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Long term issues in spinal cord injury
- 1. Long term issues in Spinal Cord Injury Dr. Mahima Agrawal
- 2. • Complete injury: People with no sensory or motor function below the level of spinal cord injury around the anal area (S4 and S5) • Incomplete injury: Preservation of some function below the level of spinal cord injury Types of injury
- 3. • Paraplegia: Injury to thoracic, lumbar or sacral segments of the spinal cord • Quadriplegia: Injury to the cervical segments of the spinal cord i.e. between C1 and T1 Types of injury
- 4. Limitation Mobility Self care Domestic activities Education Employment Social relationship Leisure
- 5. Level and Problem list
- 6. C1-C4 Breathing Head and Neck movement C4-T1 Heart rate control Upper Limb movement T1-T12 Trunk control Temperature regulation Abdominal muscles L1-S1 Lower limb movement S2-S4/S5 Bowel, Bladder and Sexual function
- 8. Triggers - any noxious stimulus (most commonly distended / blocked bowel or bladder) • Heavy sweating • Severe headache • Reddened skin • Blurred vision • Body hair standing • Cardiac arrhythmias Sudden increase in blood pressure Seen in individuals with SCI at or above T6level Autonomic dysreflexia
- 9. Most common in acute and sub acute phase But can occur any time Most common cause – long term immobility • Pain • Swelling • Tenderness • Skin discoloration • Warmth Risk factors – • Age • Obesity • Lower limb fractures • Pregnancy • Previous history of DVT Preventive measures: • Anti coagulants • Wearing compression stockings !!Can lead to pulmonary embolism Deep venous thrombosis
- 10. • Fatigue • Light headedness • Dizziness • Blurred vision • Muscle weakness • Temporary loss of consciousness !!! Sudden drop in blood pressure When a person moves from lying to sitting/standing position Orthostatic hypotension
- 11. Urinary tract infections Signs and symptoms • Episodes of incontinence • Painful urination • Increase in spasticity • Neuropathic pain • Autonomic dysreflexia • Fever • Malaise • LethargyMethods of bladder emptying- • Intermittent cathetarization • Indwelling cathetarization • Other methods Bladder overdistention, reflux, high-pressure voiding, large postvoiding residual volume, stones, and outlet obstruction Faulty, unsterile technique
- 12. Bladder Diary
- 13. PROBLEMS • Poor colonic motility • Chronic constipation • Abdominal distension • Prolonged bowel transit time • Faecal incontinence Gastrointestinal system SOLUTIONS Proper nutritional and fluid intake Dietary supplements and oral medications when needed Appropriate methods to assist defecation (physical techniques and stimulants such as laxatives, suppositories and enema) Surgery to form a stoma
- 14. There is increased stiffness of the limbs and it is difficult to move through the range of motion Spasticity Can lead to • Disabling contractures • Involuntary movements • Weakness • Fatigue • Difficulty in sleeping because of painful spasms • Difficulty with maintaining hygiene Physical therapy - exercise, stretching, and joint movements Casting or bracing Medications orally or by injection to affected muscle groups (Botox) or “intrathecally” Surgical options
- 15. Loss of bone mass immediately following SCI Sublesional osteoporosis Can lead to fractures during trivial falls, transfers Further morbidity Risk factors -Old age, use of steroids, calcium and vitamin D deficiency Management • PREVENT!!! – Drugs, care during transfers, diet • If fracture occurs, splints, immobilization, surgery
- 16. Heterotrophic ossification Formation of bone in soft tissue leading to loss of range of motion of that particular joint Most commonly affected joints: Hip, Knee, shoulder, Elbows Management • Avoid ROM • Drugs – bisphosphonates, Anti inflammatory drugs • Surgery
- 17. Respiratory system • Pneumonia • Atelectasis • Aspiration • Respiratory failure Lung capacity, ease of breathing and ability to cough and clear secretions are often compromised following a SCI Management • Annual influenza vaccine • Five yearly pneumcoccal vaccine • Prompt treatment of respiratory tract infections with anti biotics • Yearly implementation of assisted coughing for people with high level SCI
- 18. • Weight transfers • Proper bed positioning, wheelchair sitting Pressure ulcers Management • Regular skin checks • Pressure relieving methods • Adequate bladder and bowel care • Appropriate assistive devices • Good nutrition • Surgery PREVENT!!!!
- 19. • Reduces the quality of life Pain – neuropathic/musculoskeletal Management • Drugs Others- • Physical therapy • Working with a counselor
- 20. Problems • Decrease or loss of sensation, difficulties in achieving orgasm • Difficulties in moving and positioning • Lowered self esteem and confidence • In men, partial or complete impairment of penile erection and ejaculation • Female menstruation may be impaired Sexual dysfunction Respectful discussion at the appropriate time with both individual and partner Medical care and rehabilitation relevant to the individual Provision of education and information on positioning and preparation for sexual activity, birth control, prevention of STDs Assistive devices for arousal or to enhance positioning Treatment of erectile dysfunction in men( vibratory stimulation, oral medications, penile injections, vacuum devices, penile implants Assisted fertility
- 21. Levels and Functional outcomes
- 22. C1-C4 Bathing Weight shifts Driving Wheelchair propulsion Independent with power wheelchair Feeding Grooming UE Dressing LE Dressing Bed Mobility Transfers Dependent
- 23. C5 Bathing Driving Feeding Grooming UE Dressing LE Dressing Bed Mobility Assistance needed Transfers Weight shiftsWheelchair propulsion Independent with power wheelchair
- 24. C6 Bathing Driving Feeding Grooming UE Dressing LE Dressing Bed Mobility Assistance needed Transfers Independant Weight shiftsWheelchair propulsion Independent with power wheelchair
- 25. C7 Driving Feeding Grooming UE Dressing LE Dressing Bed Mobility Transfers Independant Independant Assistance needed Bathing
- 26. C8-T1 Driving Feeding Grooming UE Dressing Bed Mobility Transfers Independant Independant Bathing LE Dressing Independent with adaptation
- 27. Bathing Driving Feeding Grooming UE Dressing LE Dressing Bed Mobility Transfers INDEPENDANT Bowel and Bladder T2-T9 T10-L2 L3-S5 AMBULATION Therapeutic standing Household ambulation Community ambulation
- 28. Thank you
Editor's Notes
- Insert details from figure 1.1
- Add management