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Spinal Cord Injury Precautions

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by lauren hutchins on 11 December 2012

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Transcript of Spinal Cord Injury Precautions

Spinal Cord Injury Precautions Skin Breakdown Vital Capacity Osteoporosis Treatment Considerations
Nutrition education
Safety precautions when planning interventions
Daily standing with standing frame
Controversial
Has to be appropriate for a home program
Not always covered by insurance Caused by increased pressure in one area resulting in decreased blood supply
Increased chance due to sensory loss
Heat and shear force can damage tissue
Bony prominences are most likely to be damaged Signs to Look For Stages
Red areas
Blanching =early stages
No blanching=necrosis has begun
Blister or ulcer present Prevention Eliminate pressure points
cushions
routine turning
checking splints or orthoses Skin damage can develop within 30 minutes Common with cervical and high thoracic damage
Limited chest expansion

Complications:
Increased chance for respiratory infections
Decreased endurance

Improving Vital Capacity
Assisted breathing
Deep breathing exercises
Respiratory therapy
Strengthening sternocleidomastoid and diaphragm

Other Considerations for therapy:
Hand hygiene
Risk for HAI's Physiology Review:
Defined as low bone mass
Peak bone mass occurs at around age 25
A combination of nutrition (Ca and Vitamin D), exercise, and general health help in achieving maximum peak bone mass
Immobilization can contribute to osteoporosis
Persons with SCI's are likely to develop
Can reach advanced stages within one year of SCI
Pathological fractures common in tibia and femur and not common in UE Heterotropic Ossification (ectopic bone) Pathological formation of bone around joints
Often at hip, knee, and shoulder
Symptoms:
Swelling, warmth, decrease ROM
Treatment:
Medications, maintenance of joint ROM in early stages
Goal is to preserve biomechanics to promote correct wheelchair posture. Heterotropic Ossification If left untreated or functional ROM is not preserved:
Poor biomechanical sitting posture
trunk deformities
skin break down Orthostatic Hypotension Sudden decrease in BP when patient changes positions to quickly (usually supine to sitting)
Common with T6 and higher lesions
Blood pools in areas of decreased muscle tone causing hypotension
Symptoms:
dizziness, nausea, loss of consciousness
Treatment:
May diminish with time as sitting tolerance and endurance increase
Recline quickly:
lay patient back down or tip wheelchair back
OT Considerations:
Move patients slowly when going from supine to sit
Consider decreased endurance and sitting tolerance during treatment planning
Check blood pressure Autonomic Dysreflexia Sudden increase in BP
Can be life threatening
Associated with lesions above the T6 level
Caused by a reflex action of the ANS in response to a noxious stimuli
Symptoms:
hypertension, headache, anxiety, perspiration, chills, bradycardia, flushing
Treatment:
Do not leave client alone
Place patient in an upright position, remove anything restrictive, loosen clothing
Bladder should be drained or check tubing for obstruction
Monitor BP Spasticity Present in almost all SCI's
Changes over time:
Increase during the first 6 months and plateau at approximately one year
A sudden increase can be a sign of another medical problem such as bladder infection or skin breakdown
Treatment:
Muscle relaxant or nerve block
OT Treatments:
Prevent contractures
Positioning
ROM Exercises
E-stim Temperature Regulation
Hypothermia
Heat exhaustion
Decreased sensation
Frostbite or sunburn
Pain
Acute or chronic
3 classifications
Mechanical
Radicular
Neuropathic
May impact occupations, limit activities, and lead to decreased participation Other Complications Other Complications Fatigue
Depression
Deep Vein Thrombosis (DVT)
Monitor for asymmetry in the lower extremities in relation to size, color, and temperature
Decreased Sexual Function
OT's can provide resources and information for patients
Discuss options for patient and his/her partner Additional Resources National Spinal Cord Injury Association
http://www.spinalcord.org/

National Institute of Neurologic Disorders and Stroke
http://www.ninds.nih.gov/disorders/sci/sci.htm

UAB Spinal Cord Injury
http://www.uab.edu/medicine/sci/home Evans, C., LaVela, S., Weaver, F., Priebe, M., Sandford, P., Niemiec, P., & ... Parada, J. (2008). Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infection Control & Hospital Epidemiology, 29(3), 234-242.
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