oclc.org/doi/full/10.1111/jep.13909.

[Audio] 23 Medium to High Quality Studies Canada/ UK/ USA Gait (n = 11) Muscle strength (n = 8) Range of motion (n=6) Somatosensation (n = 6) Balance (n = 9) https://onlinelibrary-wiley-com.uea.idm.oclc.org/doi/full/10.1111/jep.13909.

[Audio] Assessment Result Result Need Observation Gait pattern & Hand Reduced foot clearance in swing phase Contraction in hands - Muscle weakness of the hip flexors and ankle dorsiflexor (Sato, 2015) - Spasticity in hands Proprioception Joint position test Unable to compromised left and right/ up and down Poor proprioception Range of motion Active movement Finger (MCP) abduction/ adduction: 5° Hip flexion: NAD | Knee extension: Reduced Ankle Dorsi-Flexion /Plantar-Flexion: NAD Reduced finger RoM, knee extension Strength Lower limb (L=R) Hip flexion: 3/5 Hip abduction/adduction: 4/5 Knee extension/flexion: 3/5 Ankle DorsiFlexion/PlantarFlexion: 4/5 Muscle weakness of the hip and knee Sensation light touch Tingling in arm and numbness in right leg Altered sensation in right arm and right leg Fall assessment Tinetti Score: 14 High risk of fall.

[Audio] Cohort Study: 13 patients with SCI Rehabilitation Plan Goal: Reduce Spasticity in hands Improve mobility Plan: Lower limb: RoM and Strengthen Exercise Hand: Stretching and RoM exercise Education RCT: 21 patient with SCI Systemic review: 82 studies (69 chronic SCI; 13 acute SCI) Strengthen exercise Upper Limb: finger abduction and adduction, thumb extension Lower Limb: Half - Squat, Standing adduction and abduction, marching on spot, seated knee extension, knee flexion Stretching Hand Education What is cervical? Expectation management Strengthen exercise Hand : Thumb to finger, finger abduction and adduction, thumb extension Lower Limb: Squat, supine adduction and abduction, knee extension, marching on spot Stretching Hand.

[Audio] Goal: Improve mobility Reduce spasticity in hands Plan: Lower limb: RoM and Strengthen Exercise Hand: Stretching and RoM exercise Education 1) The Effects of Stretching in Spasticity: A Systematic Review 21 quantities studies Short term positive effect has been proven (Bovend’Eerdt et al., 2008) 2) Stretching and Splinting Interventions for Poststroke Spasticity, Hand Function, and Functional Tasks: A Systematic Review Moderate strength of evidence to support the use of manual stretching (Kerr, Jewell and Jensen, 2020) Strengthen exercise Upper Limb: finger abduction and adduction, thumb extension Lower Limb: Half - Squat, Standing adduction and abduction, marching on spot, seated knee extension, knee flexion Stretching Hand Education What is cervical? Expectation management Strengthen exercise Hand : Thumb to finger, finger abduction and adduction, thumb extension Lower Limb: Squat, supine adduction and abduction, knee extension, marching on spot Stretching Hand.

[Audio] Need - Muscle weakness of the hip flexors and ankle dorsiflexor (Sato, 2015) - Spasticity in hands Poor proprioception Reduced finger RoM, knee extension Muscle weakness of the hip and knee Altered sensation in right arm and right leg High risk of fall Lower limb: RoM and Strengthen Exercise Marching on spot with assistance Half – Squat with assistance Standing adduction and abduction with assistance Ankle Plantarflexion and Dorsiflexion Seated knee extension/knee flexion Hand: Stretching and RoM exercise Finger abduction and adduction Thumb extension Finger stretch Strengthen exercise Upper Limb: finger abduction and adduction, thumb extension Lower Limb: Half - Squat, Standing adduction and abduction, marching on spot, seated knee extension, knee flexion Stretching Hand Education What is cervical? Expectation management Strengthen exercise Hand : Thumb to finger, finger abduction and adduction, thumb extension Lower Limb: Squat, supine adduction and abduction, knee extension, marching on spot Stretching Hand.

[Audio] Need - Muscle weakness of the hip flexors and ankle dorsiflexor (Sato, 2015) - Spasticity in hands Poor proprioception Reduced finger RoM, knee extension Muscle weakness of the hip and knee Altered sensation in right arm and right leg High risk of fall Lower limb: RoM and Strengthen Exercise Marching on spot with assistance Half – Squat with assistance Standing adduction and abduction with assistance Ankle Plantarflexion and Dorsiflexion Seated knee extension/knee flexion Hand: Stretching and RoM exercise Finger abduction and adduction Thumb extension Finger stretch Strengthen exercise Upper Limb: finger abduction and adduction, thumb extension Lower Limb: Half - Squat, Standing adduction and abduction, marching on spot, seated knee extension, knee flexion Stretching Hand Education What is cervical? Expectation management Strengthen exercise Hand : Thumb to finger, finger abduction and adduction, thumb extension Lower Limb: Squat, supine adduction and abduction, knee extension, marching on spot Stretching Hand.

[Audio] Outcome measurement Initial assessment Observation Reduced foot clearance in swing phase Contraction in hands Proprioception Unable to compromised left and right/ up and down Range of motion Finger (MCP) abduction/ adduction: 5° Hip flexion: NAD | Knee extension: Reduced Ankle Dorsi-Flexion /Plantar-Flexion: NAD Strength Hip flexion: 3/5 Hip abduction/adduction: 4/5 Knee extension/flexion: 3/5 Ankle DorsiFlexion/PlantarFlexion: 4/5 Sensation Tingling in arm and numbness in right leg Fall assessment Score: 14 2nd assessment foot clearance improved significantly in left leg, slight foot drop in right leg Spasticity stay same Able to compromised left and right/ up and down Finger (MCP) abduction/ adduction: 9° Hip flexion: NAD | Knee extension: Slight improvement Ankle Dorsi-Flexion /Plantar-Flexion: NAD Hip flexion: 4/5 Hip abduction/adduction: 5/5 Knee extension/flexion: 4/5 Ankle DorsiFlexion/PlantarFlexion: 4/5 No significant improvement Score: 15.

[Audio] Biopsychosocial Model Biological Muscle hypertrophy: Increase muscle protein synthesis (MPS) (Kumar et al., 2009) Sociological Improvement Psychology Social support theory Husband Daughter Physiotherapist (Cobb, 1976) Improve self-esteem High self-efficacy (Bandura, 1977).

[Audio] References. 17. References.

[Audio] Thanks! Do you have any questions? youremail@freepik.com +91 620 421 838 yourwebsite.com Please keep this slide for attribution.