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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
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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
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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
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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
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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
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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
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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
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Extension Bias
- The pt symptoms are lessened in positions of ext
- Standing,
- Prone,
- Anterior pevlic tilt
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Flexion Bias
- Pt symptoms are lessened in positions of flexion
- Posterior pelvic tilt
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Non- Weightbearing Bias
- Pts symptoms are lessened when in nonweightbearing positions
- Move before the Pain comes
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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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