DISCUSSION FORUM SCI

Subjective assessment
The following underneath are the other important information that should be included in the
subjective assessment part of the initial evaluation or IE:
 In the span of 10 minutes of waiting for the emergency response team to arrive in
the scenario, was there anyone from the bystanders who attempted to touch or
move the patient after being thrown off of his motorcycle? - it is important to know if
someone from the bystanders moved the patient or none because it might worsen the
injury of the patient if happened to be moved from the initial position without any
knowledge regarding first aid and proper patient handling.
 Does the patient acquired any neck problems? - it is also important to know whether
if the patient has any neck problems because it might contribute to the aggravation of the
illness of patient. Even though if the patient is wearing helmet in his head, the patient’s
neck might be affected as well in a way that the patient may acquire any neck problems
after being thrown off of his motorcycle caused by the impact of the car behind.
 How fast or what is the speed of the car upon hitting the motorcycle? - it is
important to know how speed or how fast does the car goes prior to the collision because
it can affect the severity of the injury acquired by the patient or motorcycle driver. If the
car travels fast then absolutely the car’s impact to the motorcycle is strong causing the
patient to acquire a spinal cord injury.
 What type of car that collides with the motorcycle? - it is important to know this since
a larger car or vehicle will probably make a bigger collision and a smaller one will
probably not. It is based on the speed and type of car to know how severe is the injury.
 What type of helmet does the motorcycle driver is using? - the type of helmet is also
important to know because if the patient or motorcycle driver uses a high quality helmet,
then the head injury is prevented unlike with the use of low quality helmet the severity or
the possibility to acquire any head injuries are at stake.

OBJECTIVE ASSESSMENT
In objective assessment, the therapist will be assessing the patient through various tests and
measures. It is important because it can be a basis for the foregoing plan of care of the
physical therapist to the patient who complains of any abnormalities or irregularities.
Hereunder are the other patient objective assessment wherein not included in the presented
IE or initial evaluation:
 Superficial Sensation Testing - it is important to test the patient’s superficial sensation
because he complains of sensory loss in his extremities and a burning sensation in the
patients hands. So as a therapist, it is just for me to suspect any nerve involvement in the
injury and I’ll test it through superficial sensation testing. It will test the pain sensation
with the use of paper clips, light touch with the use of camel brush or cotton, temperature
with the usage of test tubes with different temperatures of water namely hot and cold,
and lastly, pressure will be tested with the use of cotton swabs. (anticipated findings: the
patient has an impaired pain and temperature sensation in B UE & LE)
 Deep Sensation Testing - it is essential also to test whether the deep sensations of the
patient’s both upper extremity and lower extremity is either intact or not. It will test
proprioception or the motion sense and also kinaesthesia. In proprioception, patient will
do the the motion asked by the therapist and in kinesthesia, patient will tell if the motion
is going up or down. (anticipated findings: the patient has impaired deep sensation on B
UE & LE)
 Figure of 8 Measurement - it is important to know the difference between both hands
and ankles since there is the presence of edema and it should be compared for baseline
purposes to monitor whether the edema is getting bigger or smaller. It is done by the
utilization of a tape measure placed in some landmark of both extremity. (anticipated
findings: R UE=35cm, L UE=31cm, R LE=57cm, L LE=55cm)
 Range of Motion Testing - this is done to know if there is a significant change in terms
of the limb motion. It is done in both passive and active motions. (anticipated findings:
LOM on B UE & LE)

PLAN OF CARE
Hereunder are the other PT treatment strategies or interventions for a patient with spinal cord
injury or SCI:
 Postural Control Training - it is important to conduct postural control training for the
exact purpose of improving the patient’s faulty posture. Mid line orientation of the
patient’s body is also helpful to correct and improve the patient’s faulty posture. The mid
line orientation activities are done during transfers, side lying, and or sitting position.
(treatment parameters: mid line orientation activities during transfers, side lying, and
sitting x 15 mins)
 Faradism Under Pressure (FUP) - it is important to do faradism under pressure (FUP)
to spinal cord injury (SCI) patients with edema. The particular reason for this
circumstance is to increase venous and lymphatic drainage and also to relieve the
edema in the extremity of the patient. It is also a type of electrical stimulation but iit is
combined with compression and elevation at the same time.This actively demonstrates
that the application of electrical current to excitable tissue in neurologically damaged
muscles in order to relieve edema. This is also good in supporting the lymphatic flow and
venous drainage. (treatment parameters: faradism under pressure (FUP) x B hand &
ankle x 20 mins)
 Bed Mobility Exercises - it is important to do bed mobility exercises to the spinal cord
injury (SCI) patients to avoid muscle atrophy and also to avoid vascular diseases which
may be the causation of the appearance of pressure or bed sores. This will help the
patient to at least improve the muscle performance. (treatment parameters: straight leg
raises (SLR) x 10 reps x 1 set & ankle pumps x 10 reps x 1 set and progress as
tolerated)
 Deep Diaphragmatic Breathing Exercise - it is important to do this exercise for a
patient with decreased pulmonary capacity to at least increase the capacity. This is done
by instructing patient to place one hand over the diaphragm while inhaling through the
nose and exhaling through the mouth and by resisting the diaphragm’s expansion to at
least strengthen it and by that, the pulmonary capacity will be increased. (treatment
parameters: 3 reps x 3 sets x 30 secs rest interval)