-
major causes of spinal cord dysfunctions
- trauma
- neoplasms (tumors)
- viral or bacterial infections (polio)
- progressive degenerative disorders (MS)
- vascular accidents (hemorrhage, thrombus, embolus)
- compressions from arthritic spur
- congenital anomalies
-
types of spianl cord injuries
- Fracture
- dislocation
- compression
- stretching
- bending
- severing
-
characteristics of spinal cord injuries:
complete
incomplete
complete: no sensation or motor fxn below level of lesion
incomplete:some sensation or motor fxn
-
Possible effects of spinal cord injuries
- impairment of voluntary bladder/bowel control
- impairment of sexual fxn
- impairment of vasomotor and body temp reg
-
secondary complications that may occur with spinal cord injuries
- respiratory fxn
- pressure sores
- spasticity
- body temp
- risk of infection
- autonomic dysreflexia
-
decubitis ulcer
pressure sore
-
Life threatening
emergency condition in which the blood pressure increases
sharply. Problem with pts who have suffered injury at level T6
and above. Stimuli such as bowel or bladder irritation, pain
may trigger
autonomic dysreflexia (hyperreflexia)
-
Increased BP (may rise to 300/160), decreased
pulse, pounding headache, flushing, chills, sweating,
restlessness, increased spasticity
autonomic dysreflexia (hyperreflexia)
-
emergancy care for autonomic dysreflexia
- Gradually position chair upright. DO NOT RECLINE – could cause increased BP to brain.
- Call for medical
- help,
- monitor BP,
- check bladder distention, straighten catheter if clamped
-
criteria for mouth-held implements
- does not harm oral tissues
- is comfortable and allows pt to talk, swallow, and moisten lips
- does not cause fatigue
- can be cleaned easily
- easy to construct/inexpensive
-
Primary types of brain injury
- direct trauma
- indirect trauma
- hypoxia or toxi substance exposure
-
over half the trauma cases to the spinal cord result from?
motor vehicle accidents
-
majory of spinal cord injuries affect?
teenage or adult men
-
how many people do you need to trasport someone after a spinal cord injury?
at least 4
-
immediately after the injury, spinal shock causes?
complete loss of reflex activity (flaccid paralysis)
-
how long does fflccid paralysis last?
several hrs - 3 months
-
Dental chair implications for a person with a spinal cord injury
- Patient with urine bag should be sat up at frequent intervals to allow urine to drain
- empty urine bag
- don't change chair agnle abrubptly (avoid postural hypotension)
- change body position (avoid pressure sores)
- padding for patient (avoid pressure sores)
-
dh care for spinal cord injuries
- Monitor vital signs
- Be aware of patient and body needs/emergencies
- Suction to prevent aspiration. Use ultrasonic with great caution,
- if at all.
- Use rubber dam to prevent aspiration and danger of respiratory
- complications
- Keep appt as short as possible
-
Primary types of brain injruy
- direct traum
- indirect trauma
- hypoxia or toxic substance exposure
-
secondary types of injury
- edema
- hematoma
- hydrocephalus/hygroma
-
manifestation of Brain Injury
- Loss of Consciousness
- Post Traumatic Amnesia
- Concussion
- Seizures
- PERL
- Reflex issues
- Encephalopathy
-
process of blood exuding or passing out of vessel into surrounding tissues
extravasation
-
Incidence of brain injury
most often seen in men between the age of 15 and 24
- 50% vehicle accidents
- 21% falls
- 12% violence
- 10% sports
-
Congenital defect when the vertebrae fail to enclose the spinal cord
congenital spinal deformities
-
how to reduce congenital spinal deformities
folic acid
-
Types of congenital spinal deformities
- myelomenigocele
- meningocele
- spina bifida
-
Protrusion of the spinal cord and its covering (meninges) through
an opening in the bony spinal column
Flaccid paralysis of legs and part of trunk
myelomenigocele
-
Protrusion of the meninges through a defect in the skull or spinal
column
Paralysis uncommon
Meningocele
-
Congenital cleft in the bony encasement of the spinal cord
Spina Bifida Occulta(hidden) : no outpouching of meninges or
spinal cord – no symptoms
sipna bifida
-
physical characteristics of a patient with myelomeningocele
- Bony deformities
- Club foot
- Dislocation of hip
- Spinal curvatures
- Kyphosis
- Scoliosis
- Lordosis
- Loss of sensation
- Bladder and bowel paralysis
- Hydrocephalus – excessive accumulation of fluid
- on the brain.
- Seizures
- Developmental deficit
-
Medical tx for myelomeningoecele
- Neurosurgery
- Closure of the myelomeningocele
- Treatment of the hydrocephalus
- Orthopedic surgery
-
DH Care for Myelomeningocele
- General management
- Wheelchair transfer may be indicated Assistance for patients with crutches
- Need for premedication
- Ventriculoatrial – YES premed
- Ventriculoperitoneal – NO premed
- Latex allergy
- Scheduling early in the day when less contamination from glove powder is in the air
- Gingival care
- Special adaption if cervical or thoracic body levels involved
- Patient with seizures may present with gingival hyperplasia
-
Sudden loss of brain function
changes in motor fxn, communication, perception, as well as possible depression
death can occur in minutes
CVA (stroke)
-
COMMON risk factors for stroke
- transient ischemic attack (TIA)
- recent stroke
- hypertension
- cigarette smoking
- cardiac disease
- diabetes mellitus
-
POSSIBLE risk factors for stroke
- oral contraceptives
- obesity
- physical inactivity
- alcohol
- pregnancy
-
UNCOMMON risk factors for stroke
- infalmmatory disorders
- hematologic disorders
- coagulation disorders
- drug abuse
-
Etiologic factors for stroke
- Thrombosis
- intracerebral embolism (seen on pano)
- Ischemia (A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels)
- cerebral hemorrhage
- risks/predisposing factors
-
signs and symptoms of CVA
- Transient ischemic attack (TIA)
- Acute symptoms of a stroke
- Dizziness, vertigo, transient paresthesia, transient speech defects, serious headache, labored breathing, chills, paralysis one side of body,
- nausea, vomiting, convulsions, loss of
- consciousness
- Residual or chronic effects
- Two thirds have some permanent disability
- Temporary or permanent loss of thought, memory,
- speech, sensation, or motion
-
Right hemiplagia-causes
- L-CVA
- speech/vocab problems
- slow, cautious, disorganized
- right visual field deficit
-
left hemiplegia
- R-CVA
- Spatial perception problmes
- over confident and impulsive
- left visual field deficit
-
Medical tx for CVA
- Surgical
- Physical and occupational therapy
- Medications
-
Meds for strokes
- Anticoagulant – to thin blood
- Antihypertensive – to lower blood pressure
- Thrombolytic – to dissolve clots
- Vasodilator – to relax the blood vessels of the brain
- Steroid – to control brain swelling
- Antiepileptic – to help to control seizures
-
DH care for stroke patients
- Timing
- Elective dental treatment is usually not advised until 6 months or more after a stroke
- Appointment procedures
- Shorter appointments/small increments
- Four handed dentistry
- Physician consult if on anticoagulant medication
- Disease control
- Provide complete care
- Homecare modifications of devices may be indicated
- Paralysis may require caregiver to deliver daily biofilm removal
- If facial paralysis is involved, increase in biofilm, leading to
- demineralization and caries.
- Daily fluoride application
- Saliva substitutes
- Disease risk detection
- Calcifications in the carotid artery may be seen on panoramic
- radiograph
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