Management of the Patient w/ Spinal Injury: Acute Through Rehab

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  1. Spinal Shock
    • Complete loss! (of motor and sensory)
    • Secondary to acute SC injury
    • Transient absence of voluntary and reflex activity below level of injury
    • Can last days (more common) to months
  2. Autonomic Dysreflexia
    • T2 level or above - run risk of autonomic system getting set off (specifically sympathetic)
    • Caused by stress, full bladder/bowel, increased pressure, movement activity, sexual activity
    • ⇒ Widespread vasoconstriction, hypertension, baroreceptors ⇒ HR increased but BP drops
  3. ROM Considerations: UE
    • Neck: don't overstretch/avoid several pillows, can interfere w/ balance and respiration
    • Trunk: don't overstretch (esp. low back), provides passive stability for transfer/rolling/aids proper seating and respiration
    • Shoulders: 0-120 ext, 0-90 IR/ER, aids bed mobility, hooking chair, permits elbow ext w/o triceps function (reverse biceps action)
    • Elbow/Forearm: need full pronation/supination ROM, aids dressing/ADLs
    • Wrist: ext 0-90, linear WB, maximal tenodesis grip
    • Finger Flexors/Thumb Web Space: don't overstretch, tenodesis and hooking for ADL's
  4. ROM Considerations: LE
    • Hip: flex 0-120, ER 0-90, IR 0-45, aids dressing, bed mobility, transfers/brace walking, prone lying
    • Hamstring Extensibility: 0-110/120 SLR, long sit, dressing, transfers & brace walking
    • Ankle DF: need neutral position at minimum, provides suability for transfers, avoid met head breakdown, ambulation w/ braces
  5. Autonomic Changes w/ SCI
    • Spinal shock (initially)
    • Bowel/bladder
    • Postural hypotension
    • Autonomic dysreflexia
    • Sexual dysfunction
    • DVT
    • Impaired temperature regulation
Card Set
Management of the Patient w/ Spinal Injury: Acute Through Rehab
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