Case Study: SCI
The patient is a 25-year-old male, 5 ft 9 in and 172 lb (BMI = 25.4). He sustained a spinal cord injury (SCI) 12 months ago as result of a motorcycle accident. His most recent neurological examination at discharge from rehabilitation indicates a motor-complete (AIS B) SCI with a neurological level of injury at T9. He currently lives with his parents (both in good health) and is hoping to return to college to complete his degree in engineering. He uses a manual wheelchair as his primary means of mobility but has a preexisting right shoulder acromioclavicular joint injury that causes him daily pain (average 6/10), especially with active shoulder range of motion greater than 90° of flexion. The participant reports frequent flexor and extensor spasticity in the lower extremities that occurs most often during transfers and when repositioning his body in bed or on a mat. In addition, he reports occasional low back pain likely due to poor posture caused by prolonged periods of sitting, trunk weakness, and frequent spasms in the hip flexors. His current spasticity management strategy involves passive stretching of the lower limbs two to three times per week. He is currently taking medications for musculoskeletal pain (oxycodone one to two times per week at night, Ultram (tramadol) one to two times per week at night, ketoprofen topical gel, and Bayer Back and Body aspirin during the day as needed) but has discontinued the use of baclofen (antispasticity medication) as he felt that the frequency and intensity of his muscle spasms had not improved with medication. Aside from a short time in acute rehabilitation following his injury, the patient reports being very sedentary and is finding it increasingly difficult to perform activities of daily living due to pain and general muscle fatigue. His primary care physician has recommended he start an exercise program in order to improve muscular strength, mobility, and general health.
A recent graded exercise test using an arm cycle ergometer revealed the following information: resting HR 68 bpm, resting BP 124/72 mm Hg, maximum HR 146 bpm, maximum BP 133/80 mm Hg. The participant was able to arm cycle for approximately 9 minutes before volitionally terminating the test due to right shoulder pain and localized arm fatigue. He now presents to your facility for a supervised exercise program.
Case Study: SCI Questions
1. Describe preparticipation considerations and recommendations for this patient prior to additional exercise programming.
2. Determine exercise prescription guidelines for aerobic, resistance, and neuromotor training according to the FITT principles for SCI.
3. Describe any special considerations that should be taken into account during exercise testing and exercise programming..Get Nursing Assignments Help Today
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