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Hip flexors (L2) Knee extensors (L3)

Hip flexors (L2) Knee extensors (L3). Hip flexors (L2) Knee extensors (L3). Medical Treatment after SCI. Methylprednisolone “steroids” for traumatic SCI within 8 hours of injury standard of care vs. experimental. Medical Treatment after SCI. Respiratory/pulmonary

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Hip flexors (L2) Knee extensors (L3)

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  1. Hip flexors (L2) Knee extensors (L3)

  2. Hip flexors (L2) Knee extensors (L3)

  3. Medical Treatment after SCI • Methylprednisolone “steroids” for traumatic SCI within 8 hours of injury • standard of care vs. experimental

  4. Medical Treatment after SCI • Respiratory/pulmonary • Gastrointestinal • Nutrition • Neurogenic Bowel • Suppositories, mini-enemas, timed bowel program, digital stimulation, strain with increased intra-abdominal pressure • Neurogenic Bladder • Intermittant catheterization, indwelling catheter, condom catheter, vasalva or crede • Vascular/DVT • Skin

  5. FES bike • Potential benefits: • Cardiovascular • Circulation • Bone density • Muscle mass • Sense of well-being • Neurological improvement FES = functional electrical stimulation

  6. Surgical Management • Spine stabilization • Instability: under normal physiologic loads there is potential for deformity, additional neurologic deficit, or incapacitating pain • Spinal cord decompression

  7. Surgical Management • Tendon transfers • Gain function • Eliminate need for assistive devices

  8. Surgical Management • Experimental Neural Transplantation (regenerative & reconstructive cellular strategies) • Adult stem cells • Embryonic stem cells • Olfactory mucosal cells

  9. Length of Stay • Acute care unit (hospital) • 25 days – 1974 • 18 days – 2004 • Rehab unit • 115 days – 1974 • 39 days – 2004

  10. Lifetime Costs Average Yearly Expenses (in May 2006 dollars) Estimated Lifetime Costs By Age at Injury

  11. Life Expectancy Life Expectancy (years) post-injury by severity and age (for persons surviving at least 1 year after injury)

  12. Social Aspects of SCI • Quality of social support has a positive relationship with adjustment & enhancing independent functioning

  13. Psychological counseling for coping and adjustment • Patients can have difficulty maintaining relationships with friends they had before their injury • Embarrassed • feel their friends’ discomfort • let friendships “drift away” • Socially isolated

  14. Psychological counseling for coping and adjustment • Family effects: • loss of personal space & time • Financial concerns • Loss of spontaneity • Worry about the present & future • Family member role changes/role confusion • Patient’s anger - often directed at loved ones

  15. Vocation • 64% employed at time of injury (if between 16 – 59 years old) • Post-injury employment increases with time % Patients Year Post-injury

  16. Vocation • Predictors of postinjury employment: • Younger age • Greater functional capability (paraplegia > tetraplegia) • Able to drive • Greater elapsed time since injury • Physical intensity of preinjury occupation/secondary gain considerations • Social support • Internal locus of control

  17. Vocation • Job assessment (VR counselor or OT) • Functional assessment • Work environment/physical factors • Job tasks • Production needs/expectations • Adaptive equipment • State/community agencies, support groups, state/county employment programs

  18. Vocation • Benefits • Economical • Quality of life • Self esteem • Self identity • Life satisfaction/well being • Psychological adjustment to disability

  19. Assistive technology resources • www.agrabilityproject.org/assistivetech/ • www.abledata.com

  20. Factors impeding expected functional outcome • Pre-existing medical conditions • Concomitant injuries • Secondary complications • Cognitive impairment (pre-existing or injury-related) • Age • Body type • Psychological factors • Social factors • Availability of financial resources • Cultural factors

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