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Traumatic spinal cord injury (Neuro complications and associated…
Traumatic spinal cord injury
Classification
Neuroanatomical organization and structure
31 pairs of spinal nerves
Conus medullars At L1
Designation of lesion level
Internation standards for neurological classification of spinal cord injury
Neuro level
most caudal with normal sensorimotor
Motor level
Most caudal with normal bilateral motor
Sensory level
Most caudal with normal bilateral sensory
completely injuries
no sensory or motor function in the lower sacral segments (S4,5)
Incomplete injuries
Motor or sensory function below the S4, 5
Zones of partial preservation
zone of partial preservation
ASIA
Clinical syndromes
Brown squared syndrome
anterior cord syndrome
central cord syndrome
Cauda equina injuries
Neuro complications and associated conditions
Spinal shock
motor and sensory impairments
autonomic dysreflexia
Initiating stimuli
symptoms
intervention
spastic hypertonia
UMN syndrome
cardiovascular impairment
Table 20.3
impaired temperature control
pulmonary impairment
bladder dysfunction
Spastic/UMN bladder
flaccid/LMN bladder
sexual dysfunction
Male response
Reflexogenic
Psychogenic
Chance of infertility
Female response
UMN, reflexive present, psychogenic lost
LMN, reflexive lost, psychogenic preserved
Fertility
secondary medical complications
Pressure ulcers
pneumonia
DVT
Pain
Nociceptive pain
Neuropathic pain
Contractures
Osteoporosis, skeletal fractures
Heterotopic (ectopic) ossification
bowel dysfunction
UMN bowel
LMN bowel
Prognosis
ASIA B, C, D, good indicator of greater likelihood of recovery
ASIA A, likely to experience some motor recovery
Preservation of pinprick at 4 months post, good prognosis for motor recovery at 1 year
Motor recovery plateau at 12-18 mos
Early management and rehab in acute stage
Emergency care
stabilizing
physically
fracture stabilization
Immobilization
Cervical orthoses
Minerva
halo
Thoracolumbosacral orthoses
TLSO
Jewett
medically
Methylprednisolone
fracture stabilization
immobilization
PT Management in acute stage
Exam
Motor and sensory function
Respiratory
Integument
PROM
Early mobility skills
Interventions
Respiratory management
Deep breathing exercises
Glossopharyngeal breathing
Air shift maneuver
Respiratory muscle strengthening
Coughing
abdominal binder
manual stretching
Skin care
Positioning
Inspection
Early strengthening and ROM
Early mobility interventions
Education
Active rehab
PT exam
Box 20.2
Aerobic capacity/endurace
arousal, attention, cognition
enviornmental or work barriers
Gait, locomotion, and balance
Motor function
Muscle performance
Pain
Self-care and home management
work, community, and leisure integration or reintegration
Neuromuscular recovery scale
prognosis and goals
Table 20.5
Recovery of walking ability
Box 20.5
Compensation
Recovery of function
PT interventions
Patient-related education
Health and wellness
Activity based UE training
Locomotor training
Orthotics
For pts with motor complete SCI
transfers
Box 20.7
Floor to wheelchair
Sitting balance
Cardiovascular and endurance training
Bed mobility
Supine to long sit
Walking on elbows for long sitting
Supine on elbows
Prone on elbows
Supine to /from sit
Rolling
Strengthening
Motor learning
Precautions
Box 20.6
Prescriptive wheelchair
wheelchair skills
Propulsion on even surfaces
Inclines
wheelies
Neurotechnologies
Neuromodulation
neural prosthesis
neurorehab
neurosensing and diagnostics