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

RCS 6080Medical and Psychosocial Aspects of Rehabilitation Counseling,Spinal Cord Injury,RCS 6080Medical and Psychosoc,Anatomy of the Spine,VertebraeBodyFront section, shaped like drumSupports weightLaminaTowards the backBoney arch surrounds spinal canalSpinous processBoney process from archPoints of attachment for muscles and ligamentsDiscsCushions between vertebrae,Anatomy 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 togetherCoccyx,Anatomy of the Spine Vertebra,Anatomy of the Cord,Cervical CordC1-C2: C3-4: Phrenic nucleusC4: DeltoidsC4-5: BicepsC6: Wrist extensorsC7: TricepsC8: Wrist extensorsC8-T1: Hand muscles,Anatomy of the CordCervical Co,Anatomy of the Cord,Thoracic CordIntercostal muscles and associated dermatonesLumbarsacralStarts 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 roots,Anatomy of the CordThoracic Co,Dermatomes/Sensory Level,Dermatome: patch of skin innervated by a given spinal cord level,Dermatomes/Sensory Level,C2 to C4. The C2 dermatome,Myotomes/Motor Level,Myotome: Spinal nerve roots which innervates muscles groupsMost muscles are innervated by more than one root,Myotomes/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 Impairment Scale,ASIA 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 level and more than half of key muscles below the neurological level have a muscle grade 3ASIA E: Normal,ASIA Impairment ScaleASIA A: C,Definition of Disability,Tetraplegia (preferred to quadriplegia)Refers to impairment or loss of motor/sensory function in cervical segments of the spinal cordImpairment of function in arms, trunk, legs and pelvic organsASIA Scale vs quadriparesis,Definition of DisabilityTetrap,Definition of Disability,ParaplegiaRefers to impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cordArm function sparedPossible impairment of function in trunk, legs and pelvic organsASIA Scale vs paraparesis,Definition of DisabilityParapl,Clinical Syndromes,Central Cord Syndrome: lesion occurring almost exclusively in the cervical regionSacral sensory sparingWeakness UE vs LEBrown-Sequard Syndrome:Lesion that produces ipsilateral, proprioceptive and motor loss and contralateral loss of sensitivity to pain and temp,Clinical SyndromesCentral Cord,Clinical Syndromes,Anterior Cord Syndrome:Lesion that produces variable loss of motor function and of sensitivity while preserving proprioceptionCauda Equina Syndrome:Injury to the lumbosacral nerve roots w/ in the neurocanal resulting in areflexive bladder, bowel and lower limbs,Clinical SyndromesAnterior Cor,Achievement of Functional Goals,AgeBody typeComorbiditiesPrior athletic senseFatigue level,Type of stabilizationHX HO/POASpasticityPsychosocial factorsNutrition,Achievement of Functional Goal,Functional Outcomes,Motor/sensory recoveryAbility to perform or direct ADLsSocial reintegrationQuality of life,Functional OutcomesMotor/senso,Functional Outcomes,LEVEL C1-C3Limited head/neck movementRotate/flex neck (sternocleidomastoid)Extend neck (cervical paraspinals)Speech and swallowing (neck accessories)Total paralysis of trunk,UE and LE,Functional OutcomesLEVEL C1-C3,LEVEL: C1-3,24 hr care needsAble to direct care needsADLsVentilator dependentImpaired communicationDependent for all care needsMobilityPower wheelchairHoyer lift,LEVEL: C1-324 hr care needs,LEVEL: C1-C3,Equipment NeedsAdapted computerBedside/portable ventilatorSuction machineSpecialty bedHoyerReclining shower chair,LEVEL: C1-C3Equipment Needs,Functional Outcomes,LEVEL: C4Head and neck control (cerv paraspinals)Shoulder shrug (upper traps)Inspiration(diaphragm)Lack of shoulder control (deltoids)Paralysis of trunk, UE and LEInability to cough, low respiratory reserve,Functional OutcomesLEVEL: C4,LEVEL: C4,24 hr care needsAble to direct care needsADLsMay or may not be vent dependentImproved communicationAssisted coughDependent for all care needsMobilityPower wheelchairHoyer lift,LEVEL: C424 hr care needs,LEVEL: C4,Equipment NeedsAdapted computerBedside/portable ventilator as neededSuction machineSpecialty bedHoyerReclining shower chair,LEVEL: C4Equipment Needs,Functional Outcomes,LEVEL: C5Shoulder control (deltoids)Elbow flexion (biceps/elbow flexors)Supinate hands (brachialis and brachioradialis)Lack elbow extension and hand pronation Paralysis of trunk and LE,Functional OutcomesLEVEL: C5,LEVEL: C5,10hrs 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 transfers,LEVEL: C510hrs personal care n,LEVEL: C5,MobilityHoyer or stand pivotPower wheelchair w/ hand controlsManual wheelchairDrive motor vehicle w/ hand controlsEquipment NeedsPower and manual wheelchairsAdaptive splints/bracesPage turners/computer adaptations,LEVEL: C5Mobility,Functional Outcomes,LEVEL: C6Wrist extension (extensor 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 LE,Functional OutcomesLEVEL: C6,LEVEL: C6,6 hrs personal care needs4hrs homemaking assistanceADLsAssisted coughSet-up for feeding, bathing and dressingIndependent pressure relief, turns and skin assessmentMay be independent for bowel/bladder care,LEVEL: C66 hrs personal care n,LEVEL: C6,MobilityIndependent slide board transferManual wheelchairDrive with adaptive equipment,LEVEL: C6,Functional Outcomes,LEVEL: C7Elbow flexion and extension (biceps/triceps)Arm toward body (sternal pectoralis)Lack finger functionLack trunk stability,Functional Outcomes,LEVEL: C7,6hrs personal care needs2hrs homemaking assistanceADLsMore effective coughFewer adaptive aidsIndependent w/ all ADLsMay need adaptive aids for bowel care,LEVEL: C76hrs personal care n,LEVEL: C7,MobilityManual wheelchairTransfers without adaptive equipment,LEVEL: C7,Functional Outcomes,LEVEL: C8-T1Increased finger and hand strengthFinger flexion (flexor digitorum)Finger extension (extensor communis)Thumb movement (policus longis brevis)Separate fingers (introssi separates),Functional Outcomes,LEVEL: C8-T1,4hrs personal care needs2hrs homemaking assistanceADLsIndependent w/ or w/o assistive devicesAssist w/ complex meal prep and home managementMobilityManual wheelchair,LEVEL: C8-T14hrs personal care,Functional Outcomes,LEVEL: T2-T6Normal motor function of head, neck, shoulders, arms, hands and fingersIncreased use of intercostalsIncrease trunk control (erector spinae),Functional Outcomes,LEVEL: T2-T6,3hrs personal care needs/homemakingADLsIndependent in personal careMobilityManual wheelchairMay have limited walking with extensive bracingDrive with hand controls,LEVEL: T2-T63hrs personal care,Functional Outcomes,LEVEL: T7-T12Added motor functionIncreased abdominal controlIncreased trunk stability,Functional Outcomes,LEVEL: T7-T12,2 hrs personal care needs/homemakingADLsIndependentImproved coughImproved balance controlMobilityManual wheelchairMay have limited walking with bracingDriving with hand controls,LEVEL: T7-T122 hrs personal ca,Functional Outcomes,LEVEL: 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 Outcomes,LEVEL: L2-L5,May need 1hr personal care/homemakingADLsIndependent MobilityManual wheelchairMay walk short distance with braces and assistive devicesDriving with hand controls,LEVEL: L2-L5May need 1hr perso,Functional Outcomes,LEVEL: S1-S5Ankle plantar flexors (gastrocnemius)Various degrees of bowel, bladder and sexual functionLower level equals greater function,Functional Outcomes,LEVEL: S1-S5,No personal or homemaker needsADLsIndependentMobilityIncreased ability to walk with less adaptive/supportive devicesManual w/c for distance,LEVEL: S1-S5No personal or hom,Functional Outcomes,Achieving maximum functional outcomes provides the opportunity to reach the highest level of independence and quality of life,Functional OutcomesAchieving m,Spinal Cord Injury,Epidemiology30-40 million per year10,000 new cases per yearEtiologyMotor vehicle accident: 44.5%Falls: 18.1%Violence: 16.6% (and increasing),Spinal Cord InjuryEpidemiology,Spinal Cord Injury,ClassificationParaplegia/TetraplegiaASIA Impairment ScaleASIA Motor/SensoryFIM functional limitationsAcute Care ManagementImmediate spinal immobilizationMethylprednisolone within 8 hours of injury,Spinal Cord InjuryClassificati,Spinal Cord Injury,Economic 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 approach,Spinal Cord InjuryEconomic Con,Spinal Cord Injury,Potential ComplicationsDeep venous thrombosis (47-100%)Pulmonary embolism (3-15%)Pressure ulcers (25% annual incidence)PneumoniaAutonomic dysreflexia (usually above T6)Spasticity (78%) and Spasms (95%)Heterotopic ossification (16-53%)Gastrointestinal complications (e.g., impactions 33%),Spinal Cord InjuryPotential Co,Spinal Cord Injury,Potential ComplicationsUrinary tract infectionsChronic pain (69%, severe 33%)Overuse syndrome (35-68%)Post-traumatic syringomyelia (1-5%),Spinal Cord InjuryPotential Co,Additional Resources and Information from the Web,American Spinal Cord Injury Association (www.asia-spinalinjury.org)TIRR Spinal Cord Injury Research Program (www.tirr.org/research/?page=54)Spinal Cord Injury Information Network (www.spinalcord.uab.edu/show.asp?durki=19679)American Paraplegia Society (www.apssci.org),Additional Resources and Infor,Additional Resources and Information from the Web,National Spinal Cord Injury Association (www.spinalcord.org)Christopher & Dana Reeve Paralysis Resource Center (www.paralysis.org)Paralyzed Veterans of America (www.pva.org)American Association of Spinal Cord Injury Psychologists and Social Workers (www.aascipsw.org),Additional Resources and Infor,