hip flexors (l2) knee extensors (l3)
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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T10 – L1 Levels Expected Functional Outcomes Equipment
Respiratory
Bowel Independent • Elevated or standard padded toilet seat
Bladder Independent
Bed Mobility Independent • Full to king standard bed
Transfers Independent • May need transfer board
Pressure relief Independent W/C pressure-relief cushion Postural support devices as indicated Pressure-relief mattress or overlay may be indicated
Eating Independent
Dressing Independent
Grooming Independent
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T10 – L1 Levels Expected Functional Outcomes Equipment
Bathing Independent • Handheld shower• Padded tub transfer bench
W/C propulsion Independent • Manual lightweight rigid or folding W/C
Standing/ Ambulation
Standing: Independent Ambulation: some assist to independent
• Standard standing frame• Forearm crutches or walker• Knee, ankle, foot orthosis (KAFO)
Communication Independent
Transportation Independent in car, including W/C loading/unloading
• Hand controls
Homemaking Independent complex meal prep and light housecleaning; some assist for heavy housekeeping
Assist Required • Homecare: 2 hours/day
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L2 – S5 Levels Expected Functional Outcomes Equipment
Respiratory
Bowel Independent • Standard padded toilet seat
Bladder Independent
Bed Mobility Independent • Full to king standard bed
Transfers Independent • May need transfer board
Pressure relief Independent • W/C pressure-relief cushion• Postural support devices as indicated
Eating Independent
Dressing Independent
Grooming Independent
Hip flexors (L2) Knee extensors (L3)
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L2 – S5 Levels Expected Functional Outcomes Equipment
Bathing Independent • Handheld shower• Padded tub transfer bench
W/C propulsion Independent • Manual lightweight rigid or folding W/C
Standing/ Ambulation
Standing: Independent Ambulation: some assist to independent
• Standard standing frame• Forearm crutches or cane as indicated• Knee, ankle, foot orthosis (KAFO) or ankle, foot orthosis (AFO)
Communication Independent
Transportation Independent in car, including W/C loading/unloading
• Hand controls
Homemaking Independent complex meal prep and light housecleaning; some assist for heavy housekeeping
Assist Required • Homecare: 0-1 hours/day
Hip flexors (L2)Knee extensors (L3)
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Medical Treatment after SCI
Methylprednisolone “steroids” for traumatic SCI within 8 hours of injury standard of care vs. experimental
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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
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FES bike
Potential benefits: Cardiovascular Circulation Bone density Muscle mass Sense of well-being Neurological
improvement
FES = functional electrical stimulation
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Surgical Management
Spine stabilization Instability: under normal physiologic
loads there is potential for deformity, additional neurologic deficit, or incapacitating pain
Spinal cord decompression
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Surgical Management
Tendon transfers Gain function Eliminate need for assistive devices
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Surgical Management
Experimental Neural Transplantation (regenerative & reconstructive cellular strategies) Adult stem cells Embryonic stem cells Olfactory mucosal cells
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Length of Stay
Acute care unit (hospital) 25 days – 1974 18 days – 2004
Rehab unit 115 days – 1974 39 days – 2004
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Lifetime Costs
Severity of Injury First Year
Each Subsequent Year
25 years old 50 years old
High Tetraplegia (C1-C4)
$741,425 $132,807 $2,924,513 $1,721,677
Low Tetraplegia (C5-C8)
$478,782 $54,400 $1,653,607 $1,047,189
Paraplegia $270,913 $27,568 $977,142 $666,473
Incomplete Motor Functional at Any Level
$218,504 $15,313 $561,827 $472,392
Average Yearly Expenses(in May 2006 dollars)
Estimated Lifetime Costs ByAge at Injury
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Life Expectancy
Age at Injury
No SCI Para Low Tetra (C5-C8) High Tetra (C1-C4) Ventilator Dependent
20 58.4 46.3 41.7 37.9 23.3
40 39.5 28.6 24.7 21.6 11.1
60 22.2 13.5 10.8 8.8 3.1
Life Expectancy (years) post-injury by severity and age(for persons surviving at least 1 year after injury)
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Social Aspects of SCI
Quality of social support has a positive relationship with adjustment & enhancing independent functioning
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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
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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
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Vocation 64% employed at time of injury
(if between 16 – 59 years old) Post-injury employment increases with time
0
10
20
30
40
50
1 2 5 10 15 20 25
paraplegia tetraplegia% Patients
Year Post-injury
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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
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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
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Vocation Benefits
Economical Quality of life
Self esteem Self identity Life satisfaction/well being Psychological adjustment to disability
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Assistive technology resources
www.agrabilityproject.org/assistivetech/ www.abledata.com
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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