Spinal Cord III

other term for pressure ulcer

decubitus ulcer

RF for decubitus ulcers

decreased activity, severity of injury, moisture, impaired sensation, atrophy, poor nutrition, smoking, M, lower education, unemployment

90% of SCI pts get

pressure ulcers in their lifetime

1/3 pressure ulcers develop in

acute/IPR

30% have

recurrent pressure ulcer issues

common supine ulcer sites

heels, sacrum/coccyx, elbow, dorsal thoracic, occiput

sidelying ulcer sites

malleoli, anterior knee, trochanter, ischium, shoulder, side of head

seated ulcer sites

foot, posterior, knee, ischial tuberosity, sacrum/coccyx, shoulder blade

factors contributing to osteoporosis

decreased WB, neural, vascular, and nutritional factors

pts lose % of BMD /month

2-4

within 2 years, % of BMD is lost

40%

most common places for osteoporotic changes

distal femur, proximal tibia

osteoporosis RF

motor complete/paraplegic, white, age, F, lower BMI

osteoporosis tx

biphophonates, also low quality evidence for rehab in prevention/restoration

complications of osteoporosis

low impact fractures

spasticity

velocity dependent resistance to passive movement

spasticity results from

changes in tonic phase of stretch reflex (exaggerated stretch reflex)

clonus

involuntary rhythmic m contraction to rapid stretch

clonus is due to

changes in phasic stretch reflex (decreased descending inhibition, exaggerated pattern generator response, stretch reflex arc)

spasms

FLX or EXT moments affecting multiple joints in response to cutaneous stimuli

spasms are caused by

changes in multi-segmental cutaneous reflex arcs (decreased supra spinal inhibition)

hyperreflexia is caused by

reduced inhibition of Ia afferents

stiffness

resistance to AROM and PROM

stiffness results from

myoplastic changes

V1

as slow as possible

V2

speed of gravity

V3

As fast as possible

Clinical outcome measures to m tone abnormalities

Modified Ashworth, Tardieu, Spinal Cord Assessment Tool for Spastic Reflexes (SCATS)

Self-report outcome measures for m tone abnormalities

Penn spasm frequency scale, Snow spasm frequency scale, patient reported impact of spasticity measure (PRISM)

25% of pts view spasticity as

beneficial

m tone management drugs

baclofen (lioresal), diazepam (valium), dantrolene (tantrum), Tizanidine (Zanaflex), chemodenervation

chemodenervation blocks

NMJ

Baclofen and diazepam are

GABA agonists

dantrolene limits

contractile capacity of m fibers

tizanidine is an

alpha-2 adrenergic receptor agonist

Rehab strategies for m tone management

positioning, splinting, orthoses, ROM, stretching, WB, strengthening, Estim, cool, heat

Estim for m tone management

reciprocal inhibition, induction of fatigue of hypertonic m

cool/heat can

decrease n conduction velocity, decreased sensitivity of peripheral sensory receptors, facilitation of uptake to neurotransmitters

segmental zone pain can be

2 segments above and below

neuropathic pain below injury level can be

constant with fluctuating intensity, central pain, phantom limb pain, may be related to cortical reorganization

Central sensitization

increased synaptic efficacy of substantia gelatinous neurons in the dorsal horn, dysfunction of cortical circuits associated with sensory pain and processing

maladaptive plasticity

imbalance of excitatory and inhibitory inputs, cortical reorganization

Pyschosocial contributions to pain

higher stress, lower SES, decreased self efficacy, negative mood, decreased acceptance, anxiety

pharmacology for pain

opioids, anti-convulsants, anti-depressants, cannabinoids

neurostimulation for pain

TENS, spinal cord stimulation, TMS, tDCS

perceptual remodeling

combining imagery/VR and neurostimulation techniques to help with pain

non-SCI waist circumference

men 102cm, women 88cm

non-SCI and SCI elevated triglycerides

>150 mg/dl

non-SCI reduced HDL-C

M <35 mg/dl, F <39 mg/dl

non-SCI and SCI HTN

SBP >130, DBP >85, SCI may be using meds

non-SCI dysglycemia

>100mg/dl

SCI obesity

M >22% body fat, F >35%

SCI reduced HDL-C

M <40mg/dl, F<50mg/dl

SCI dysglycemia

fasting glucose >100mg/dl

common spots for overuse injury (most to least)

shoulder, wrist, elbow

40-60% of SCI develop

carpal tunnel

Significant pain

requiring medication, associated with 2+ ADLs or severe pain requiring stopping activity

significant pain prevalence

59% in quadriplegics, 41% paraplegics

significant pain correlated to

QoL, employment status, independence, rate of functional decline

prevention of pain

transfers, wheelchair fit and training, weight, exercise

STOMPS

Strengthening and Optimal Movements for painful shoulder

elements of stomps

horizontal abd/add, upper trap and lev scap, AROM thumb up, rotation, shoulder squeeze, arm diagnoals

low QoL contributers

pain, spasticity, less independence, incontinence, unable to return to work, SNF

High QoL contributers

meaningful relationships, maximizing function, access to environment, private home