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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 Presentation
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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
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
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)
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)
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 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
FES bike
Potential benefits: Cardiovascular Circulation Bone density Muscle mass Sense of well-being Neurological
improvement
FES = functional electrical stimulation
Surgical Management
Spine stabilization Instability: under normal physiologic
loads there is potential for deformity, additional neurologic deficit, or incapacitating pain
Spinal cord decompression
Surgical Management
Tendon transfers Gain function Eliminate need for assistive devices
Surgical Management
Experimental Neural Transplantation (regenerative & reconstructive cellular strategies) Adult stem cells Embryonic stem cells Olfactory mucosal cells
Length of Stay
Acute care unit (hospital) 25 days – 1974 18 days – 2004
Rehab unit 115 days – 1974 39 days – 2004
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
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)
Social Aspects of SCI
Quality of social support has a positive relationship with adjustment & enhancing independent functioning
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
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
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
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
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
Vocation Benefits
Economical Quality of life
Self esteem Self identity Life satisfaction/well being Psychological adjustment to disability
Assistive technology resources
www.agrabilityproject.org/assistivetech/ www.abledata.com
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