L6 Clinical Presentation after SCI Flashcards
(37 cards)
Acute Cardiac Dysfunction after SCI
occurs days to weeks
SCI at T1-L1 or higher will block communication of brainstem and sympathetic nervous system
-PNS is still intact, vagnus nerve
-the disruption results in bradycardia, bradyarrhythmia, peripheral vasodilation, hypotension
Usually most present in lesions above T6
Chronic Cardiac Dysfunction after SCI
reduced exercise tolerance
exercise induced hypotension
reductions in cardiac output, can be severe enough to cause atrophy of L ventricle (tetraplegia)
Autonomic dysreflexia
PT considerations for acute cardiac dysfunction
must monitor vitals
will need supportive measures when changing positions
progress to upright slowly
assistive clothing
TED hose is good for DVT, not much else
PT Considerations for Chronic Cardiac Dysfunction
physical inactivity is common
this will lead to deconditioning
leads to more functional limitations
Impaired Thermoregulation
SCI above L1 interrupts communication between hypothalamus and sympathetic
-the more rostral the injury, the more SCI will affect this
-shivering will be absent below the LOI
Acute Thermoregulation impairments
hypothermia due to unchecked vasodilation from parasympathetic system
after days-weeks, reflexive regulation of vasoconstriction returns
Chronic impairments of thermoregulation
loss of ability to sweat below the lesion, does not return
Thermoregulation and PT
you may need to assist them with thermoregulation
acute = blankets
Chronic = fans, room temp, etc Education
Areflexive or flaccid bladder
T12 or below injury, usually S2-S4 or cauda equina
the bladder remains flaccid
the cells bodies of S2 to S4 preganglionic are damaged, resulting in no parasympathetic innervation to the detrusor muscle
The detrusor muscle will not contract even when stretched
Bladder can’t empty, and will overflow or dribble
High risk for medical complications w/out medical program
Spastic or Reflexive Bladder
Injury above T12
Reflexively functioning bladders
S2-S4 reflex arc is intact
descending input from cortex and pontine miturition centers are disrupted
bladder empties reflexively when full, voluntary control is lost
Bladder Management Program
Can include the following, depending on the impact on S2 to S4
Indwelling catheter, intermittent catherter, suprapubic cather, reflexive bladder empty, valsalva voiding, medications to control spasms
During phase of spinal shock (bladder)
Options are:
indwelling catherization, which increases risk of infection or Intermittent catherterization (4-6 hours)
reflexive bladder may still be intact, which can cause unintential bladder emptying with abdominal pressure
If bladder function is not well managed
can be life threatening __> autonomic dysreflexia, kidney damage, UTI, sepsis
skin breakdown
Changes to Bowel Function
similar to bladder function changes
T12/higher = loses voluntary control
S2/4 intact = reflexive emptying
peristalsis will be slowed
make sure they are up on their fluids
Bowel Programs
during spinal shock, manual evacuation of stool is required
Bowl retraining involves emptying at scheduled times. Nutrition, hydration, abdominal massage, helps with this process.
Patient may have to manually remove stool (areflexive) or stimulate removal (reflexive)
PT and Bowel Program
Bowel program is required
Constipation or impaction can trigger autonomic dysreflexia
help them minimize bowel incontinence, because it increases skin breakdown and decreases community reintergration
Autonomic Dysreflexia
an abnormal, overreaction of the autonomic nervous system to pain or discomfort below the nerologic LOI after SCI
Emergency situation if not addressed. Has serious complications like stroke, seizure, organ damage, brain injury, death
Medical Management of Respiratory Impairment
Supplemental O2
Suction
Invasive Mechanical Ventilation
Supplemental O2
in early phases of recovery until ventilatory mm strength improves to adequately supprot day to day activities
Invasive Mechanical Ventilation
used with high cervical SCI
typically achieved using intermittent positive pressure ventilators
Causes inhalation either by delivering a set pressure, set volume of air
Can be stationary or portable models
PT assessment of respiratory function
O2 sats
postural assessment
quality of inspiration
quality of forced expiration
Impact of SCI on Ventilation and Coughing
LOI is going to impact muscles of inspiration/expiration and postural muscles
Higher lesions interrupt innervation to muscles of both inhalation and expiration
Lower lesions impact mm of expiration
Ventilation training
encourage diaphragmatic breathing during quiet breathing. Can use visual and verbal cues.
Supine is easier than sitting after SCI, abdominal binder can support sitting
Compensatory = cueing, strengthening intact muscles
PT Tx of REspiratory Function
strengthening
increase chest wall mobility
address postural alignment
open chest as much as you can
