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Elderly SCI treatment

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by

Mario Novo

on 17 August 2014

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Transcript of Elderly SCI treatment

Spinal treatment
with geriatric patients

Patient associated
identifiers
Drug use and interaction
Age
Co-morbidities and complications
Functional decline
Common drug interactions
Spinal Cord Injury Classification
Comorbidities and medical complications
Age and Etiology
Presented by:
Rose Cardentey, Carlos Florian and Mario Novo
A global understanding
Treatment
Areas of treatment
In the U.S the elderly stage of life starts at 65 y/o

The term geriatrics comes from the greek geron which means "old man" and iatros means" healer "
Funtional decline
Vision problems
Loss of Hearing
Balance problems
Memory and brain problems
Weakness (muscle/bones)
More likely to have a pulmonary disease due to a lifetime of smoking
Frequent complaints fatigue and pain
Weakness in respiratory muscles
More prone to infections
Demographics

The incidence of Traumatic SCI in the U.S is aprox 12,000 new cases a year

The number of people living in the US today with SCI is between 231,000 and 311,000.

53% of traumatic SCIs occur in persons aged 16 to 30 years

Persons older than 60 years of age at injury have increased from 4.7% before 1980 to 11.5% for injuries ocurring since 2000.
Aging population
Interdisciplinary collaboration
Address the global aspect of the patient
Frailty
Bone
Sarcopenia
abnormal reduction or deficiency
in muscle mass

atrophy
motor unit loss type II
Cardiovascular
Connective tissue
Physiology and frailty
decreased loading strength
increased risk of fracture
Proliferation of type 1
decrease in type 3
Decreased HR
Decreased stroke volume (O2 pulse)
SV X HR = Q
Muscle
Impairments
Independence
Neuromuscular
Musculoskeletal
Functional
Muscle tone
Hypo/Hyper
Proprioception
Bowel/Bladder control
Breathing
Capsular tightening
Contracture
Heterotopic ossification
Loss of strength (muscle atrophy)
Ambulation
Balance
Bed mobility
Transfers
Patient satisfaction
Neuromuscular
Pain
TREATMENT
Musculoskeletal
Functional
PAIN
Pseudoarthrosis
Peripheral bone and soft-tissue injury
Peripheral nerve injury with neuritis
Degenerative joint disease (DJD) of the spine
Tumors
Nerve root pain (radiculopathy)
Autonomic hyperreflexia
Hyperhidrosis
Horners1 Syndrome
Scarring
Arachnoiditis
Abnormal axonal sprouting
Cord tethering in the dorsal horn region
Tone inhibition techniques: stretching modalities
PNF
aquatic therapy
Tone facilitation techniques:
Quick stretch
quick ice
Vibration
E-stim
PROM
AAROM
AROM
Flexibility
Aerobic training
Therapeutic exercise
Breathing techniques
Positioning
Bed mobility
Balance
Transfer
Assistive device
Gait
Pharmacology
Electrical stimulation
Thermal Modalities with
Ultrasound
THANK YOU
Type of Trauma
Functional Category
American Spinal Injury Association
(ASIA) Impairment Scale
Lesion Level
Posterior Cord Syndrome
Anterior Cord Syndrome
Central Cord Syndrome
Brown-Sequard Syndrome
Traumatic
Non-Traumatic
Tetraplegia (Quadriplegia)
Lesion in Cervical SC
Paraplegia
Lesion in Thoracic or Lumbar SC or Cauda Equina
Neurological Level
Motor Level
Myotomes
MMT
Sensory Level
Dermatomes
Light Touch
Pin Prick
Complete SCI
No Sensory or Motor Function at S4 and S5
Incomplete SCI
Presence of Sensory and/or Motor Function at S4 and S5
Further classified into Syndromes
Based on Common Clinical Features
Damage to Posterior Columns
Symptoms: Bilateral
Proprioception
Epicritic Sensations
Two point discrimination
Stereognosis
Common Cause: Cervical Flexion Injury
Anterior Spinal Artery
Symptoms: Bilateral
Damage to Corticospinal Tract
Loss of Motor Function
Damage to Spinothalamic Tract
Pain
Temperature
Common Cause: Cervical Hyperextension Injury
Congenital Narrowing of Spinal Canal
Symptoms: Bilateral
Hemorrhage
Edema
UE's affected more than LE's
Cervical Tracts run Central
Lumbar/Sacral Tracts run Peripheral
Common Cause: Hemisection of SC
Penetration wounds (ex. Gunshot wound)
Symptoms:
Sensation
Decreased Reflexes
Absent Superficial Reflexes
Clonus (Involuntary Reflex)
Positive Babinski Sign
Ipsilateral: Proprioception, Kinesthesia, Vibration
Contralateral: Pain & Temp.
Tests & Measures
Seating and Wheelchair Exam
Wheelchair Skills Test
Functional Independence Measure (FIM)
Walking Index for SCI
Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)
Full transcript