OPTA 222 (SCI)
Cuases of SCI
- Trauma
- Disease Process
- Congenital
Quadriplegia
Involves motor and sesory function loss from the neck down
Paraplegia
Involves Motor and sensory loss of functions from the waist down
-may or maynot include trunk
SCI Related diseases
Upper Motor Neuron Disorder
- Respiratory infections - cough muscles
- Cardiovascular and other inactivity related disorders: Diabetes, Obesity
- Suicide
- Genitourinary infections: Bladder dysfunction, Urinary tract infections, Kidney stones
- Sexual dysfunction
- Spasticity
- Pain syndromes - body is potentially misinterpreting/exaggerating a pain signal
- *Pressure ulcers, Most common: Decrease blood flow_ leading to pressure ulcers,
-Autonomic dysreflexia_emergency if occurs: Makes blood pressure ++high and heart rate ++low; Can lead to stroke, seizure or cardiac arrest; Trauma, illness, full bowel/bladder, exercise can lead to autonomic
dysreflexia
- Despite related chronic illness, mortality rate 1 year post injury for spinal cord injury patients is 90% of that of the remaining population: Higher level injury increases mortality rate in that first year
Complete SCI
- total absence of sensory and/or motor in lowest sacral segment. Complete cut through nerve tracts.
- often damage the nerve root in the foramer
Incomplete SCI
- partial preservation of sensory and/or motor function below the neurological level and in the lowest sacral segment.
- Test your anal sphincter to see if its complete or incomplete
SCI Demographic Most common
Sex: males
Age: 19
Injury Cause: Motor Vehicle accident
Neurological Category at Discharge: Incomplete tetraplegia
Common Injury Site: C5
SCI Charts
- Used to determine what level of SPI a person is at. Look at sensory, and motor function, as well as complete and incomplete.
- Used to classify the level of injury.
Central Cord Sydrome
-causes bleeding into central grey matter. Impairment of function in upper body more than in lower. most common
INC SCI
-Impairment in arms and hands to lesser extension in legs
- signal are more reduced than blocked from lower part of body
Anterior Cord Syndrome
Motor, pain and temp sensation are lost bilaterally below the injured segment. Return of bowel and bladder function poor
Brown Sequard Sydrome
- Ipsilateral loss of motor function and position sense and contralateral loss of pain sensation several levels below the lesion
Cauda Equina Sydrome
occurs when the nerve roots in the lumbar spine are compressed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage. If patients with cauda equina syndrome do not seek immediate treatment to relieve the pressure, it can result in permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems. Even with immediate treatment, some patient may not recover complete function.
Conus Medullaris
Injury of the sacral cord and lumbar nerve roots results in a clinical picture of lower extremity motor and sensory loss and an areflexic bladder and bowel
SCI Medical Management
- Pharmacological:Steroids – decrease inflammation
- Surgical Stabilization of spine:** Progressive neuro involvement - something is getting worse, Type and extent of bony lesions, Degree of spinal cord damage
Early Rehab
- Primary emphasis is to lessen adverse effects of neurotrauma and immobilization: ROM and voluntary movement (exercise), positioning
- Goal: prevent secondary complications
What might TA be involved in
- early intervention:
-assist mgmnt of pressure
-booties (heels)
-turning (depending on injury and orders)
-ROM
Inpatient Rehab
- Patient gains varying levels of independence in specific skills: ADLs, Transfers, Mobility
- Family training
- Home modification
- Vocational planning (Job)
- Equipment – Alberta Aids to Daily Living (AADL)
- Home management skills
- Home exercise programs
- Driving evaluation
- Referrals
- Communication
Functional Goal Setting
- Bathing
- Bed mobility
- bladder/bowel control
- Communication
- Environmental access
- Feeding
- Dressing
- Gait
- ROM/positioning
- Skin care mgmt
- Transfers
- w/c mobility
- w/c management
- Transportation/driving
- Grooming
- Home mgmt
Goals For Seating
- Maximize functional independence
- Optimize pressure distribution
- Optimize comfort
- Enhance quality of life
- Good postural alignment
- Compensate for fixed deformities
- Ease of transport
- Tilt (the whole body is tilting backwards in the chair) vs Recline (reclining only the trunk)
- Amp board (for people with amputations to rest their stump).
- Neutral pelvic alignment
- Symmetry of trunk and neck
- Neutral head positioning over pelvis
- Maintenance of horizontal gaze
-Maintenance of a 90 degree angle at hips knees and ankles
- Maintenance of thighs in neutral abduction
- Neutral shoulder positioning
Management post Rehab
- Contracture prevention
- Skin management
- Prevention/management of respiratory conditions: Inspiratory muscle training, Phrenic nerve pacing(pacemaker for breathing), Glossopharyngeal breathing, Secretion clearance
- Orthoses
- Bladder/bowel mgmnt
- Sexual issues
- Psychosocial issues
SCI Lesion Epectations: C1- C5
-Transfers: C1-4 Max Assist, C5 Mod to Max Assist
- Indep Lev w ADLs: Dependant w w/c, Inde w Pw/c Bathing 2PA Mod/Max
- Required care: Mod to mostly Max asssist for activities
SCI Lesion Expectation: C7-C8
Tranfers
- Bed Mobility: Indepentand
- Car: Mod
- Floor: Max
Indepen w ADLs:
- dressing 1PA Mod
- Eating 1PA Mod
Care Required: Indep to Max depending on activity
SCI Lesion Expectation: C6
Transfers:
- Floor: Max
- Bed mobility and slideboard: min
Indep w ADLs:
-Dressing: Mod
-Outings: Max
Required Care: Indep to max depending on activity
SCI Lesion Expectations: Para 4th
Transfers:
-Indep w level sufaces to min on floor
Indep w ADLs:
-Indep to Min on most ADLs
Required Care: Mostly Independant