bs-sci rehabilitation 1

8/13/2019 Bs-sci Rehabilitation 1

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Bayu SantosoDepartment of Physical Medicine and Rehabilitation

School of Medicine Airlangga UniversityDr. Soetomo General Hospital

Surabaya

REHABILITATION OF SPINALCORD INJURY PATIENT


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INTRODUCTION

Among all types of injury, neurotrauma - injuryto the central nervous system - has especiallygrave consequence

Estimates of brain and spinal cord injuryoccurrence indicates that these injuries causes

enormous lossesto individuals, families andcommunities

WHO, 1995


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SCI leads to :

IMPAIRMENT

Functional limitation

Activity restriction

DISABILITY

HANDICAP

Life long

Primary Prevention

Secondary Prevention

Tertiary Prevention

YearsBedbrook, 1985


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BEDBROOK( 1985 )

Disability process is not static

Complications can easily

worsen the handicap


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EPIDEMIOLOGY ( USA ):

Incidence : 29.4 50 / 1000.000 pop

Mostly striking the vibrant, young activeand well-educated people

Age : > 50% under 30

Male : Female : 2.4 4 : 1


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1.Vehicle crashes : 45.4 %

2.Falls : 16.8 %

3.Sport injuries : 16.3 %

4.Violence

ETIOLOGY :


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EPIDEMIOLOGY ( SBY ) 1999 2001:

Number of patients : 425

Age ( average ) : 35

Male : Female : 2.4 4.4 : 1

Frankel / ASIA : A 24 %

B 9.5 %

C 10.3 %

D 11.1%E 45.2 %

Level : Cerv. 16.9 % Th. 26.7 % L 56.4 %

Etiology : Traffic Accident 86 % Falls 14 %


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NEUROLOGICAL CLASSIFICATION

OF SCI :

SCI are classified according to the

International Standards for Neurological

and Functional classification of SCI

( ASIA and IMSOP )

Sensory function

Motor function


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TERMINOLOGIES :

1.TETRAPLEGIA

injury to SC in the cervical region

2. PARAPLEGIA :

injury in the Thoracic,Lumbar or Sacral segments

Notes : Tetraplegia and Paraplegia do no t

include lesions to per ipheral

nerves ou tside the neural canal

Quadr iparesis and Paraparesis are

imp recise and should no t be used


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SCALE FOR MOTOR TESTING :

0 : Total paralysis

1 : Trace

2 : Poor

3 : Fair

4 : Good5 : Normal

NT : Not Testable


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0 : Absent

1 : Impaired

2 : Normal

NT: Not testable

Scale for Sensory testing :

( Pin pr ick and L ight touch)


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International Standards for Neurological and

Functional Classification of SCI ( ASIA / IMSOP ):

10 MYOTOMES

28 DERMATOMES


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THE NEUROLOGICAL LEVEL :

Is the most caudal neurological

segment of the SC retains normal

sensory and motor on both sides ofthe body

T 10 Paraplegia - A

e.g.


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IMPAIRMENT SCALE :

A : Complete.No motor or sensory function is preserved in the sacral segments S4-S5

B : Incomplete.Sensory but not motor function is

preserved below the neurological level S4-S5

C : Incomplete. Motor function is preserved below

the neurological leve. Majority of key muscles

below the level : < 3

D : Incomplete.~ C , majority of key muscles > 3E : Normal.Motor and sensory function is normal


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CLINICAL SYNDROMES IN SCI :

Central Cord Syndrome

Brown

Sequard SyndromeAnterior Cord syndrome

Conus Medullaris Syndrome

Cauda Equina Syndrome


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COMPLICATIONS :

UTI, Impaired kidney function,following

neurogenic bladder dysfunction

Constipationfollowing neurogenic bowel

Pressure sorefollowing paralysis

Contracture and deformityfollowing spasticity

Pain Sexual dysfunctionand infertility

Depressionand other psychosocial problems


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Goals of Rehabilitation in Acute Care :

TO PREVENT COMPLICATIONS DUE TO

PROLONGED IMMOBILIZATION

Prevent pressure ulceration

Maintain joint ROM

Begin Bowel and Bladder Programs Begin

Sitting Program

Prevent Pulmonary complications Prevent Autonomic dysreflexia, etc

Prevent DVT


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Type A Type B

Type C Type D

Hyperreflexic detrusor

Spastic sphincter

Hyperreflexic detrusor

Areflexic sphincter

Areflexic detrusor

Spastic sphincter

Areflexic detrusor

Areflexic sphincter


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BLADDER IN ACUTE SCI :

Consequences : Securing of bladder

emptying

Methods : Intermittent catheterization ( IC )

Indwelling catheterization ( IDC )

Suprapubic catheterization

Spontaneous voiding


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AUTONOMIC DYSREFLEXIA :

An acute syndrome of massive sympathetic discharge

May occur in SCI above T6

Most common causes : Bladder and Bowel distention

Characterized by : Paroxysmal hypertension,

pounding headache, sweating, nasal congestion, facial

flushing, piloerection, reflex bradycardia

Management : patient should be placed in sitting

position to decrease cerebral blood pressure

Medications :Nifedipine, Glyceryl trinitrate


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FUNCTIONAL INDEPENDECE LEVEL

( FIM ) :

SELF CARE :Eating, Grooming, Bathing,Dressing, Toileting

SPINCTER CONTROL : Bladder, Bowel

TRANSFER :Bed-Chair-WC, Toilet, Tub-Shower

LOCOMOTION : Walk / WC, Stairs

COMMUNICATION : Comprehension, Expression

SOCIAL COGNITION : Social interaction,Problem

solving, Memory


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