Spinal Cord Injury - Part 4 Possible Complications and Precautions, Prognosis and Treatment

Question 1

Heterotopic Ossification - Time frame, Location, Definition and Treatment

Answer 1

Appearing between 1-12 months after lesion (4th month highest).
Periarticular ossification, capsule surrounding joint getting calcified. Joint pain in hip, knees and elbows due to overuse on supporting and stretching.
Prevention is the best treatment!

Question 2

Pressure Ulcer

Answer 2

Patient repositioning very important!

Question 3

Spasticity - Definition, Pathways

Answer 3

Velocity dependent increase in muscle tone (hypertonia). Exaggerated tendon jerks, clonus and spasms.
Lesion of both pyramidal (corticospinal) and extrapyramidal motor pathways.
70-80% of SCI patients develop it.
Different mechanisms underlying spinal spasticity (MN damage) than cortical damage (stroke,TBI).

Question 4

Spinal Spasticity vs Cortical Spasticity

Answer 4

Spinal: results of a neural mechanism: f.ex. enhancement in excitability of motoneurons and interneurons.
Cortical: altered muscle contractile properties, Upper MN syndrome.

Question 5

Behavior and Awareness Deficit (5)

Answer 5

Depression
Aggression
Anxiety
Knowledge deficit about condition and prognosis.
Impaired cognitive function due to CSF reduction, leading to LOC.

Question 6

Other complications (3)

Answer 6

Respiratory: Infection, patient can’t cough.
Deep vein thrombosis
Contractures

Question 7

Precautions Related to Positioning (2)

Answer 7

Lack of sufficient variation can lead to MSK, dermatologic or respiratory complications.
Don’t compromise patients sensory stimulation with positioning.

Question 8

Precautions Related to Transfers SCI (5)

Answer 8

Loss of balance due to inappropriate stabilization or support.
Loss of postural control due to inappropriate use or non- use of key points of control.
Incorrect head control.
Insufficient management of hospital equipment.
Negligence of safety considerations in use of assistive devices.

Question 9

Prognosis - Complete vs Incomplete, Influencing aspects

Answer 9

Only done after shock phase.
Good for incomplete lesions, minimal change for complete lesions.
Influenced by:
- degree of pathological changes
- precaution taken to prevent further damage
- Prevention of additional neurological damage due to hypoxia and hypertension

Question 10

PT Examination (5)

Answer 10

Respiratory Function: resp. muscles, chest wall compliance, cough and breath sounds.
Motor Function: myotomes, muscle tone and spinal reflexes.
Sensory Function: dermatomes
Functional Status: ICF activity and participation.
Cognition: attention, reasoning, orientation and psychiatric conditions.

Question 11

Treatment in Acute Phase (5)

Answer 11

Respiratory management.
Prevention of dermatological, msk and vascular complications.
Facilitation of active movement in available muscles.
Orientation to the vertical position.
Pain relieve, if applicable.

Question 12

Treatment in Active Phase (after spinal shock) (6)

Answer 12

Maximizing function
Development and training compensatory strategies
Transfers
Education about self mobilization and skin inspection
Care giver education from patient
Orthostasis and gait