Transcript: - Falls 21% - Sports related 6% Top causes - Violence 28% Definition: - Vehicular accidents 39% Spinal cord injury - Other 8% An injury to the spinal cord caused by trauma. symptoms vary depending on where the nerve roots are damaged. some symptoms are pain but in worse cases, paralysis to incontinence
Transcript: (Atchison & Dirette, 2012) Levels (Quadripeliga Motor vehicle accidents: Leading cause of spinal cord injury in the U.S with more than 35 percent of new spinal cord injuries each year. Falls: Cause more than one-quarter of spinal cord injuries. Acts of violence: Around 15 percent of spinal cord injuries result from violent encounters, Including: Gunshot & Knife wounds. Sports injuries: Cause about 9 percent of spinal cord injuries. Alcohol: A factor in about 1 out of every 4 spinal cord injuries. Diseases: Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries. OT after a Spinal Cord Injury Atchison, B., & Dirette, D. K. (2012). Spinal cord injury. In Conditions in occupational therapy: Effect on occupational performance (4th ed., pp. 257-283). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. ("Levels of Function in Spinal Cord Injury," 2008) Maintain or increase joint ROM Prevent deformity Increase strength of all innervated & partially innervated muscles. Increase physical endurance. Maximize independence in all aspects. Aid in the psychosocial adjustment to disability. Evaluate, recommend, and train the patient in the proper use of adaptive equipment. Ensure safety in the home & environment. (Early,2013) Loss of movement. Loss of sensation, including the ability to feel heat, cold and touch. Loss of bowel or bladder control. Exaggerated reflex activities or spasms. Changes in sexual function, sexual sensitivity and fertility. Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord. Difficulty breathing, coughing or clearing secretions from your lungs. (“Levels of Injury-Understanding Spinal Cord Injury,” 2016) Levels (Parapeligia) Quadriplegia (“Living with a Spinal Cord Injury,” 2015) Thoracic: Innervation & function of all UE muscles, including hand muscles. (Early,2013) Levels of Function (McKinley, 2015) Spinal Cord Injury References Posttraumatic Complications What is Spinal Cord Injury? Decubitus Ulcers Decreased Vital Capacity Osteoporosis Orthostatic Hypotension Autonomic Dysreflexia Spasticity Heterotopic Ossification S. (2016). Levels of injury - understanding spinal cord injury. Retrieved March 28, 2016, from http://www.spinalinjury101.org/details/levels-of-injury Complete vs. Incomplete High Cervical Nerves ( C1-C4) Arms, hands, trunk & legs are affected. Most severe of the spinal cord injury levels. Patients may not be able to breath on their own, cough, or control bowel or bladder movements. Reduced or impaired ability to speak. Also known as Tetraplegia. Requires complete assistance with ADLs. May be able to use a power chair with special controls to move around on their own. C8: Functional finger flexion. SCI in the United States are estimated at 40 cases a year. (excluding those that are dead at the scene). 12,000 new cases of SCI every year. 80 % of persons who sustain a spinal cord injury are males. Thoracic Nerves (T1-T12) Arm & hand function is usually normal. Usually affect the trunk & legs. Most likely can use a manual wheelchair. Can learn to drive a modified car. Some can stand in a standing frame Others may be able to walk with a brace. ("Spinal Cord Injury", 2014) Signs & Symptoms Paraplegia ("Living with Spinal Cord Injury," 2014) ("Occupational Therapy Practice: Physical Rehabilitation," 2012) Incidence M. (2014, October 08). Spinal cord injury. Retrieved March 28, 2016, from http://www.mayoclinic.org/ diseases-conditions/spinal-cord-injury/basics/definition/con-20023837 Prevalence McKinley, W. (2015, July 27). Functional outcomes per level of spinal cord injury. Retrieved April 13, 2016, from http://emedicine.medscape.com/article/322604-overview#a7 Complications with Spinal Cord Injury Complete: If all sensory function and all ability to control motor function are lost below the spinal cord injury. C1-C4: Little or no movement of upper & lower extremity muscles Damage to any part of the spinal cord or nerves at the end of the spinal canal; often causes permanent changes in strength, sensation and other body functions below the site of the injury. Nicole Connelly April 25, 2016 No way to reverse a spinal cord injury Medications: IV Methylprednisolone: If given within eight hours of the injury it will help by reducing damage to nerve cells and decreasing inflammation near the site of injury. Surgery: To remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Also may be needed to stabilize the spine to prevent future pain or deformity. Experimental Treatments: Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. (“Levels of Injury-Understanding Spinal Cord Injury,” 2016) Quadriplegia and quadriplegic. (2015). Retrieved March 28, 2016, from http://www.apparelyzed.com/quadriplegia-quadriplegic.html OT & Spinal Cord Injury (“Levels of Injury-Understanding
Transcript: Spinal Cord Injury Inclusion Program Description of the Disability Medical and Health Care Needs Spinal cord injury is defined as damage to the spinal cord as a result of a direct injury or trauma or damage that is the result of an existing disease in the surrounding bone or tissue. There are different levels of severity of spinal cord injury, the higher the injury is along the spinal cord, the more severe the damage is and the less function the person will have. If the injury is lower on the spinal cord they will have more function and mobility. Spinal cord trauma can include “assault, falls, gunshot wounds, industrial accidents, motor vehicle accidents, and sports injuries (particularly diving in shallow water)” (Spinal cord trauma). These types of trauma usually occur in young healthy people who are participating in high risk, and often dangerous activities. “Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy axons -- extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis” (Spinal cord information). The type of injury and the location of the damage along the spinal cord will determine the level of function that the person has as well as how much of the lost function they will be able to regain. There are 5 sections of the spinal cord. The cervical spine or the neck, thoracic or upper back, lumber or lower back, and the sacral and coccygeal regions. SCI that occur at the cervical spine will be more severe and cause more loss of function than an injury that occurs at the lumbar spine. There are different types of spinal cord injuries such as quadriplegic and paraplegic. Quadriplegia affects all four limbs and paraplegia usually only affects two limbs. Quadriplegics often have little to no trunk control whereas paraplegics may have total or partial trunk control. There are two different sets of symptoms associated with spinal cord injuries, symptoms that are representative of a newly acquired spinal cord injury and symptoms that are secondary to the injury itself. Symptoms that occur after an accident or trauma that may indicate a spinal cord injury include “extreme back pain or pressure in your neck, head or back, weakness, incoordination or paralysis in any part of your body, numbness, tingling or loss of sensation in your hands, fingers, feet or toes, loss of bladder or bowel control, difficulty with balance and walking, impaired breathing after injury, and an oddly positioned or twisted neck or back” (Spinal cord injury-symptoms). Anyone that suffers an injury to the back or neck should seek medical attention immediately because spinal cord injuries may not be noticeable immediately after the accident. The time between when the injury occurs and when treatment begins is crucial to having the opportunity to regain lost function. The symptoms that are a result of a spinal cord injury are similar to the symptoms that are present immediately after the injury but many of them are long term. Some of these symptoms include loss of movement, loss of sensation, including the ability to feel heat, cold and touch, loss of bowel or bladder control, exaggerated reflex activities or spasms, changes in sexual function, sexual sensitivity and fertility, pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord, and difficulty breathing, coughing or clearing secretions from your lungs” (Spinal cord injury-symptoms). Resources NSCIA: The national spinal cord injury association. (2012). Retrieved from The National Spinal Cord Injury Association website: http://www.spinalcord.org/ Paralysis resource center. (2012). Retrieved from Christopher & Dana Reeve Foundation website:http://www.christopherreeve.org/site/c.mtKZKgMWKwG/ b.4451921/k.24E/Reeve_Foundations_Paralysis_Resource_Center.htm Research. restoration. recovery. (n.d.). Retrieved from International Center for Spinal Cord Injury at Kennedy Krieger Institute website: http://spinalcordrecovery.org/?gclid=CI-X6LPm4LICFYyZ4AodSFEARw Resources & information for brain and spinal cord injury survivors. (2012). Retrieved from BrainandSpinalCord.org website: http://www.brainandspinalcord.org/ Spinal cord injuries. (2012). Retrieved from MedlinePlus website: http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html Spinal cord injury. (2012). Retrieved from Mayo Clinic website: http://www.mayoclinic.com/health/spinal-cord-injury/DS00460 UAB spinal cord injury model system information network. (n.d.). Retrieved from UAB School of Medicine website: http://www.uab.edu/medicine/sci/ Welcome to spinal cord injury network international. (n.d.). Retrieved from Spinal Cord Injury Network
Transcript: Prognosis Loss of movement Loss of sensation, including the ability to feel heat, cold and touch Loss of bowel or bladder control Exaggerated reflex activities or spasms Changes in sexual function, sexual sensitivity and fertility Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord Difficulty breathing, coughing or clearing secretions from your lungs Description A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury. Causes Much of the prognosis and recovery depends on the location and severity of the injury. Some patients recover well and others may be paralyzed for life. Generally, patients experience more paralysis when the injury is higher in the spinal column. Spinal Cord Injury Symptoms Spinal cord injuries result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord. Medications Immobilization Surgery Experimental treatments Modern wheelchairs Computer adaptations Electronic aids to daily living Electrical stimulation devices Robotic gait training Treatment
Transcript: Injury Questions ? Vertebrae Cord Nerves CSF Blood Anatomy SPINAL CORD INJURY SPINAL CORD INJURY PhD Candidate Stephen Mattucci
Transcript: Spinal Cord Injury Incomplete: Spinal cord has been severed or damaged in a way that allows no function or movement below the level of the injury. Complete: Spinal cord has been severed or damaged in a way that allows some function or movement below the level of injury. Main nursing diagnosis: Impaired mobility Cervical Nerves: Head, neck, shoulders, arms, and hands Thoracic Nerves: Portions of the upper abdomen and muscles in the back and chest area Lumbar Nerves: Lower back and legs Sacral Nerves: Buttocks, legs, feet, anal and genital areas of the body History Pain LOC Airway, Breathing, Circulation Skin temperature Sensations (begin at area with no feeling, this will help localize area of injury) Muscle Strength Reflexes Sphincters Immobilization Devices: Cervical Pullover shirts/sweaters may be an issue Button shirts easiest to wear Lots of pockets Shower with collar in place Padding may be changed No hot tubs or whirlpools if there is an incision Use non-slip bath mats Grab bar Shower Chair No lotions, powders, or oils Shampoo okay by physician After surgery ->sore throat and difficulty swallowing solid foods This may persist for several weeks Eating soft foods like yogurt, macaroni and mashed potatoes may help Eat with head up straight Cut food into smaller pieces requires 2 -3 people explain procedure provide privacy flatten bed, lower siderail Fold pt's arms over chest Maintain full spine alignment Once rolled, pillows placed under top leg, under the upper forearm to protect bony areas, and behind back to prevent the pt from rolling No driving until doctor allows Avoid strenuous activity Avoid activities that involve straining the neck Maintain balanced position Do not lift anything > 4 pounds Gradually increase activity Walking No biking, running, jogging Limit car rides Use chair with handles for assistance Redness that does not go away Any discharge from the incision Increased tenderness Increasing discomfort Sudden neck or back pain Bruising and swelling on the neck or back Experience numbness, weakness, tingling or Loss of feeling in the arms or legs SOB Chest pain Trouble swallowing Loss of bowel and bladder control Experience chills, shaking, fever or sweats Flu like symptoms Questions? Sudden severe twist to neck or body Etiology MVA Implications for nurses: TLSO Bathing Clothing Nutrition Activity When might a doctor need called? Anti-inflammatory medications Most common Activity Interventions Pain Turning Teaching Bathing Activity Immobilization Devices: Thoracic Lumbar Sacral Malibu Philadelphia Complete immobilization of neck and head Bathing Nutrition Miami J Severe blow to head or neck Clothing Log roll Implications for clients once discharged: SUMMARY Turning Falls Treatment When should you call your doctor? Assessment Aspen :) Physical therapy
Transcript: Spinal cord injury is direct trauma to the nerves themselves or indirect damage to the bones and soft tissues and vessels surrounding the spinal cord.It can be caused by many things such as sports or car accidents. problems walking loss of control of the bladder or bowels inability to move the arms or legs feelings of spreading numbness or tingling in the extremities unconsciousness headache pain or stiffness in the neck area signs of shock unnatural positioning of the head -Webmd.com -Healthline.com -mayoclinic.org -ninds.nih.gov Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car. Prevent falls. Use a step stool with a grab bar to reach objects in high places. Take precautions when playing sports. Always wear recommended safety gear. Avoid leading with your head in sports. For example, don't slide headfirst in baseball, and don't tackle using the top of your helmet in football. Use a spotter for new moves in gymnastics. Don't drink and drive. By:Angel Rizor Treatment Computerized tomography (CT) scan: may provide a better look at abnormalities seen on an X-ray. X-rays. Medical personnel typically order these tests on people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine. Magnetic resonance imaging (MRI). This test is very helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord. Spinal cord injuries are classified as either complete or incomplete. A incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day. Prevention Strategies Unfortunately, there's no way to reverse damage to the spinal cord. Medications. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement. However, this isn't a cure Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body. Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. Ask your doctor about the availability of such treatments. THE END! Diagnostic Test Spinal Cord Injury Etiology Prognosis Signs & Symptoms Bibliography
Transcript: Rehabilitation for Injury Special Considerations? Signs and Symptoms Created By: Cali Ciccarelli - Prevention in sports is to practice correct form (always avoid going head first) - Support needed after irreversible spinal cord injury occurs. Person may not be able to do normal activities any more and will often become frusturated and/or depressed. - Extreme back pain or pressure in your neck, head or back - Weakness, incoordination or paralysis in any part of your body - Numbness, tingling or loss of sensation in your hands, fingers, feet or toes - Loss of bladder or bowel control - Difficulty with balance and walking - Impaired breathing after injury - An oddly positioned or twisted neck or back Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries can be complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, you are paralyzed below the injury. With an incomplete injury, you have some movement and sensation below the injury. - Vertebrae - membrane - spinal column: cervical, thoracic, lumbar, sacrum, coccyx, - spinal nerve cells - disks How the Injury Occurs What is it? When treating : Surgery can be used to reverse some damage/ stabilize spine, Medications used, traction used Spinal Cord Injury Thoracic/ Lumbar: Braces Used Structures Involved Cervical: - sudden, traumatic blow to your spine that fractures, dislocates, crushes, or compresses one or more of your vertebrae. - gunshot or knife wound that penetrates and cuts your spinal cord. emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks
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