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Quick Reference to Common



Precaution/Contraindication What can happen What to do in this situation
JOINTS Lower back 1. No bending at the waist.
2. No lifting – will have lifting precautions in place.
3. No twisting at the waist.
Possible damage to what has been done during surgery /interference with healing process. PREVENTITION

• Educate the patient in body mechanics to avoid bending at the waist, lifting and twisting.
-bend at the hips and knees
-turn entire body when moving or carrying items.
-log roll in bed to avoid twisting.
-cross foot over opposite knee to don socks and shoes.
-sit and pivot to enter/exit a vehicle.
-get help to move heavy items.
-do not carry children except for very small infants.
• Help patient adapt home and work environments to avoid lifting and twisting tasks.
-sit to bathe and dress.
-store frequently used items between eye and waist level.
-use long handled tools for housework, gardening
-use a utility cart to move items rather than carrying them.

Hips Anterior Approach:
1. Avoid extension of the hip backward. Do not step backwards with surgical leg.
2. Avoid external rotation of the hip.
3. Avoid hip adduction. Do not cross legs. Use a pillow between legs when rolling.
Posterior Approach:
1. Avoid hip flexion past 90 degrees.
2. Avoid hip adduction (no crossing legs).
3. Avoid hip internal rotation.
Possible dislocation of hip joint PREVENTION

• Educate the patient and patient’s caregivers in hip precautions.
• Train in use of adaptive equipment to compensate for bending during hygiene, dressing, mobility, light household activity.
• Reinforce adaptive transfer techniques to/from bed, chair and toilet.
• Evaluate the home for safety and needed adaptations.

Knees 1. No squatting.
2. No kneeling on the affected knee.
3. No pivoting or twisting the affected knee.
4. Knee must be flat when lying in bed.
5. Knee may be immobilized post-surgery – specific precautions may be ordered by the surgeon.
PAMS Children

Active epiphysis- (generally 16 years old or younger, although the plate may not close in some individuals until between ages 18 and 25)

Ultrasound Ultrasound over unfused epiphyseal growth plates may alter bone growth.




Superficial Heat

Cold increases sympathetic tone and produces peripheral vasoconstriction, which increases blood pressure

Generalized peripheral vasodilatation is produced by heating a large surface area of the body. Elevation in skin blood flow requires more cardiac output in order to maintain blood pressure. People with impaired heart function may not tolerate the increased cardiac demand

Malignancy Electrical stimulation (all forms)
Superficial Heat
E-stim may stimulate growth and promote spread of cancer cells

Superficial Heat- Increasing tissue temperature stimulates metabolic activity of all types of cells.

Ultrasound Sound- waves applied to tumor cells can stimulate growth and induce new blood-vessel growth, which helps provide fuel for further tumor growth and potentially promotes metastases.

Pacemaker Electrical stimulation (all forms)
Electrical stimulation (all forms) may cause malfunction

Ultrasound may affect the function of pacemakers


Pregnancy . Superficial Heat
Electrical stimulation (all forms)
Superficial Heat – heating fetal tissues can alter fetal growth and development. large areas, or at sufficient intensity to raise core temperature, in pregnant women

Electrical stimulation (all forms) – may lead to unwanted uterine contractions and, potentially, to miscarriage or premature labor.

Ultrasound- Sound waves transmit through amniotic fluid and could cause fetal malformations

Raynaud’s Phenomenon

Sudden constriction of a blood vessel that reduces blood flow

Cryotherapy /Cold pack In Raynaud’s disease, the blood vessels are commonly in a state of vasospasm, which would be exacerbated by applying cold. Prolonged vasoconstriction can lead to thrombus formation, tissue ischemia, and necrosis.
Seizures Electrical Stimulation (all forms) 


May induce seizures
Sensory Impairment Electrical Stimulation (all forms)
Superficial Heat
Impaired sensation that prevents patients from giving accurate and timely feedback can be harmful.

Electrical Stimulation (TENS, NMES)- unable to distinguish the prescribed and/or maximum safe level of current intensity.

SPLINTS Flexor Tendon Injury Position of hand


Tendons can rupture


Splint in FLEXION
Extensor Tendon Injury Position of hand


Tendons can rupture


SCI Autonomic Dysreflexia (AD)

– Sudden onset of excessively high blood pressure.


Recognize the symptoms, and understand the causes.
– T6 and above
– More common with cervical and complete lesionsCommon Causes:
– Bladder distension – most common triggering factor
– Bowel distension
– Pressure ulcerSymptoms:
• High blood pressure
• Pounding headache
• Flushed face
• Sweating above the level of injury
• “Goose bumps” below the level of injury
• Nasal stuffiness
• Nausea
• Slow pulse (slower than 60 beats per minute).

Life-threatening condition

The Five B’s

1. Bed Up
2. BP
3. Bladder
4. Bowels
5. Body

BED UP: Sit the patient up or raise their head to 90 degrees. Lower their legs if possible.

Loosen any tight clothing and/or constrictive devices/splints/ braces-especially around the torso and quickly check the catheter for blockages.

BP: Closely monitor BP- every 5 mins or more.

Search for and eliminate the trigger

BLADDER: Check bladder drainage equipment for kinks or other causes of obstruction to flow

BOWEL: Check if impacted

BODY: Skin issues
 During  therapy AD may be triggered by muscle stretching, either from range-of-motion or passive stretching.

Orthostatic Hypotension (OH)
Also known as Postural Hypotension
– Drop in blood pressure that occurs when a person stands up from sitting or lying down.

Recognize the symptoms, and understand the causes.

commonly seen cervical and high thoracic lesions

• Dizziness
• Light Headedness
• Nausea
• Headache
• Pallor
• Yawning
• Sweating
• Muscle weakness
• Fatigue
• Occasionally syncope (temporary loss of consciousness)

Patient could faint
Associated with fatigue and impacts quality of life and participation in rehabilitation.
May result in deficits in cognitive performance.
For an acute episode: The patient must be reclined quickly and, if sitting in a wheelchair, should be tipped back with legs elevated until symptoms subside.

Other management strategies include:
•  Application of compression stockings/pressure stockings and abdominal binders,
•  Adequate hydration
•  Gradual progressive daily head-up tilt

MEDICAL Diabetes Wound healing

2 main causes for susceptibility to injury and slow healing wounds
• Diabetic peripheral neuropathy- skin cuts and blisters often go unnoticed until they become more complicated.
• Impaired ability to fight infection- wound becomes a portal for infection that can lead to sepsis and require limb amputation.






Diabetic wounds are likely to progress into a deep infection that kills healthy tissue and delivers infection directly into your bone. This type of infection is hard to stop once it begins, making amputation the only procedure capable of halting the spread of infection and saving the patient’s life. Most common diabetic amputations occur on the toes, feet, and lower legs. Diabetes is the leading cause of non-traumatic lower extremity amputation.


If diabetic hypoglycemia isn’t treated, signs and symptoms of severe hypoglycemia can occur and can lead to serious problems, including seizures or unconsciousness, that require emergency care.




Teach proper diabetic wound care- protect wound from infection and help the healing process.


HYPOglycemic episode- offer carbohydrates (candy, fruit, juice, honey)

Vital Signs
OTHER Down’s Syndrome atlantoaxial instability (AAI) – a misalignment of the first two cervical vertebrae of the neck Avoid activities that place the neck in extreme flexion, such as tumbling, in individuals who test positive for AAI.