1. Living Well with SpinalCord InjuryDos & Donts

2. Mark Wren, MD, MPHPhysical Medicine & RehabilitationMedical Director, HealthSouthRehabilitation Hospital of Texarkana3510 Richmond Rd Suite 400903-831-6275 3. Winningest coach of all time said Leadership, like coaching, isfighting for hearts & souls ofmen & getting them to believein you.Eddie Robinson 4. easierit would be calledfootball 5. Why is it Important?90% of SCI individuals survive 67% greater survival 1990s vs 1970s 6. History Of SCI 2500 BC - An ailment not tobe treated 1940s - Sir Ludwig Guttmannpioneers SCI rehab & patients beginto survive with surgery & antibiotics 7. History Of SCI 1990 - High doseMethylprednisolone within8 hours of injury 1996 - Peripheral nerve bridges 8. Anatomy 101The Nervous System 9. Function Equals Form Cervical Thoracic Lumbar and Sacral 10. SCI Myth #1People with SCI cannot lead an active life 11. Mechanism Injury Flexion Hyperextension Compression Rotation 12. 12,000 new SCI cases in the United Stateseach year, 25% to 33% of these individualsregain some degree of ambulation by thetime of discharge Melissa Riggins, Michael Boniger 13. The Cytotoxic Cascade 14. Axonal Regeneration PERIPHERAL - Schwann cellspromote growth of nerve fibers CNS - Oligodendrocytes inhibitgrowth of axons 15. The Future Reduce secondary injury -neuroprotection Immunotherapy - antiinflammatory Nerve growth factor Axonal bridges Motor neuron implants Control collateral sprouting 16. SCI research Chondroitinase ABC + rehabimproves forelimb function bysprouting cortiocospinal tract inchronic SCI, allowing rehab &improved function PTEN deletion enables injured SCIneurons to mount a robustregenerative response never seenbefore in mammals 17. SCI research Epidural stimulation + task-specifictraining may reactivate previously silentspared neural circuits or promoteplasticity Miami project begins transplant ofschwann cells in humans (FDA phase 1,we believe is as important as mans 1ststep on the moon! 18. Hope for Recovery!My Mayo Clinic professor said,Dont take away hope.Let us hold unswervingly to thehope we profess, for he whopromised is faithful. Hebrews 10:23 19. It Might NOT be today 20. Hope is the only thing stronger than fear Hunger Games 21. Clinicaltrials.gov 22. Classification ofSpinal Cord Injury 23. Touring ASIAA: Complete InjuryB: Incomplete Injury (preserved sensation only)C: Incomplete Injury (some sensory and motor function preserved) 24. Touring ASIAD: Incomplete Injury (preserved motor function)E: Normal 25. Golden Rules1. Rehabilitation is a long process2. Treatment should not focus completely on physical deficits3. Recreational & vocational therapies are essential 26. Golden Rules4. Rehabilitation must include and involve the family5. You must realistically believe that improvement is possible 27. The Six Arenas Mobility Bladder and bowel Sexuality Skin care Complications Emotional issues 28. Mobility Therapy Transfer techniques ROM exercises Positioning Pressure relief Stretching Strengthening 29. Biofeedback and Facilitation 30. Spinning Your Wheels Manual Powerchair 31. Wheelchair Tips Control Tires Brakes Leg rests and footrests Arm rests Seats and cushions 32. Bladder and Bowel 33. Failure to Store vs.Failure to Empty 34. Alternatives Intermittent catheterizationprogram Foley catheter Suprapubic catheter Bladder augmentation - diversion Condom catheter 35. Bowel Management Regularprogram Stool softeners Bulk Medications Exercise 36. Sexuality Sex Drives Rules1. Feeling good about yourself (take care: PAP, mammogram, colonoscopy ect)2. Having the ability to communicate3. Using all your senses4. Using common sense doesnt hurt 37. SCI Myth #2People with SCI cannot have children 38. Sexual Changes In Women Loss of sensation Loss of lubrication Enhancement other sensesabove the level of injury Initial loss of menstrual cycle Alternative to oralcontraceptive (>DVT risk) 39. Sexual Changes In Men Psychogenic erections Reflex erections Vasoactive substances Vacuum tumescence constrictiontherapy Penile prostheses Viagra 40. Skin Care Loss of sensation Pressure relief Pressure sores ProtectionInspectionProtection 41. Avoid Spilling hot foods (burns) Smoking (15 year shorter lifespan) Extreme weather (less adaptation) Too much skin moisture (yeast) Tight clothing (ulcer) 42. Positions Please! 43. SCI Complications 44. Autonomic Dysreflexia Usually injuries above T6 Pounding headache Chills Profuse sweating Flushing Blurred vision Stuffed nose 45. What To Do ! Sit up Stop - look - listen Catheter check - fullbladder Constipation - impaction Infection Irritants Nitroglycerin paste 46. Spasticity Excessive muscle tone Extension or flexion Can be a friend or foe Worsened by: pressuresores, full bladder,constipation, stress 47. Spasticity Treatment Therapy Medication Standingprogram/proning Splints BOTOX Intrathecal Baclofen (ITB) Surgery 48. Other Complications UTI, stones, renalfailure (annual US,BUN/Cr) Heterotopic ossification(ROM) Osteoporosis (DEXA) Bowel obstruction, 49. Other Complications Deep veinthrombosis lovenox8-12wk, ASA Gallstones Pneumonia Syringomyelia 50. Emotional Responses Depression Alcohol and substance abuse Violence Dependency Anxiety 51. Kbler-Ross Six Stages1. Denial2. Anger3. Bargaining4. Depression5. Acceptance6. Hope 52. SCI Myth #3People with SCI end updivorced or in bad marriages 53. Organizations