SCI medical management Flashcards
medical intervention
Steroids to reduce swelling
- Neurological examination
- radiography
- immediate stabilization of spine
- internal fixation
- External fixation
spinal fusion
taking metal rods and screwing them into vertebrae to stabilize.
-in rehab, as progressing they will not have a lot of cervical movement (internal fixator)
Halo
Arms and legs are free but the neck is completely stabilized from the neck up.
-progress from a halo to a c collar when not as much stability is needed.
Spinal shock
complete loss of neurological function
- diminished reflex activity below level of injury
- affected area (decrease sensation, deep tendon reflex, BP, flaccid muscle function, frequent loss of B and B control)
- Lasts 1 to 6 weeks.
- initial spike in BP due to catecholamines
- men get Priapism (penis remains erect due to retention of blood)
Acute management
positioning/deformity control
- Skin integrity
- Initial ADL skill
- Education but action is primary feature
- Start upright tolerance
- Building blocks (skill needed to complete ADLs)
- Strengthening/ROM- this also helps to start acclimating them to their body.
Start initial ADLs in bed
Inpatient (initial) rehab
Upright tolerance
- Deformity control
- Skin issues become more directive
- ADLs
- Strengthening/ROM
- learning body in space skills
- Functional mobility
- Spinal shock resolves
- Education
Have them work on sitting up, head control, turning pages.
-Gear towards community integration at this point (either going home or to a SNF)
Outpatient/Home health
Finishing what you started
- ROM/strengthening
- body in space
- ADL skills
- Functional mobility skills
- Community access
- Training family
More worried about doing things right.
-Perineal hygiene is a big one as well as sexual dysfunction.
Orthostatic Hypotension
Treatment:
- if sitting in chair tilt chair backwards
- if sitting EOB lie patient back down
- Coming to upright position slowly can help decrease incidents of orthostatic hypotension
- Use Ace wrap to help regulate blood flow
- abdominal binder
- gradual increase in sitting tolerance
Autonomic Dysreflexia
Lesion at T6 or above
Treatment:
- elevate to sitting position
- take BP in both arms (systolic can be 9-110 mmHg range normally)
- check for blockage/kinks in bladder and bowel system
- check for areas of restriction- tight clothing
- relieve urinary pressure
- seek medical attention
ingrown toenail can be a cause as well
DVT- deep vein thrombosis
Risk factors- immobilization, post op, age>40, cardiac disease, limb trauma, coagulation d/o, obesity, advanced neoplasm (abnormal growth), pregnancy.
Clinical signs:
- pain
- swelling
- Superficial venous distention
- Fever
Treatment:
- Blood thinners- Coumadin, heparin
- compression
- Bed rest
If in thigh there is a greater concern.
-common after CVA or SCI
Pain
Acute:
-from injury
Chronic:
-For SCI can be at any level
Musculoskeletal (tear or injury)
Neuropathic
-Described as sharp, shooting or burning
Musculoskeletal
Secondary overuse (pressure syndromes)
- occur months or years after injury
- caused by overuse
Muscle spasm pain
-Involuntary movements in areas that have lost some of all motor function
Mechanical instability of spine
- Occurs shortly after injury but can occur later
- pain usually around area of instability
Neuropathic pain
Spinal cord injury (central) pain
- Can begin within weeks of injury
- Pain at or below level of injury where there is sensation loss
Segmental pain
- Occurs around border where have normal sensation and sensation loss
- Associated with allodynia and hyperalgesia
Neuropathic pain
Nerve root entrapment
- Begins days or weeks after injury and may worsen over time
- Occurs at or just below level of injury
- Has a distinct pattern
- Brief waves of stabbing or sharp pain or band of burning pain at point where normal sensation stops
- Light touch increases pain
- Compression of nerve root by bone or disk
Come from the spine
Waives of stabbing or sharp pain. Happens when the sensation stops (light touch will increase this pain)
pain management
medications
Modified activities
Self evaluation of what causes and reduces pain
