SCI Complications

Question 1

Define heterotopic ossification

Answer 1

Bone (not just calcium) in soft tissue near the joint.

Question 2

When does a heterotopic ossification happen?

Answer 2

Occurs in paralyzed part of the body with SCI, TBI.

Question 3

With a SCI, __________ are the most common site of HO.

Answer 3

Hips

Question 4

With a TBI, _________ are the most common site of HO.

Answer 4

Elbows (hemi side)

Question 5

HO grows ____ times faster than normal bone.

Answer 5

3 times faster

Question 6

What is the incidence rate for HO with SCI or TBI?

Answer 6

20%

Question 7

When does HO typically onset after injury?

Answer 7

1-3 months

Question 8

What fraction of patients with HO experience symptoms vs no symptoms?

Answer 8

1/3 experience symptoms
2/3 no symptoms

Question 9

Two major symptoms of HO:

Answer 9

Loss of ROM
Inflammation of the limb

Question 10

What do you always need to do first when you suspect HO?

Answer 10

check for DVT

Question 11

T/F Xray can usually catch HO early on.

Answer 11

False. Often misses HO in early stages

Question 12

With osteoporosis, males lose ____% of bone density.

Answer 12

33%

Question 13

With osteoporosis, females lose ____% of bone density.

Answer 13

40%

Question 14

Two causes of osteoporosis:

Answer 14

Lack of weight bearing

Abnormal autonomic nerve signals to the bone in paralyzed part of the body.

Question 15

Five things to consider when treating osteoporosis:

Answer 15

Don’t overtreat spasticity (help with bone density)

Bisphosphonates (inhibit osteoclast activity)

Early standing program using standing frames (30 min a day)

Calcium and vit D

Get X-ray for any bruises or swelling as it could be a fracture.

Question 16

What persons with SCI experience spasticity?

Answer 16

65-78%

Question 17

In what percent of people who experience spasticity is it problematic?

Answer 17

28-43%

Question 18

What percentage of people who experience spasticity need medication?

Answer 18

43-49%

Question 19

Is spasticity more common in complete or incomplete SCI?

Answer 19

incomplete

Question 20

Is spasticity more common in Tetraplegic or paraplegic cases?

Answer 20

Tetraplegic

Question 21

Is spasticity more common in the arms or the legs?

Answer 21

Legs

Question 22

Is flexion spasticity more or less common than extensor spasticity?

Answer 22

Extension is more common

Question 23

Medications for spasticity (5):

Answer 23

Baclofen, Tizanidine, Clonidine, Dantrolene, Clonazepam

Question 24

What injection can help with spasticity? How often?

Answer 24

Botox every 3 months

Question 25

What implant can help with spasticity?

Answer 25

Intrathecal baclofen pump (micro doses directly to spinal cord).

Question 26

What modality can help reduce spasticity? What do you need to consider?

Answer 26

E-stim.

Short lived benefits. Some can have increased spasticity. Worth trying but may not be good fit depending on individual.