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Spinal Cord Injury
Terms in this set (50)
from cervical area injury of the SC
from injury to thoracic, lumbar or sacral area of SC
After swelling goes down, that's it.
may recover for up to 2 years
-24 hours to 6 weeks post-injury
- Flaccid below injury at first, then develop spasticity below lesion
........Level of last fully functioning neurological segment of the cord is the
level of diagnosis.
Spinal cord level
It determines what ADL equipment and techniques will be
needed. It also determines prognosis in terms of how much rehab and
home care the person will need.
Example :Ball-bearing Feeder
Flexor hinge splint
American Spinal Injury Assoc. (ASIA) Impairment Scale
complete, no motor or sensory below
incomplete; only sensation below neurological level and in S5-4
incomplete; motor function below less than grade 3
incomplete: motor function below with grade 3 or greater
Normal motor and sensory function.
Central Cord Syndrome:
-UEs affected more than LEs
- UE nerve tracts are more central in SC
- Elderly with narrowed SC from arthritis are at risk—especially in MVA with cervical hyperextension (whiplash)
Brown-Sequard (one side only)
-Hemisection of cord—gunshot, knife injury
-Because motor and sensory fibers cross over at different levels :
--Ipsilateral side—motor paralysis, pro-prioception
-- Contralateral side-
o Loss of pain,
o Temperature, touch
Anterior Spinal Cord Syndrome
-Descending fibers that inhibit reflexes are affected
- Results in spasticity, paralysis, loss of pain, temperature, and touch.
- Proprioception is preserved
Cauda Equina (peripheral)
-May regrow peripheral N,
--grows back 1"/month
- Good prognosis
- Flaccid, variable losses
Population at risk
-young, risk-seeking males
-35% MVA, 19%falls, 30% violence
-poor work history or tree
Causes of SCI
-often limited insurance
-Eventually will go on Medicare as chronic disabled
- as last resort they could end up stashed in NH on Medicaid
- Vocational Rehab may be option
-Regional spinal centers for acute care
- Rehab should be at spinal cord center—Shepard in Atlanta, Craig in
Colorado, Spaulding for NE
- Need physiatrist esp. for urinary problems
- High unemployment ~90%
-Excellent to return to roles if paraplegic
- Much more difficult if quadriplegic.
- However many with mild incomplete injury return to regular life
Evaluation—Determine dermatomes and myotomes
-Very specific ROM, Manual muscle tests, and Sensory Tests
- as medically safe
-especially detailed around borders of lost area.
- Given frequently to measure change
Common Frames of Reference in SCI Rehab
-Motor control/motor learning--Task-oriented
-Focus on analyzing activity pt. Wants to do with his level of function and
available equipment or methods.
- Splinting, ROM, strengthening, grading, building endurance, coordination
- Modalities—E Stim, Biofeedback
Motor Control/Motor Learning FOR
-Motor Control/Motor Learning FOR
-Practice, Practice with variation
-Use meaningfulness and context of the activity, motivation, visualization
-- Outgrowth of motor Control/ML
-- Use purposeful activity as primary modality
-- Performance context, interaction of person with environment
- Preset programs
- More groups
Call the physician immediately if...
The spinal level for motor or sensory changes and the patient can do LESS
than in last session.
Skin breakdown, pressure sores, decubiti
Inactivity during recovery can lead to pneumonia and skin breakdown
Watch out for shearing—from sliding pt. On bed on sheets.
Look for red spots—can also be caused by moisture and heat
Decreased vital capacity
Especially with cervical and high thoracic lesions
Prone to respiratory tract infection
Give deep breathing exercises, strengthen sternocleidomastoid Mm.
Osteoporosis of disuse
Why most SCI patients will not benefit from neural regeneration.
Especially in LE.
Change in position results in sudden drop in BP
Blood pools in LE and abdomen and pt may pass out.
If this happens—decline them quickly
Monitor BP on Standing Table, increase sitting tolerance gradually. Wear
abd and leg binders, TED hose
Sympathetic reflex to adverse stimuli
Injury above T4-T6
Triggered by heat, bladder distended, constipation
Symptoms—swollen viscera, headache,perspiration, flushing, chills,
Place them upright, remove restrictions, get them to physician if they
From uninhibited reflexes
A moderate amount of spasticity in LE can be helpful for standing,
Treated with botox injections, baclafen with intrathecal pump
If severe—tendon release surgery or nerve blocks
Serial casing after deformity develops
Swellings that are bone develop in abnormal locations, such as in the
muscles around the hip, knee, elbow and shoulder, 1-4 months post, can
Try to maintain ROM and treat with meds.
Swelling and redness in legs
Wear TED hose or pressure foot device to promote circulation
Rampant in this population
Can die from septicemia
Phases of treatment
Rehabilitation at Rehab Hospital or SNF
Follow-up care as outpatient, home health or inpatient for complications
-Assessment and Triage
Can't make prognosis until spinal shock clears
Usually in special rotating bed wearing TED hose or foot blood pressure
Halo patient—cervical fracture; O.T trains in precautions in self care
ROM—start AROM, AAROM and PROM.
Strengthening can begin of remaining motion if tolerated and safe.
Educate pt and family on positioning and safety issues
Adaptive equipment introduced as needed
Initial splint—Maintain functional position—do not let wrist tendons get
stretched out, keep fingers slightly flexed. This will help later tenodesis
adaptive equipment and techniques
Bowel and bladder programs
Respiratory issues—breathing, coughing
Weight shifting (every 30 mins)
Checking skin for breakdown
Beginning work skills
Sexual needs addressed
Home eval should be done before discharge
Dynamic splint may be needed
Training in in tenodesis grip if C5/C6
Shoulder resistance may be limited based on location of SCI
Strengthening is key to independence
May need abnominal binder to help with breathing and sitting
Ability to pull to sit—may need trapeze bar or rope ladder
Increase ability to sit up with tilt table if necessary
Increase standing tolerance with standing table
Design of w/c controls, wrap wheels with tubing, manual vs.
-ADLs and IADLs
May be referred to OP OT by Vocational Rehab specifically
for SCI program; may write justifications to get needed equipment from
poor positioning and not doing ROM. If they can
tolerate it—lie on stomach 15 mins a day.
Exercises to strengthen rotary cuff Mm.
Modify / drop activities
Give up manual and use electric chair
Aging appears to be accelerated in SCI
Research in SCI
-FES (Functional electric stimulation
-Well being research in SCI
THIS SET IS OFTEN IN FOLDERS WITH...
Cancer/Stoke Language Disorders/Oswestry
CVA Task-Oriented FOR Tx/TBI RANCHO/Glasgow/ALS
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