Paraplegia Flashcards
What are the charachteristics of paraplegia?
When the level of injury is low enough in the spinal cord that it no longer affects the UE’s, just trunk and LE involvement
At what spinal level are you at risk for autonomic dysreflexia?
T6
What are some cardio system considerations for someone with paraplegia?
DVT/PE
Low BP
What are some pulmonary considerations for someone with paraplegia?
Decreased use of thoracic mm’s for respiration (depending on level)
What are some MSK considerations for someone with paraplegia?
Weakness/paralysis
HO
Osteoporosis
What are some neuro considerations for someone with paraplegia?
Sensation changes
Neuropathic pain
Tone/spasticity/UMN above T12
What are some integumentary system considerations for someone with paraplegia?
Pressure injuries
What are some GI/GU system considerations for someone with paraplegia?
Hyper (above T12) reflexive bowel/bladder
Hypo (below T12) flaccid bowel/bladder
What are the components for motor complete UMN injury?
Above T12
No function of LE’s or trunk below level of injury
May have hyperreflexia, tone, clonus
ASIA A (sensory and motor complete)
ASIA B (motor complete, sensory incomplete)
Bowel, bladder, sex, reflexive
What PROM interventions would you perform for someone who has a motor complete UMN injury in acute care?
Maintain muscle length for functional mobility
Prevent contractures
What type of positioning considerations would you perform for someone with a motor complete UMN injury in acute care?
-Prevent pressure injuries
-Should be on air mattress
-HOB should never exceed 30 due to shear on sacrum
-Use tilt-in-space wheelchair (TISWC) when initially getting up –> for WS
-WS patient every 15 min for 2 minutes when in a chair for the first time
What are the considerations for upright trials in a tilt-in-space?
Get patient up in TISWC for timed trials
Use mechanical lifts
Start at 15 minutes, progress by 15 minutes each session until patient can sit for one hour with no adverse events
Check skin pre and post
-Check for incontinence of bowel
-Check vitals every 15 minutes, especially if above T6 (if dropping, use an abdominal binder and ted hose to regular or lift)
-Tilt every 15 minutes for 2 minutes while up
What are some types of interventions in acute care to initiate functional mobility training?
-Short sit balance
-Long sit balance
-Bed mobility (rolling)
-Scooting
-Educate on head hip relationship
What are the POC/Discharge planning consideration for acute care with someone with a motor complete UMN injury?
Depends on severity
Other comorbidities
Previous mobility level
Medical level
Insurance
Bed availability motor complete UMN injury in acute care
How many weeks would a pateint benefit from avute care rehab?
4 to 12 weeks
If patients do not have the tolerance for being discharged home, what setting do they go to next
Subacute rehab
What are intervention components for outpatient PT for someone with a motor complete UMN injury?
Education
Mechanics for any functional mobility problems
Strengthening, efficiency with mobility, overall aerobic health training
Prevention of secondary complication
W/c changes as needed
Return to sport or work training
What is a motor incomplete UMN injury?
-Like motor complete, but you may have some muscle groups below the level of injury that are starting to return
-They may be able to (walk, use LE’s to assist in all functional task, may also have better bowel and bladder control)
-ASIA C and D
What are interventions for someone with motor incomplete UMN injury in acute care?
Depends on the ASIA and how many muscle groups are functioning against gravity below level of injury
What are the components of an incomplete LMN injury?
Below T12
Conus medularis and below
Will have a mixed/LMN/incomplete presentation becasue the nerve start spreading out from the cord there
Flaccid paresis
Flaccid bowel and bladder below this level (completely different management strategies
