Keterangan
Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Chronic and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients’ functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life.
Ringkasan
- The presentation covers the management of chronic spinal cord injury (SCI), classifying it as complete (sacral segments involved) or incomplete, and paraplegia (thoracic, lumbar, sacral) or quadriplegia (cervical involvement). SCI limitations include mobility, self-care, domestic activities, education, employment, social relationships, and leisure. Complications depend on the spinal cord injury segment, such as breathing issues with C1-C4 involvement and bladder/bowel issues with S2-S5.
- Autonomic dysreflexia, a complication of SCI, is triggered by stimuli like bowel/bladder distension or pressure ulcers, leading to a sudden BP increase. Management includes elevating the patient, loosening clothing, and addressing the cause (e.g., catheter blockage). DVT is another risk, with prevention involving anticoagulants, compression stockings, and ankle pumps. Orthostatic hypotension, common in bedridden patients, is managed with postural changes, high salt intake, and medications like midodrine.
- Neurogenic bladder and urinary tract infections are common complications. Bladder management strategies include intermittent catheterization, indwelling catheters, and suprapubic cystostomy. The presentation emphasized maintaining a bladder diary to plan CIC frequency and manage water intake. Bowel issues, such as constipation and incontinence, are addressed with nutrition, fluid intake, bowel enemas, and a regular bowel movement routine.
- Spasticity, a velocity-dependent increase in muscle tone, is managed through physical therapy, progressive casting, Botox injections, and medications like baclofen. Subacute osteoporosis is addressed with calcium and vitamin D supplementation, diet, and care during transfers. Heterotopic ossification is managed with bisphosphonates, anti-inflammatory drugs, and surgery. Respiratory complications, such as pneumonia, are managed with breathing exercises, chest physical therapy, and vaccination.
- Pressure ulcers are prevented through weight transfers, bed positioning, wheelchair adjustments, and regular skin checks. Management includes ripple beds, air-fluidized beds, nutrition, and regular dressing changes. Neuropathic pain is managed with medications and counseling. Sexual dysfunction is addressed with counseling, medical care, positioning, birth control, and assisted devices for arousal. Functional outcomes achievable depend on the SCI level.
- The Royal College of Physicians' guidelines emphasize self-awareness, training, and assessment in SCI management. Early detection of complications, such as respiratory problems, autonomic dysreflexia, and pressure ulcers, is crucial. Discharge planning involves the patient, family, and relevant team members, including transport, housing assessment, and community care coordination. Key is the early identification of acute complications and comprehensive treatment.
Contoh Sertifikat
Tentang Pembicara
Dr.Sharad Kumar Kedia
Consultant Physiatrist, Rehabilitation Physician and Director Of college of Physical Therapy & Occupational Therapy at NIMS University
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