1. 1. Rehabilitation _SCI complications R
2. 2. SCI
3. 3. SCI AD
4. 4. autonomic dysreflxia (98-1-66,94-1-95) 1. 2. 3. 4.
5. 5. AUTONOMIC DYSREFLEXIA
6. 6. Onset syndrome of massive imbalanced reflex sympathetic discharge in patients with SCI above the splanchnic outflow (T5L2). May appear within 24 weeks postinjury. Classically occurs in patients with neurological complete SCI, although it may occur in patients with incomplete SCI.
7. 7. Most common causes Bladder: blocked catheter Bowel: fecal impaction Abdominal emergency (appendicitis, cholecystis, Pancreatitis) Labor Pressure ulcers Fractures Ingrown toenails Orgasm Urinary tract infections Epididymitis Bladder stones Gastric ulcers
8. 8. Signs and Symptoms Headache Sweating above level of SCI Flushing above level of SCI Elevated blood pressure Bradycardia Piloerection Pupillary constriction Sinus congestion
9. 9. (94-1- 93) -adrenergic blockers abdominal corset
10. 10. Orthostatic hypotension Treatment RepositionTrendelenburg/ recliner wheelchair Elastic stocking/abdominal binder/ace wrap LE Accomodationuse of tilt table Fluid resuscitation: increase fluid intake Pharmacological Salt tablets 1 gram QID Midodrine (alpha 1 adrenergic agonist): 2.510 mg TID Florinef (mineralocorticoid): 0.050.1 mg QD Use caution: once orthostatsis improves, the patient may be at risk for autonomic dysreflexia.
11. 11. 1 (94-1-93)
12. 12. Treatment RepositionTrendelenburg/ recliner wheelchair Elastic stocking/abdominal binder/ace wrap LE Accomodationuse of tilt table Fluid resuscitation: increase fluid intake Pharmacological Salt tablets 1 gram QID Midodrine (alpha 1 adrenergic agonist): 2.510 mg TID Florinef (mineralocorticoid): 0.050.1 mg QD Use caution: once orthostatsis improves, the patient may be at risk for autonomic dysreflexia.
13. 13. (98-1-64) spina bifida syringomyelia
14. 14. Important Levels to Remember T6 and above: individuals with SCI are considered to be at risk for Autonomic Dysreflexia Orthostatic Hypotension T8 and above: if lesion above T8, patient cannot regulate and maintain normal body temperature. (Note: an easy way to remember this level is to spell the word temp eight ture.) Central temperature regulation in the brain is located in the hypothalamus.
15. 15. 2 health care policy and research (99-2-61) 1.stage 0 2.stage I 3.stage II 4.stage III
16. 16. MECHANISMS OF DEVELOPING A PRESSURE ULCER 1. Ischemia: lack of blood supply to the tissue Frequently associated with hyperemia in the surrounding tissue. Increased local O2 consumption occurs. 2. Pressure: Prolonged pressure over bony prominences, exceeding supracapillary pressure (70 mmHg pressure) continuously for 2 hours results in occlusion of the microvessels of the dermis with subsequent tissue ischemia. 3. Friction (Shearing Forces): Friction mechanically separates the epidermis immediately above the basal cells.
17. 17. (100-2-69) 1. iliac crest 2. greater trochanter of femur 3. shoulder 4. ankle
18. 18. (99-2-61) 1. 2. 15 3. 15 4. 2
19. 19. Surgery Intervention Musculocutaneous flap: most common and most often recommended in severe pressure ulcers in SCI. Skin transferred with underlying muscle/blood vessels Rotation flap: Semicircular flap rotating about a pivot point to close a triangular defect Transposition flap: Rectangular flap rotates about its base to fill an adjacent defect Advancement flap: Moved into a defect without lateral or rotational movement
20. 20. Postop Management for Musculocutaneous Flap Procedures Strict bed restat least 34 weeks Vigilant pressure relief and avoidance of shear forces Air-fluidized bed Temperature adjustable, good pressure relief, absorption of wound fluids away, bacteriostatic capabilities of the beads Sitting time: if no problem after immobilization Slowly increased: start 15 minutes daily and increase by 15 minutes BID. Monitor flap closely afterwards.
21. 21. (pressure ulcer) (93-1-72) 1. 2. 3. 4.
22. 22. (100-1-57) 1. 2. 3. 4.
23. 23. Female Infertility After SCI Immediately following SCI, amenorrhea occurs in 85% of women with cervical and high thoracic injuries and 5060% of women overall. However, 50 and 90% (respectively) have return of menstruation within 612 months after injury. SCI does not affect female fertility once menses return.
24. 24. Pregnancy The likelihood of pregnancy after spinal cord injury is unchanged, since fertility is unimpaired. Pregnant women with SCI may develop: Pressure ulcers Recurrent UTIs Increased spasticity Decreased pulmonary function
25. 25. Autonomic dysreflexia: may be the only clinical manifestation of labor Uterine innervation arises from T10T12 level. Patients with lesions above T10 may not be able to perceive uterine contractions. Treatment of choice is epidural anesthesia Epidural should continue at least 12 hours after the delivery or until the dysreflexia resolves Need to distinguish from preeclampsia Slightly increased incidence of preterm labor Constipation Thromboembolism Leg edema
26. 26. (92-1-95) 1. 2. 3. 4.
27. 27. (97-2-54) 1. 2. 3. 4.
28. 28. SEXUAL DYSFUNCTION AFTER SCI Male Sexual Act Male erectile and ejaculatory functions are complex physiologic activities that require interaction between vascular, nervous, and endocrine systems. Erections are controlled by parasympathetic nervous system. Ejaculations are controlled by sympathetic nervous system.
29. 29. Male Infertility After SCI Fertility in men after SCI is impaired. As mentioned above, two major causes are ejaculatory dysfunction and poor semen quality. Poor semen quality is secondary to: Stasis of prostatic fluid Testicular hyperthermia Recurrent UTIs Abnormal testicular histology Changes in hypothalamic-pituitary-testicular axis Possible sperm antibodies Type of bladder management Long-term use of various medications