what is the main focus of treatment in the first 2 – 4 weeks
medical stability
treatment of other injuries
stability of surgery – fusions are common to stabilize fracture, patients refer to this as rods or cages
what is the main focus of treatment during 4 –6 weeks
seating and adaptive equipment
transfer training
Tolerance to sitting/standing
Weight-bearing if appropriate – ASAP
Patient and family education
Planning for next phase of rehab, home modifications
what is the main focus during outpatient therapy
neuromuscular recovery
Ambulation
Tolerance to sitting/weight-bearing
Balance
Posture
Strength
true or false – outpatient therapy is on-again and off-again because patients can hit plateaus in performance
true
what is compensation
treatment focused on teaching patient to use what strength they have to accommodate for motor loss as a result of spinal cord injury
what is recovery
more recent treatments focus on stimulating the neuromuscular system to promote recovery or regrowth of neurons
what are some types of treatments for compensation
early-onset of bracing in splinting
limited weight-bearing
bed mobility, transfers
what are some treatments for recovery
locomotor training
Estim (FES) – FES bikes, Bioness
Early initiation of weight-bearing
Facilitation to achieve appropriate kinematics with all activities
what is Locomotor training
complex treatment that focuses on specific motor neurons to get muscles working
what is the goal of locomotor training
goal is to stimulate and retrain the nervous system for recovery of function – sensory, motor, decreased muscle spasm, improve B&B control
true or false – this is an example of locomotor training
true
goal is to retrain the nervous system
true or false – the best treatment is a combination of compensation and recovery
true
what are some complications of spinal cord injuries
autonomic dysreflexia
pressure ulcers
posture/scoliosis
pulmonary embolism, deep vein thrombosis
orthostatic hypotension
urinary tract infection, bowel complication
tone, spasm
contractures
decreased bone density
autonomic dysreflexia is an issue for injuries above _____
T6
what is the cause of autonomic dysreflexia
triggered by noxious stimulus, is an imbalance between parasympathetic and sympathetic activity
true or false – autonomic dysreflexia can be a medical emergency, the cause must be found and removed immediately
true
true or false– autonomic dysreflexia can be a lifelong problem
true
true or false – research shows 10 min. out of every hour is minimal requirement to allow re-vascularization of superficial blood vessels
true
this is especially important in spinal cord injuries because the patient's are at an increased risk of developing pressure ulcers
what is pressure mapping
is a special device that shows area of increased pressure that are at increased risk of ulceration. This helps the therapist to choose appropriate cushion
what are some important things to remember when addressing postural collapse/scoliosis
impaired mobility may cause gravity to increase scoliosis and pelvic obliquities
adjustments should be made to seating surface and seat back to assist patient with upright posture
once a scoliosis curve develops gravity will generally assist with development of obliquity and progression of both
true or false – patients who suffer from a spinal cord injury have an increased risk of pulmonary embolism's and deep vein thrombosis
true
orthostatic hypotension is also known as?
postural hypotension
what causes orthostatic hypotension
decrease in blood pressure as a result of change in position
supine to sit
sit to stand
result in dizziness, fainting
what is the treatment for orthostatic hypotension
slow progression of position changes
UTI stands for?
urinary tract infection
what increases the risk of urinary tract infection
catheter use
what are some of the signs and symptoms of urinary tract infection
changing color, consistency or smell of urine, pain with urination, change of frequency
how can a physical therapist help the patient who suffers from a urinary tract infection
patient should be educated in clean technique with catheters and how to monitor for complete emptying
true or false – patients that suffer from joint contractures are at an increased risk of ulceration
true
what are some of the psychosocial issues for a patient that suffers from a spinal cord injury
depression
grieving
anxiety
changes in personality
changes in family and other relationships
Probably not going to be excited about therapy
what are some issues a physical therapist should educate a patient with a spinal cord injury
pressure relief
signs and symptoms of urinary tract infection
signs and symptoms of autonomic dysreflexia
proper proportion techniques
home exercise program to maximize recovery – because our time is very limited
