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
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
