Complications post SCI

Question 1

autonomic dysreflexia

Answer 1

pathological autonomic reflex
lesions at or above T6, complete or incomplete
pathological reflex from noxious stimuli below LOL
medical emergency

Question 2

autonomic dysreflexia symptoms

Answer 2

HTN, bradycardia, HA, sweating above LOL, increased spasticity, flushing above LOL, nasal congestion/ constricted pupils, goose bumps, blurred vision, anxiety

Question 3

Initiating stimuli for autonomic dysreflexia

Answer 3

bladder distention, rectal distention, tight clothing/ orthotics/ straps, pressure sores, urinary stones, bladder infection

Question 4

Intervention for autonomic dysreflexia KNOW

Answer 4

1. sit pt up
2. search for noxious stim and correct
3. call for help- code
4. monitor BP/ keep head up
5. document event

Question 5

pressure ulcers

Answer 5

85% will develop at least one
can lead to sepsis, osteomyelitis, infection, death
causes: prolonged pressure, shear forces, skin collagen degradation, exposure to moisture, temperature elevation, low blood flow

Question 6

ulcer stages

Answer 6

1. non-blanchable erythema
2. partial thickness- partial loss of dermis, shallow wound
3. full thickness skin loss- may be in subcutaneous
4. full thickness tissue loss- down to ms, tendon, bone

Question 7

most susceptible areas to ulcer

Answer 7

sacrum, coccyx, heel, ischial tuberosity, scapula, malleolus, occiput, SP, under straps

Question 8

ulcer PT tx

Answer 8

prevention- turn pt q 2 hrs, q 10 min with sitting
local wound care
diet- increase protein
surgical management

Question 9

respiratory problems

Answer 9

most common cause of death
reduction in inspiratory/ expiratory ability
ineffective cough
can lead to atelectasis, pneumonia, respiratory insufficienvy

Question 10

contractures

Answer 10

inability to move and ms imbalance, spasticity, habitual posture, can significantly affect function, increase likelihood of skin breakdown
common are: SH ext, elbow FL, wrist FL, knee FL

Question 11

Heterotrophic ossification

Answer 11

deposition of bone in soft tissues around peripheral joints
below LOL
common: hip, knee, SH, elbow
1-6 mo post SCI

Question 12

HO symptoms

Answer 12

joint swelling/ warmth
joint pain? (no sensation)
decrease ROM
differential: thrombosis, cellulitis, infection, hematoma

Question 13

HO Dx

Answer 13

plain film most common
bone scan for early detection, monitor growth
MRI/CT good to determine relationship to blood vessels, nerves in prep for Sx

Question 14

HO Tx- meds

Answer 14

prophylactic- NSAIDs- inhibits osteogenic cells, inhibits post-trauma bone growth by suppressing prostoglandin-mediated response
bisphosphonates- inhibits CA phosphate precipitation

Question 15

HO Sx

Answer 15

1 year following development for SCI
lesion must “mature” or will come back
bone scan to determine metabolic activity

Question 16

HO PT management

Answer 16

ROM- not aggressive, strengthening, post-op: edema control, scar management

Question 17

osteoporosis and Fracture

Answer 17

rapid bone loss in first few months, 25% hip and 50% knee bone loss first 2 years
primarily below LOL
motor complete>incomplete
UE in tetraplegia

Question 18

Fx risk

Answer 18

2x more likely than able-bodied
distal femur/ proximal tibia
associated with increased morbidity
non-union fx site, pressure ulcer, hospital LOS 7x longer with fx

Question 19

Fx causes

Answer 19

fall from WC, weakest in shear and twisting
transfer from WC
rolling over in bed

Question 20

Fx interventions

Answer 20

1. WB exercise- moving treadmill, e-stim biking
acute- dynamic- ms stimulates bone
duration- longer better
not sustained- lose progress if stop
chronic- research shows no effect on osteoporosis
2. low magnitude vibration
3. FES- site specific
4. bisphosphonates
5. anabolic agents (parathyroid hormone)

Question 21

Fx summary

Answer 21

SCI have marked bone loss
more likely to fx with small force
act in acute phase
no rehab intervention has demonstrated complete or sustained recovery of bone loss

Question 22

Pain

Answer 22

traumatic- fx, lig, ms, sx
nerve root- radicular pain
dysesthesias- diffuse no pattern
musculoskeletal- posture, overuse

Question 23

GI

Answer 23

2-22% develop stress ulcers in stomach/duodenum
paralytic ileus
gallstones
hemorrhoids
fecal impaction/ bowel obstruction

Question 24

Urinary tract

Answer 24

urinary retention
kidney/bladder stones
kidney failure
septicemia
increased risk of bladder CA

Question 25

DVT/PE

Answer 25

highest incidence- 72 hrs- 2 weeks
rare in chronic SCI
consequence of decreased ms function and mobility, hypercoagulability
PE- leading cause of death during 1st year

Question 26

CV disease

Answer 26

higher than general population

contributing factors- sedentary lifestyle, increase body fat, lipid abnormalities, altered glucose metabolism, DM

Question 27

syringomyelia

Answer 27

development of abnormal cyst of cavity within spinal cord

Question 28

cause of syringomyelia

Answer 28

unknown, several months- years after SCI
cyst compresses spinal cord
cavity fills with CSF in SC, causing cyst

Question 29

areas of occurrence- syringomyelia

Answer 29

most common- lower cervical
brainstem- syringobulbia- dysarthria, nystagmus, ataxia
lumbosacral segments- B&B problems

Question 30

Syringomyelia Tx

Answer 30

neurosurgery

drain cavity, place shunt to drain CSF

Question 31

Effects of aging

Answer 31

incidence of pressure ulcers increases
increased risk respiratory complications
increased incidence sleep apnea
urinary tract complications
GI- constipation, hemorrhoids