SCI medical considerations

spinal shock

initial transient physiological depression below level of injury resulting in loss of sensory, autonomic, reflexes

clinical presentation that emerges as spinal shock resolves

hyperreflexia

neurogenic shock

hypotensive state due to loss of sympathetic outflow

result of neurogenic shock

vasodilation and decreased peripheral vascular resistance, hypotension, bradycardia, hypothermia, decreased CO

what can PTs do for shock

education, monitor pt, re-evaluate motor and sensory changes often

result of paralysis of phrenic nerve

impaired inspiratory/expiratory function, reduced vital capacity, reduced lung complicance, quicker fatigue

major cause of morbidity and mortality in SCI

respiratory compromise

PT interventions for respiratory compromise

assisted cough, ROM of chest wall, postural education, early and often mobilization, percussion

cardiovascular complications post SCI

loss of outflow and vascular tone, reduced ability to regulate BP, limited muscle contraction for venous return

common cardiovascular complications

OH and autonomic dysreflexia

what to do for OH

slow progression to upright position, ensure hydration, take medications, tilt table, ace wraps

autonomic dysreflexia physiology

noxious stimulus causes sympathetic response of vasoconstriction and hypertension

presentation of autonomic dysreflexia

increased BP and decreased HR (opposite of OH), headache, dizziness, goosebumps

who is at risk for autonomic dysreflexia

T6 and above

most common causes of autonomic dysreflexia

bowel and bladder

what to do for autonomic dysreflexia

sit pt up and take BP, find source of trigger

other cardiovascular complications that could occur in acute SCI

DVT and pulmonary embolus

why are pts with SCI at increased risk for pressure injuries

impaired sensation, immobilization, decreased bulk around bony prominences, shearing during transfers

what can PT do for pressure injuries

education, early and often mobilization, skin checks, pressure relief program

parts of pressure relief program

turning schedule and seated pressure reliefs

thermoregulation impairments

initial concern for hypothermia then hyperthermia following shock

bone complications

osteoporosis, increased risk of fracture, heterotropic ossification

cervical spinal precautions

no bending, rotation

spinal precautions

no bending, lifting, twisting, hip flexion >90

types of early equipment

adaptive equipment, abdominal binder, tilt table, positioning device

steps of neurological exam

review PMH → ask about goals, support → assess sensory, motor, functional mobility

points of education for pt and family

many changes, basic interventions, skin concerns, early and often mobility, rehab process

function of tenodesis

using wrist extension to flex fingers to create a functional grasp

useful ROM in LE

hip abduction and external rotation for bowel management and dressing, tightness in low back for trunk control

components of functional mobility assessment

need for equipment, need for assistance, transfers, bed mobility

common goals for SCI

focus on mobility, independence, prevention of secondary complications

risk factors of lower functional outcomes following SCI

other injuries, age, pain level, limited ROM, obesity, impaired cognition, psychological, other medical complications