CRRN: spinal cord injury

what are the symptoms of autonomic dysreflexia?

• elevated systolic bp

• sudden onset headache

• bradycardia

• sweating/flushing

• piloerection (goosebumps)

• cold clammy skin

• blurred vision

• nasal congestion

• cardiac arrhythmias

• feelings of apprehension/anxiety

what is autonomic dysreflexia?

excessive, uncontrolled sympathetic nervous system response

what is the pathophysiology for autonomic dysreflexia?

• stimulus

  • fecal impaction

  • bladder distention

• afferent stimulus

• massive sympathetic response

• vasoconstriction

• hypertension

  • triggers activation of PNS and inhibition of SNS, but signals can’t travel below level of injury

• baroreceptors

• reflex bradycardia

• descending signals blocked

what initial steps should caregiver follow in response to autonomic dysreflexia?

• recognize signs and symptoms of AD

• take BP, continue to monitor at 1-2 minute intervals

• sit patient upright and lower legs

• loose any clothing or constrictive devices

• if SBP is resolved…

  • continue to monitor BP every 2-5 mins until stable

  • monitor closely for at least 2 hours for recurrent AD or hypotension

• if SBP not resolved

  • if SBP >150 mmHg consider rapid-onset and short duration pharmacological management

  • assess for instigating causes and treat

what is the treatment for autonomic dysreflexia?

• treat the cause

  • bladder distention and bowel impaction most common

• if SBP >150 mmHg consider rapid-onset and short duration pharmacological management assess

  • nitroglycerin paste recommended

• monitor closely for at least 2 hours for recurrent autonomic dysreflexia or hypotension

• review cause with pt and caregiver and provide education

what are the functional outcomes for a patient with C1-3 spinal cord injury?

• vent dependent

• limited head and neck movement

• dependent for all ADLs and mobility

• use of power wheelchair with head, chin, or breath control

• talking can be difficult to impossible

  • adaptive equipment needed

what are the functional outcomes for a patient with C2 spinal cord injury?

• may initially require vent but likely able to wean

• typically has head/neck control and sometimes can shrug shoulder

• control power w/c sip/puff or chin/head control

• verbalize care

• adaptive equipment for communication

what are the functional outcomes for a patient with C5 spinal cord injury?

• typically has head/neck/shoulder control, can bend elbows, turn palms face up

• UE dressing, feed self w/equip

• most of hygiene

• operate power wheelchair with hand controls

• may have strength to push a manual wheelchair for short distances over smooth surfaces

what are the functional outcomes for a patient with C6 spinal cord injury?

• typically has head, neck, shoulder, arms, wrist control

• can shrug shoulders, bend elbows, turn palms up and down, extend wrists

• UE/LE dressing, grooming, B&B w/assist, feed self

• independently do transfers and often requiring a sliding board

• may independently perform light housekeeping duties

• may propel manual w/c

• may also be able to drive an adapted vehicle

what are the functional outcomes for a patient with C7-8 spinal cord injury?

• typically has head, neck, shoulder, arms, wrist control

• can shrug, bend elbows, turn palms up and down

• extend wrists with added ability to straighten elbows

• independent with transfers bed/car/toilet

• dressing w/equipment, groom, feeding, self-care

• B&B w/ minimal assist

what are the functional outcomes for a patient with T1 spinal cord injury?

• same control as C7-8 but with precision of fingers, giving them limited/natural hand function

• independent with all transfers

• use manual w/c

• can complete self-care, home making w/some assist

• B&B management independently

what are the functional outcomes for a patient with T2-6 spinal cord injury?

• normal motor function in head, neck, shoulders, arms, hands, and fingers with increased use of rib and chest muscles and trunk control

• should be totally independent with all activities

• individuals are capable of limited walking with extensive bracing

what are the functional outcomes for a patient with T7-12 spinal cord injury?

• increased abdominal control

• should be totally independent with all activities

• able to perform unsupported seated activities

what are the functional outcomes for a patient with L1-5 spinal cord injury?

• has additional return of motor movement in the hips and knees

• walking with braces or crutches (functionally)

what are the functional outcomes for a patient with S1-5 spinal cord injury?

• independent with all activities

• increased ability to walk with fever or no supportive devices

• may still have impaired B&B, sexual function