Medical-and-Psychosocial-Aspects-of-Rehabilitation-Counseling康复咨询的医疗和心理方面(-53)课件

1、RCS 6080Medical and Psychosocial Aspects of Rehabilitation CounselingSpinal Cord InjuryRCS 6080Medical and PsychosocAnatomy of the SpineVertebraeBodyFront section, shaped like drumSupports weightLaminaTowards the backBoney arch surrounds spinal canalSpinous processBoney process from archPoints of at

2、tachment for muscles and ligamentsDiscsCushions between vertebraeAnatomy of the SpineVertebrae Anatomy of the Spine Vertebrae:7 CervicalFlexion, extension, bending and turning of head12 ThoracicChest region, allows mostly for rotation5 LumbarLarger boney structures to support added wgt 5 SacralFused

3、 togetherCoccyxAnatomy of the Spine Vertebra Anatomy of the CordCervical CordC1-C2: C3-4: Phrenic nucleusC4: DeltoidsC4-5: BicepsC6: Wrist extensorsC7: TricepsC8: Wrist extensorsC8-T1: Hand musclesAnatomy of the CordCervical CoAnatomy of the CordThoracic CordIntercostal muscles and associated dermat

4、onesLumbarsacralStarts at T9 and continues to L2Innervates hips, legs, buttocks and anal regionCauda Equina (horses tail)Spinal cord ends at L2Tip called conus, below conus a spray of spinal rootsAnatomy of the CordThoracic Co Dermatomes/Sensory LevelDermatome: patch of skin innervated by a given sp

5、inal cord levelDermatomes/Sensory Level C2 to C4. The C2 dermatome Myotomes/Motor LevelMyotome: Spinal nerve roots which innervates muscles groupsMost muscles are innervated by more than one rootMyotomes/Motor Level Medical-and-Psychosocial-Aspects-of-Rehabilitation-Counseling康复咨询的医疗和心理方面(-53)课件ASIA

6、 Impairment ScaleASIA A: Complete: no motor or sensory function is preserved in the sacral segments S4-S5ASIA B: Incomplete: sensory but NOT motor function is preserved below the neurological level and includes the sacral segmentsASIA C: Incomplete: motor function is preserved below the neurological

7、 level and more than half of key muscles below the neurological level have a muscle grade 3ASIA E: NormalASIA Impairment ScaleASIA A: CDefinition of DisabilityTetraplegia (preferred to quadriplegia)Refers to impairment or loss of motor/sensory function in cervical segments of the spinal cordImpairme

8、nt of function in arms, trunk, legs and pelvic organsASIA Scale vs quadriparesisDefinition of DisabilityTetrapDefinition of DisabilityParaplegiaRefers to impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cordArm function sparedPossible impairment of fu

9、nction in trunk, legs and pelvic organsASIA Scale vs paraparesisDefinition of DisabilityParaplClinical SyndromesCentral Cord Syndrome: lesion occurring almost exclusively in the cervical regionSacral sensory sparingWeakness UE vs LEBrown-Sequard Syndrome:Lesion that produces ipsilateral, propriocept

10、ive and motor loss and contralateral loss of sensitivity to pain and tempClinical SyndromesCentral CordClinical SyndromesAnterior Cord Syndrome:Lesion that produces variable loss of motor function and of sensitivity while preserving proprioceptionCauda Equina Syndrome:Injury to the lumbosacral nerve

11、 roots w/ in the neurocanal resulting in areflexive bladder, bowel and lower limbsClinical SyndromesAnterior CorAchievement of Functional GoalsAgeBody typeComorbiditiesPrior athletic senseFatigue levelType of stabilizationHX HO/POASpasticityPsychosocial factorsNutritionAchievement of Functional Goal

12、Functional OutcomesMotor/sensory recoveryAbility to perform or direct ADLsSocial reintegrationQuality of lifeFunctional OutcomesMotor/sensoFunctional OutcomesLEVEL C1-C3Limited head/neck movementRotate/flex neck (sternocleidomastoid)Extend neck (cervical paraspinals)Speech and swallowing (neck acces

13、sories)Total paralysis of trunk,UE and LEFunctional OutcomesLEVEL C1-C3LEVEL: C1-324 hr care needsAble to direct care needsADLsVentilator dependentImpaired communicationDependent for all care needsMobilityPower wheelchairHoyer lift LEVEL: C1-324 hr care needsLEVEL: C1-C3Equipment NeedsAdapted comput

14、erBedside/portable ventilatorSuction machineSpecialty bedHoyerReclining shower chairLEVEL: C1-C3Equipment NeedsFunctional OutcomesLEVEL: C4Head and neck control (cerv paraspinals)Shoulder shrug (upper traps)Inspiration(diaphragm)Lack of shoulder control (deltoids)Paralysis of trunk, UE and LEInabili

15、ty to cough, low respiratory reserveFunctional OutcomesLEVEL: C4LEVEL: C424 hr care needsAble to direct care needsADLsMay or may not be vent dependentImproved communicationAssisted coughDependent for all care needsMobilityPower wheelchairHoyer liftLEVEL: C424 hr care needsLEVEL: C4Equipment NeedsAda

16、pted computerBedside/portable ventilator as neededSuction machineSpecialty bedHoyerReclining shower chairLEVEL: C4Equipment NeedsFunctional OutcomesLEVEL: C5Shoulder control (deltoids)Elbow flexion (biceps/elbow flexors)Supinate hands (brachialis and brachioradialis)Lack elbow extension and hand pro

17、nation Paralysis of trunk and LEFunctional OutcomesLEVEL: C5LEVEL: C510hrs personal care need6 hrs homemaking assistanceADLsSet-up/equipment: eating, drinking, face wash and teethAssisted coughDependent for bowel, bladder and lower body hygiene Dependent for bed mobility and transfersLEVEL: C510hrs

18、personal care nLEVEL: C5MobilityHoyer or stand pivotPower wheelchair w/ hand controlsManual wheelchairDrive motor vehicle w/ hand controlsEquipment NeedsPower and manual wheelchairsAdaptive splints/bracesPage turners/computer adaptationsLEVEL: C5MobilityFunctional OutcomesLEVEL: C6Wrist extension (e

19、xtensor carpi ulnaris and extensor carpi radialis longus/brevis)Arm across chest (clavicular pectrocialis)Lack elbow extension (triceps)Lack wrist flexion Lack hand controlParalysis of trunk and LEFunctional OutcomesLEVEL: C6LEVEL: C66 hrs personal care needs4hrs homemaking assistanceADLsAssisted co

20、ughSet-up for feeding, bathing and dressingIndependent pressure relief, turns and skin assessmentMay be independent for bowel/bladder careLEVEL: C66 hrs personal care nLEVEL: C6MobilityIndependent slide board transferManual wheelchairDrive with adaptive equipmentLEVEL: C6Functional OutcomesLEVEL: C7

21、Elbow flexion and extension (biceps/triceps)Arm toward body (sternal pectoralis)Lack finger functionLack trunk stabilityFunctional OutcomesLEVEL: C76hrs personal care needs2hrs homemaking assistanceADLsMore effective coughFewer adaptive aidsIndependent w/ all ADLsMay need adaptive aids for bowel car

22、eLEVEL: C76hrs personal care nLEVEL: C7MobilityManual wheelchairTransfers without adaptive equipmentLEVEL: C7Functional OutcomesLEVEL: C8-T1Increased finger and hand strengthFinger flexion (flexor digitorum)Finger extension (extensor communis)Thumb movement (policus longis brevis)Separate fingers (i

23、ntrossi separates)Functional OutcomesLEVEL: C8-T14hrs personal care needs2hrs homemaking assistanceADLsIndependent w/ or w/o assistive devicesAssist w/ complex meal prep and home managementMobilityManual wheelchairLEVEL: C8-T14hrs personal careFunctional OutcomesLEVEL: T2-T6Normal motor function of

24、head, neck, shoulders, arms, hands and fingersIncreased use of intercostalsIncrease trunk control (erector spinae)Functional OutcomesLEVEL: T2-T63hrs personal care needs/homemakingADLsIndependent in personal careMobilityManual wheelchairMay have limited walking with extensive bracingDrive with hand

25、controlsLEVEL: T2-T63hrs personal careFunctional OutcomesLEVEL: T7-T12Added motor functionIncreased abdominal controlIncreased trunk stabilityFunctional OutcomesLEVEL: T7-T122 hrs personal care needs/homemakingADLsIndependentImproved coughImproved balance controlMobilityManual wheelchairMay have lim

26、ited walking with bracingDriving with hand controlsLEVEL: T7-T122 hrs personal caFunctional OutcomesLEVEL: L2-L5Added motor function in hips and kneesL2 Hip flexors (iliopsas)L3 Knee extensors (quadriceps)L4 Ankle dorsiflexors (tibialis anterior)L 5 Long toe extensors (ext hallucis longus)Functional

27、 OutcomesLEVEL: L2-L5May need 1hr personal care/homemakingADLsIndependent MobilityManual wheelchairMay walk short distance with braces and assistive devicesDriving with hand controlsLEVEL: L2-L5May need 1hr persoFunctional OutcomesLEVEL: S1-S5Ankle plantar flexors (gastrocnemius)Various degrees of b

28、owel, bladder and sexual functionLower level equals greater functionFunctional OutcomesLEVEL: S1-S5No personal or homemaker needsADLsIndependentMobilityIncreased ability to walk with less adaptive/supportive devicesManual w/c for distanceLEVEL: S1-S5No personal or homFunctional OutcomesAchieving max

29、imum functional outcomes provides the opportunity to reach the highest level of independence and quality of lifeFunctional OutcomesAchieving mSpinal Cord InjuryEpidemiology30-40 million per year10,000 new cases per yearEtiologyMotor vehicle accident: 44.5%Falls: 18.1%Violence: 16.6% (and increasing)

30、Spinal Cord InjuryEpidemiologySpinal Cord InjuryClassificationParaplegia/TetraplegiaASIA Impairment ScaleASIA Motor/SensoryFIM functional limitationsAcute Care ManagementImmediate spinal immobilizationMethylprednisolone within 8 hours of injurySpinal Cord InjuryClassificatiSpinal Cord InjuryEconomic ConsequencesBetween $7.3 billion and $8.3 billion per yearA person with a high cervical injury at age 25 incurs lifetime costs of more than $3 millionRehabilitation TreatmentSystematic, intensive, coordinated team approachSpinal Cord InjuryEconomic ConSpinal Cord InjuryPotential ComplicationsDeep