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Spinal Cord Injury

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by

Justin Villamayor

on 4 October 2013

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Transcript of Spinal Cord Injury

"HUB"
Spinal Cord Injury
C1: Little or no sensation of head and neck, no diaphragm control; requires continuous ventilation. Requires voice or sip n puff electric wheelchair.
C2-C3: Little head & neck sensation; independent of mechanical ventilation for short periods
C4: Good head & neck sensation
and motor control; some shoulder
elevation; diaphragm movement.
C5: Full head and neck control; shoulder strength; elbow flexion.
C6: Fully innervated shoulder; wrist extension or dorsiflexion.
C7-C8: Full elbow extension; wrist plantar flexion; some finger control.
S1-S5: Full leg, foot, and ankle control; innervation or perineal muscles for bowel, bladder, and sexual function (S2-S4)
T11
-L5: Hip flexors, hip abductors (L1-L3); knee extension (L1-L4); knee flexion and ankle dorsiflexion (L4-L5).
T6-10: Abdominal muscle control, partial good balance with trunk muscles.
T1-T5: Full hand and finger control; use of intercostals and thoracic muscles.
Spinal Injury C1-C8
Almost 200,000 people in the US live each day with a disability from SCI.
Estimated 11,000 new injuries occur each year.
Primarily an injury of young adult males and
50% of those injured are between 16-30 years of
age.
-MVA 48%
-Gunshot Wounds 23%
-Falls 23%
-Recreational Activities 9%


Enhancing Coping Mechanisms


Counseling on Sexual Expression


Preventing Disuse Syndrome

Promoting Skin
Integrity
Increasing Mobility

Exercise Programs

Mobilization
Nursing Care In Rehab
Improving Bladder Management

Establishing Bowel Control
Cyclical process that includes assessment, establishment of goals and collaborative plan to work towards:
Rehabilitation is a creative, dynamic process that requires a team of professionals that represent a variety of disciplines which includes:
High dose IV corticosteroid
Breathing

Motor Ability
Sensation
Skeletal Traction
Acute Phase
Rehabilitation Phase
The Rehabilitation Team
Physician
Social Workers
Nurse
Physical Therapist
Occupational Therapist
Speech Therapist
Orthotists & Prosthetists
A client is being discharged home on a Halo Traction after a SCI. Which one of the patient statements indicate a need for further teaching?

A) I will make sure to report signs of redness, drainage, or loosening of the pins.
B) I am allowed to open the vest to wash my torso.
C) I can apply powder on my skin to prevent dryness.
D) I will make sure to perform pin care daily.
A 29 year old male comes into the ED after a motor vehicle accident. Recent X-Ray has shown a spinal fracture at the cervical site. What would the nurse assess first?

A) Neurologic Status
B) Gag Reflex
C) Breathing Pattern
D) Rhomberg's Test
NCLEX Question #1
NCLEX question #2
Goals:
Spinal Cord Injury
Provides physician-directed rehabilitation programs in its acute-care hospital, transitional living, residential, outpatient, specialized clinics, children's services and community programs, such as the Outdoor Adventures program which provides more than 150 days of trips annually to persons with disabilities.
Spinal Cord Injury Hospitals
& Rehabilitation Centers
California
The program focuses on understanding the effects and complications of spinal cord injury:
Neurogenic Bowel & Bladder
Sexuality & Fertility enhancement
Self-Care: prevent skin breakdown, bed mobility, transfers, driving with adaptive equipment.
Other areas of focus include vocational assessment, training, and re-entry into employment and the community
Spinal Cord Injury Rehab
Long Term needs depend on the severity of the injury and the degree of the affected areas.
GOAL: Enhance Quality of Life, and provide maximal independence.
Long Term needs of the SCI patient
SCI Center: "PROJECT WALK"
HUB
"Sp ke"
Ambulatory Devices:
Wheelchair
Canes, Crutches, Walkers
Ramps in the entrance
Accessible Shower
Bionic Legs
The Home Setting

"Brain Control Interface"
Communication

Everyone clear your desk and put your books away, it's time for a Pop-Quiz
Provides comprehensive medical rehabilitation services, for both outpatient and inpatient care, to empower people with disabilities to achieve optimal quality of life. For more than 50 years, the not-for-profit facility (formerly known as Rehabilitation Institute of Santa Barbara) has been recognized for excellence, innovation and excellent outcomes of care.
Serves individuals who have had brain injuries or spinal cord injuries by providing information, education, and support for injured persons and their families.
Recognized for innovative and advanced contributions in managing patients with spinal cord injuries consistently earning the distinction of being the only Regional Spinal Cord Injury Care System of Southern California. It is the only rehab center in California ranked in the top ten in America by U.S. News & World Report.

"Project Walk" Spinal Cord Injury and Recovery
http://www.projectwalk.org/current-research-projects/
Stanford hospital & Clinics
Uses a team approach committed to rehabilitation, patient care, research and education. Rehabiliatation services include physical, occupational, speech and recreational therapy divisions. Ranked as a top rehabiliation hospital by U.S. News & World Report
Casa Colina Centers for Rehabilitation
Cottage Rehabilitation Hospital
Rancho Los Amigos National Rehabilitation Center
Santa Clara Valley Medical Center
long term complications:
Infection
Sepsis
long term complications:
Spasticity
A. Signs of redness, drainage, or loosening of the skin can be indicative of infection. Notifying your HCP is an appropriate intervention.
B. The vest may be opened from the sides to perform care of the torso.
C. Applying powder in between the skeletal traction and the skin can cause 'caking'. Resulting in skin breakdown or a fungal infection.
D. Pin Care must be performed daily to prevent infection of the wound site.
A. Assessing the Neurologic status of the patient is not priority at this time and may be done at a later time when the patient has stabilized.
B. Checking for Gag reflex is not a priority and may be done before the patient starts feeding by mouth.
C. Breathing is the priority assessment as this time. Injury at the cervical portion of the spine is frequently associated with inadequate ventilation.
D. Rhomberg's Test is used to assess the patient's balance. That is not a priority assessment at this time.
NCLEX Question #2
Doctor
Nurses
SCI Primary care teams
Prevent secondary injury, observe for symptoms of progressive neurologic deficits, and prevent complications.
Treatments:
Social Worker
Home Health aids
Psychiatrists
http://www.projectwalk.org/
Maximize Independence
Preventing long term complication
Social Needs
Social Services- helps the SCI patient to understand the overall system of care

DESIGN:

"HUB and SPOKE"
Full transcript