Prevention of Secondary Changes

Question 1

Types of secondary changes

Answer 1

Pressure lesions 
Musculoskeletal changes
Adaptive motor behaviours 
Learned non-use 
Subluxation/joint malalignment 
Pain 
Physical deconditioning 
Depression and insomnia 
Late effects of disability

Question 2

Pressure Lesions

Answer 2

develop from pressure and shear forces
Stage 1 - redness
Stage 2 - redness and superficial skin damage
Stage 3 - ulcer develops damages soft tissues
Stage 4 - ulcer goes deeper and affects bone tissue

Question 3

Musculoskeletal Changes

Answer 3

• increased thixotropy
• muscle atrophy
• increased fat content
• reduced bone density
• adaptive changes in muscle fibre profile
• muscle contracture

Question 4

Adaptive motor behaviours

Answer 4

• compensatory movements by using remaining voluntary muscle movement
  results in further loss of normal movement

Question 5

learned non-use

Answer 5

any unsuccessful motor attempts result in negative feedback. Any successful motor attempts result in positive feedback.
Continued reduced movement of affected side = contraction of cortical representation zones
All results in non-use

Question 6

Subluxation/Joint Malalignment

Answer 6

Most commonly affected the GHJ

• surrounding muscle paralysis
• effect of gravity
• poor UL positioning due to flaccidity
• poor UL self care
• poor handling by carers

Results in…

• pain
• soft tissue management
• adaptive soft tissue shortening
• joint restriction
• joint dysfunction
• hygeine issues

Question 7

Physical deconditioning

Answer 7

reduced CV fitness
increased muscle fatiguability
immobility quickly results in de-conditioning - need to get them moving
important for participation in rehabilitation

Question 8

Depression and insomnia

Answer 8

loss of function
can compound cognitive function and participation
may have an excessive desire to sleep
need help from other HCP

Question 9

Late effects of disability

Answer 9

Consequence of muscle imbalance, joint malalignment and compensation
Results in long term issues

Question 10

Prevention of Secondary Changes

Answer 10

Anticipate and prevent contracutre
Wheelchair prescription 
Provide opportunities for early usccess
Encourage use of the affected side 
Utilise motor learning principles 
Maintain and improve physical fitness
Prevent and manage pain