Neuro Summary 5-10 Exam PDF

9.5 sci rehab management secondary skeletal conditions heterotopic ossification :formation of mature lamellar bone outside the skeletal system (around jnts usually) incidence: 10-53% - 2-3 wks post injury below level of injury highest incidence in hip>>knees>>elbows>>shldrs limits jnt ROM pain hinde...

9.5 sci rehab management secondary skeletal conditions heterotopic ossification :formation of mature lamellar bone outside the skeletal system (around jnts usually) incidence: 10-53% - 2-3 wks post injury below level of injury highest incidence in hip>>knees>>elbows>>shldrs limits jnt ROM pain hinder fxnal mobility rehab process ex: hip: loss of sitting and balance -leads to decreased ability to to perform transfers, dress and self care activities clinical presentation sensation: jnt/muscle pain w/o sensation: sudden decrease in PROM. tissue swelling, redness or heat @ jnt, low grade fevers sudden decrease in ROM: VERY NOTICABLE risk and associated factors for heterotopic ossification yolcu 2020 (SR and MA) risk factors for developing HO maile asia a complete pneunomia pressure ulcers smoking urinary tract infections spasticity 9x more at risk management of heterotopic ossification -having UTI: most impactful factor a. prophylactics use of NSAIDs (early) -less than 3 wks after sci common meds: rofecoxib or indomethacin -bisphosphonates: to slow/halt progression most effective: 3-6 wks after sci monitor: ROM avoid rigorous stretch to affected jnt continue gentle stretches to minimize continued bone formation or loss of ROM pathophysiology of bone loss in sci 2nd complication: osteoporosis or osteopenia causes decreased bone density (multifactorial) disuse of LE limited mobility poor nutrition ^ factors due to autonomic. dysregulation and innervation no connection bw level of injury DVT tracheostomy changes changes in hormon metabolic levels disordered vasoregulation predispose the skeletal system towards an imbalance between osteoclast and osteoblast activity bone loss after sci high calcium levels level 4-6 months= high bone resorption acute & subacute: 1% bone loss/wk bone loss 1-3 yrs after injury -levels range 25-50% below age match norms at hip and knee -bones look like a 70 yo female density levels= high risk of fractures negative sequelae of limited mobility, pain and decrease fxn osteoporosis and sci target trabecular bone— rather than cortical bone -significant decreased bone density in lower and upper 1/3 of femur and upper 1/3 of tibia sublesional oestoporosis (SLOP) cortical bone loss more evident management of bone loss in sci sci pts= high risk of fragility fx fragility fx fx occurring spontaneously or following minor trauma 1-4% of sci population have fx w/in given yr typically affect proc tibia or distal femur delayed healing post fx and increase 5 yr mortality rate injury: contribute to limited mobility, independence w daily activities and overall participation summary bone loss and heterotopic ossification are more common msk complications for individuals w sci PT role is to educate, monitor, prevent, and treat both conditions legs 9.6 SCI Rehab Management Secondary Conditions GI most significant hindrance in SCI 32% world wide 36% developing one pressure ulcer in acute/rehab 17.7% rehospitalized within a year of dx 37.4% hospitalized w/in 20 yrs of dx acute care locations: calcaneus, occipital, sacral regions rehab setting: ischium most common can delay recovery, result in hospitalization, infxn, death m glutes more prone to pressure ulcers AIS A AIS B ASIA A: 4.5x more likely further risk prior hx of pressure ulcer pneumonia pulmonary conditions (including mechanical vent) incontinence * age, gender, steroid use in acute phase, diabetes, urinary infxns dont impact development of pressure ulcers * male w/ low edu or longer time since injury, DVT, pneumonia or hx of pressure ulcers = risk factors acute phase pressure relief is key minimize sitting in bed in reclined pos greater than 90 degrees fwd lean over knees most effective at relieving ischial pressure followed by fwd diagonal lean reclining can add shear forces leading to ulcers push up method: poor compliance = ineffective!! - 1 min every 15 min of siting for 45 sec to 1 min education best! (risk, self mod, reduction of risks) Interventions fxnal mob training, skin checks, weight shift, exercise, jt range, glute EMS Neurogenic bladder in SCI: autonomic n signaling abnormal control of bladder resulting in urinary dysfxn affects 80% trauma SCI pts What happens poor voiding incontinence UTI retro flow kidney failure Impacts length of hospitalization fxnal recovery mental & physical QOL How to asses bowel and bladder control in SCI 1. Catheter to manage urinary output while stabilizing injury bc bladder atonic 2. voluntary anal contraction consistently checked to remove catheter 3. trial voiding with bladder scans 4. determine if option or not If cant void voluntarily clean intermittent catheterization (CIC) - medically stable pt - urinary outputs stabilized less than 1.5 liters per day & can be done indep or caregiver - cost effective, improves QOL, better than the other one above Hydrophilic coated catheters decreases of UTI & hematuria minimize infection!! - wash hands, genital area, sterilized supplies, lube pts w/neurogenic bladder drugs anticholinergic for urinary incontinence & involuntary detrusor contraction neuropathic pain in SCI = common direct damage to nervous system itself typically described as burning, shooting pain, skin can be numb, tingling, extremely sensitive to light touch most common 37% below level pain 42% at level Factors increasing chances of neuropathic pain psychological distress older age light touch vs prin prick discrepancy allodynia more likely to develop pain Summary bladder dysfxn, pressure ulcers, and neuropathic pain common complications for individuals w/ sci PT role varies, education most important 9.7 SCI rehab management: cardiometabolic health & health promotion remember: SCI has immediate impact on autonomic fxn ↓ HDL choles higher chance of hypercholestremia orthostatic hypotension, autonomic dysrefflexia 20% higher 5 year incidence of cardiometabolic morbidity in SCI dysarhymias heart failure atherosclerosis nonalcoholic fatty liver disease chronic kidney disease type 2 diabetes hypercholestorlemia hypertension cardiometabolic disease leading death after 1 yr of injury secondary lifestyle and reduced activity makes it worse ↑ in order to diagnose w/ CMD 3 or more of abdominal obesity insulin resistance dyslipedmia high density lipoproteins development = combo of cardiovascular, renal, metabolic, prothrombotic, and inflammatory risk aka energy expenditure unbalance w/ daily energy intake = E cardiometabolic syndrome management multidisciplinary approach - nutrition, PT, pharmacological, bariatric surgery caloric assesment to see how much energy used DASH helpful pharmacological avoid prescription of herbals, nutraceuticals, or others for weight management consider anti hyperglycemia medications (metformin) anti hypertensive medication (manage diabetes, HTN, C hypercholesterolemia) bariatric last resort efficacy of exercise in SCI for cardiometabolic health PA improve all of these in younger people and older people - but just not as much! - exercise has low impact on bone health - - I - know this chart!!! decreases risk of heart disease and diabetes exercises · - arm cranking/ergometry wc ergometry wc propulsion hand cycling FES cycling/rowing summary cardiometabolic dysfxn long term impact on health and wellness in individuals w/ sci