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Bayu SantosoDepartment of Physical Medicine and Rehabilitation
School of Medicine Airlangga UniversityDr. Soetomo General Hospital
Surabaya
REHABILITATION OF SPINALCORD INJURY PATIENT
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INTRODUCTION
Among all types of injury, neurotrauma - injuryto the central nervous system - has especiallygrave consequence
Estimates of brain and spinal cord injuryoccurrence indicates that these injuries causes
enormous lossesto individuals, families andcommunities
WHO, 1995
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SCI leads to :
IMPAIRMENT
Functional limitation
Activity restriction
DISABILITY
HANDICAP
Life long
Primary Prevention
Secondary Prevention
Tertiary Prevention
YearsBedbrook, 1985
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BEDBROOK( 1985 )
Disability process is not static
Complications can easily
worsen the handicap
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EPIDEMIOLOGY ( USA ):
Incidence : 29.4 50 / 1000.000 pop
Mostly striking the vibrant, young activeand well-educated people
Age : > 50% under 30
Male : Female : 2.4 4 : 1
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1.Vehicle crashes : 45.4 %
2.Falls : 16.8 %
3.Sport injuries : 16.3 %
4.Violence
ETIOLOGY :
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EPIDEMIOLOGY ( SBY ) 1999 2001:
Number of patients : 425
Age ( average ) : 35
Male : Female : 2.4 4.4 : 1
Frankel / ASIA : A 24 %
B 9.5 %
C 10.3 %
D 11.1%E 45.2 %
Level : Cerv. 16.9 % Th. 26.7 % L 56.4 %
Etiology : Traffic Accident 86 % Falls 14 %
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NEUROLOGICAL CLASSIFICATION
OF SCI :
SCI are classified according to the
International Standards for Neurological
and Functional classification of SCI
( ASIA and IMSOP )
Sensory function
Motor function
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TERMINOLOGIES :
1.TETRAPLEGIA
injury to SC in the cervical region
2. PARAPLEGIA :
injury in the Thoracic,Lumbar or Sacral segments
Notes : Tetraplegia and Paraplegia do no t
include lesions to per ipheral
nerves ou tside the neural canal
Quadr iparesis and Paraparesis are
imp recise and should no t be used
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SCALE FOR MOTOR TESTING :
0 : Total paralysis
1 : Trace
2 : Poor
3 : Fair
4 : Good5 : Normal
NT : Not Testable
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0 : Absent
1 : Impaired
2 : Normal
NT: Not testable
Scale for Sensory testing :
( Pin pr ick and L ight touch)
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International Standards for Neurological and
Functional Classification of SCI ( ASIA / IMSOP ):
10 MYOTOMES
28 DERMATOMES
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THE NEUROLOGICAL LEVEL :
Is the most caudal neurological
segment of the SC retains normal
sensory and motor on both sides ofthe body
T 10 Paraplegia - A
e.g.
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IMPAIRMENT SCALE :
A : Complete.No motor or sensory function is pre- served in the sacral segments S4-S5
B : Incomplete.Sensory but not motor function is
preserved below the neurological level S4-S5
C : Incomplete. Motor function is preserved below
the neurological leve. Majority of key muscles
below the level : < 3
D : Incomplete.~ C , majority of key muscles > 3E : Normal.Motor and sensory function is normal
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CLINICAL SYNDROMES IN SCI :
Central Cord Syndrome
Brown
Sequard SyndromeAnterior Cord syndrome
Conus Medullaris Syndrome
Cauda Equina Syndrome
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COMPLICATIONS :
UTI, Impaired kidney function,following
neurogenic bladder dysfunction
Constipationfollowing neurogenic bowel
Pressure sorefollowing paralysis
Contracture and deformityfollowing spasticity
Pain Sexual dysfunctionand infertility
Depressionand other psychosocial problems
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Goals of Rehabilitation in Acute Care :
TO PREVENT COMPLICATIONS DUE TO
PROLONGED IMMOBILIZATION
Prevent pressure ulceration
Maintain joint ROM
Begin Bowel and Bladder Programs Begin
Sitting Program
Prevent Pulmonary complications Prevent Autonomic dysreflexia, etc
Prevent DVT
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Type A Type B
Type C Type D
Hyperreflexic detrusor
Spastic sphincter
Hyperreflexic detrusor
Areflexic sphincter
Areflexic detrusor
Spastic sphincter
Areflexic detrusor
Areflexic sphincter
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BLADDER IN ACUTE SCI :
Consequences : Securing of bladder
emptying
Methods : Intermittent catheterization ( IC )
Indwelling catheterization ( IDC )
Suprapubic catheterization
Spontaneous voiding
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AUTONOMIC DYSREFLEXIA :
An acute syndrome of massive sympathetic discharge
May occur in SCI above T6
Most common causes : Bladder and Bowel distention
Characterized by : Paroxysmal hypertension,
pounding headache, sweating, nasal congestion, facial
flushing, piloerection, reflex bradycardia
Management : patient should be placed in sitting
position to decrease cerebral blood pressure
Medications :Nifedipine, Glyceryl trinitrate
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FUNCTIONAL INDEPENDECE LEVEL
( FIM ) :
SELF CARE :Eating, Grooming, Bathing,Dressing, Toileting
SPINCTER CONTROL : Bladder, Bowel
TRANSFER :Bed-Chair-WC, Toilet, Tub-Shower
LOCOMOTION : Walk / WC, Stairs
COMMUNICATION : Comprehension, Expression
SOCIAL COGNITION : Social interaction,Problem
solving, Memory
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