Spinal Cord Injury Flashcards
SCI
most often results from trauma including MVA, GSW, stab wound, falls, diving accidents,
secondary injury from disease including ALS, MS, Myelomeningocele, cancer, syringomyelia
Zone of Partial Preservation
refers to complete injury that have some innervations of dermatomes below level of injury. strengthening in this area may drastically improve functional performance
Spinal Shock
Initial stages of an SCI that may last between 24 hours and 6 weeks. Reflex activity ceases below level of injury and results in spasticity
C 1-4
- Medical Management: respiratory assistance required complete assistance for personal and domestic care
- Movement: limited head and neck movement; tetraplegia
- Nervous System: sympathetic nervous system compromised, possible autonomic dysreflexia, no bowl or bladder control
- Mobility: electric WC w/ sip n puff possible
C 5
- Medical Management: low stamina, has breathing with diaphragm, complete assistance for personal and domestic care
- Movement: full head and neck, ability to raise arms and flex elbows (no extn)
- Nervous System:sympathetic nervous system compromised, possible autonomic dysreflexia, no bowl or bladder control
- Mobility: electric WC w/ hand controls
C 6
- Medical Management: low stamina, can breathe with diaphragm, moderate assistance required
- Movement: full head and neck, ability to raise arms and flex elbows (no extn); some wrist extn
- Nervous System: little bowl or bladder control
- Mobility: electric WC w/ hand controls, manual wc for short distances, way drive w/ hand controls
C 7
- Medical Management: low stamina, breathing with diaphragm limited assistance personal care, partial assistance for heavy duty domestic care
- Movement: full head neck, ability to raise arms and flex/extend elbows, wrist flexion and extn, partial finger movement
- Nervous System: little bowl or bladder control
- Mobility: independent transfers, electric wc w/ hand controls, manual wc for short distances, may drive w hand controls
C 8
- Medical Management: low stamina, breathing with diaphragm, primarily independent w/ partial assistance for heavy duty home care
- Movement: full head and neck, ability to raise arms and flex/ext elbows, wrist flex/ext, partial finger movement
- Nervous System: little bowl or bladder control
- Mobility: independent trasnfers, electric wc w/ hand controls, manual chair for short distances, may drive with hand controls
T1 - T5
- Medical Management: respiratory capacity and endurance may be compromised independent in personal care, partial heavy duty assistance
- Movement: normal UE ROM / strength
- Nervous System: little bowl or bladder control
- Mobility: independent trasnfers, may use manual chair or may stand in standing frame or walk with braces may drive with hand controls
T6 - T12
- Medical Management: respiration and endurance may be compromised, independent in personal care, partial heavy duty assistance
- Movement: Normal UE rom/strength
- Nervous System: little bowl or bladder control
- Mobility: independent trasnfers, may use manual chair, may walk with braces, may drive with hand controls
L1 - L5
- Medical Management: respiration and endurance may be compromised, independent in personal care, partial heavy duty assistance
- Movement: Normal UE rom/strength and partial paralysis in hips and legs
- Nervous System: little bowl or bladder control
- Mobility: independent trasnfers, may use manual chair, may walk with braces, may drive with hand controls
S1 - S5
- Medical Management: respiration and endurance may be compromised, independent in personal care, partial heavy duty assistance
- Movement: Normal UE rom/strength and some loss of function in hips and legs
- Nervous System: little bowl or bladder control
- Mobility: independent trasnfers, likely able to walk with assistance or aids, though slowly and with difficulty, may drive with hand controls and load WC into car independently
Prognosis
depends on if complete or incomplete. if sensation or motor function return below level of injury does not occur in 24-48 hours motor function is less likely to return. Most recovery occurs within first three months
Implications for therapy
- sensory loss increases risk of skin breakdown
- decreased vital capacity can influence treatment sessions
- orthostatic hypotension can be addressed by positioning in supine and elevating feet above heart. must use caution during transfers
- autonomic dysreflexia may be addressed by standing a client up so that blood pressure drops or by loosening clothing or by checking catheter
- spasticity may be addressed through medical intervention and may lead to functional impairments and contractures
- heterotrophic ossification may be controlled through proper positioning
- DVT lookout by inspecting for asymmetry of color, size or temperature
- temperature regulation is often affected
- pain may be nociceptive (muscle overuse) or nuropathic (noxious sensation below level of injury)
- Fatigue
- Sexual function may be affected
OT Evaluation
Top-Down beginning with occupational profile and then assessment of occupational psycho social needs.
Evaluate medical precautions including movement and load
ROM/strength, tone, sensation, trunk balance, MMT, endurance, fatigue, pain
evaluation of hand and wrist function
Specific Assessments (Spinal Cord Independence Measure, Quadriplegia Index of Function, FIM, COPM)
OT Intervention
designed around cooperative goals determined by client and family, OT, team members. goals centered around performance areas and underlying problems that hinder functional performance
Intervention: Acute Recovery Phase
often in ICU, sessions are short and usually limited to 15 minutes
- client family support and education
- allowing environmental control for the client
- maintaining normal UE ROM done through exercises and positioning/splinting
- facilitating tenodesis grasp for clients with tetroplegia. splints should be dorsal and support the wrist in extension and thumb in opposition
- ongoing evaluation for sitting up and ADL training
- possible evaluation of swallowing ability
Intervention: Acute Rehabilitation Phase
providing education and support and helpingthe client find meaningful activities that restore a sense of self-efficacy and self-esteem
- education and training in self care
- caregiver training in ROM, positioning, pressure relief, ADL assistance, equipment use
- occupational performance interventions to train the client to perform many ADLs.. mix in need and want
- selection and training in use of equipment
- physical interventions related to lower cervical injury.. UE ROM, strengthening, bed and WC positioning, splinting (C5 may benefit from mobile arm support, universal cuff or c-clamp; C6/7 can use tenodesis for grasp)
- psycho social adaptation
Intervention: Transition Rehabilitation Phase
phase may involve outpatient occupational therapy services if the client has been unable to achieve optimal outcomes int he acute rehabilitation phase. The focus of interventions in this phase is to max strength gains in the first year post injury. continued training in the use of adaptive devices and consideration of the use of other equipment are also important
