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

1、RCS 6080Medical and Psychosocial Aspects of Rehabilitation CounselingSpinal Cord InjuryAnatomy of the SpinenVertebraenBodynFront section,shaped like drumnSupports weightnLaminanTowards the backnBoney arch surrounds spinal canalnSpinous processnBoney process from archnPoints of attachment for muscles

2、 and ligamentsnDiscsnCushions between vertebrae Anatomy of the Spinen Vertebrae:n7 CervicalnFlexion,extension,bending and turning of headn12 ThoracicnChest region,allows mostly for rotationn5 LumbarnLarger boney structures to support added wgtn 5 SacralnFused togethernCoccyx Anatomy of the CordnCerv

3、ical CordnC1-C2:nC3-4:Phrenic nucleusnC4:DeltoidsnC4-5:BicepsnC6:Wrist extensorsnC7:TricepsnC8:Wrist extensorsnC8-T1:Hand musclesAnatomy of the CordnThoracic CordnIntercostal muscles and associated dermatonesnLumbarsacralnStarts at T9 and continues to L2nInnervates hips,legs,buttocks and anal region

4、nCauda Equina(horses tail)nSpinal cord ends at L2nTip called conus,below conus a spray of spinal roots Dermatomes/Sensory LevelnDermatome:npatch of skin innervated by a given spinal cord level C2 to C4.The C2 dermatome Myotomes/Motor LevelnMyotome:nSpinal nerve roots which innervates muscles groupsn

5、Most muscles are innervated by more than one root ASIA Impairment ScalenASIA A:Complete:no motor or sensory function is preserved in the sacral segments S4-S5nASIA B:Incomplete:sensory but NOT motor function is preserved below the neurological level and includes the sacral segmentsnASIA C:Incomplete

6、:motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade 3nASIA E:NormalDefinition of DisabilitynTetraplegia(preferred to quadriplegia)nRefers to impairment or loss of motor/sensory function in cervical segments of t

7、he spinal cordnImpairment of function in arms,trunk,legs and pelvic organsnASIA Scale vs quadriparesisDefinition of DisabilitynParaplegianRefers to impairment or loss of motor/sensory function in thoracic,lumbar or sacral segments of the spinal cordnArm function sparednPossible impairment of functio

8、n in trunk,legs and pelvic organsnASIA Scale vs paraparesisClinical SyndromesnCentral Cord Syndrome:nlesion occurring almost exclusively in the cervical regionnSacral sensory sparingnWeakness UE vs LEnBrown-Sequard Syndrome:nLesion that produces ipsilateral,proprioceptive and motor loss and contrala

9、teral loss of sensitivity to pain and tempClinical SyndromesnAnterior Cord Syndrome:nLesion that produces variable loss of motor function and of sensitivity while preserving proprioceptionnCauda Equina Syndrome:nInjury to the lumbosacral nerve roots w/in the neurocanal resulting in areflexive bladde

10、r,bowel and lower limbsAchievement of Functional GoalsnAgenBody typenComorbiditiesnPrior athletic sensenFatigue levelnType of stabilizationnHX HO/POAnSpasticitynPsychosocial factorsnNutritionFunctional OutcomesnMotor/sensory recoverynAbility to perform or direct ADLsnSocial reintegrationnQuality of

11、lifeFunctional OutcomesnLEVEL C1-C3nLimited head/neck movementnRotate/flex neck(sternocleidomastoid)nExtend neck(cervical paraspinals)nSpeech and swallowing(neck accessories)nTotal paralysis of trunk,UE and LELEVEL:C1-3n24 hr care needsnAble to direct care needsnADLsnVentilator dependentnImpaired co

12、mmunicationnDependent for all care needsnMobilitynPower wheelchairnHoyer lift LEVEL:C1-C3nEquipment NeedsnAdapted computernBedside/portable ventilatornSuction machinenSpecialty bednHoyernReclining shower chairFunctional OutcomesnLEVEL:C4nHead and neck control(cerv paraspinals)nShoulder shrug(upper t

13、raps)nInspiration(diaphragm)nLack of shoulder control(deltoids)nParalysis of trunk,UE and LEnInability to cough,low respiratory reserveLEVEL:C4n24 hr care needsnAble to direct care needsnADLsnMay or may not be vent dependentnImproved communicationnAssisted coughnDependent for all care needsnMobility

14、nPower wheelchairnHoyer liftLEVEL:C4nEquipment NeedsnAdapted computernBedside/portable ventilator as needednSuction machinenSpecialty bednHoyernReclining shower chairFunctional OutcomesnLEVEL:C5nShoulder control(deltoids)nElbow flexion(biceps/elbow flexors)nSupinate hands(brachialis and brachioradia

15、lis)nLack elbow extension and hand pronation nParalysis of trunk and LELEVEL:C5n10hrs personal care needn6 hrs homemaking assistancenADLsnSet-up/equipment:eating,drinking,face wash and teethnAssisted coughnDependent for bowel,bladder and lower body hygiene nDependent for bed mobility and transfersLE

16、VEL:C5nMobilitynHoyer or stand pivotnPower wheelchair w/hand controlsnManual wheelchairnDrive motor vehicle w/hand controlsnEquipment NeedsnPower and manual wheelchairsnAdaptive splints/bracesnPage turners/computer adaptationsFunctional OutcomesnLEVEL:C6nWrist extension(extensor carpi ulnaris and ex

17、tensor carpi radialis longus/brevis)nArm across chest(clavicular pectrocialis)nLack elbow extension(triceps)nLack wrist flexion nLack hand controlnParalysis of trunk and LELEVEL:C6n6 hrs personal care needsn4hrs homemaking assistancenADLsnAssisted coughnSet-up for feeding,bathing and dressingnIndepe

18、ndent pressure relief,turns and skin assessmentnMay be independent for bowel/bladder careLEVEL:C6MobilitynIndependent slide board transfernManual wheelchairnDrive with adaptive equipmentFunctional OutcomesnLEVEL:C7nElbow flexion and extension(biceps/triceps)nArm toward body(sternal pectoralis)nLack

19、finger functionnLack trunk stabilityLEVEL:C7n6hrs personal care needsn2hrs homemaking assistancenADLsnMore effective coughnFewer adaptive aidsnIndependent w/all ADLsnMay need adaptive aids for bowel careLEVEL:C7nMobilitynManual wheelchairnTransfers without adaptive equipmentFunctional OutcomesnLEVEL

20、:C8-T1nIncreased finger and hand strengthnFinger flexion(flexor digitorum)nFinger extension(extensor communis)nThumb movement(policus longis brevis)nSeparate fingers(introssi separates)LEVEL:C8-T1n4hrs personal care needsn2hrs homemaking assistancenADLsnIndependent w/or w/o assistive devicesnAssist

21、w/complex meal prep and home managementnMobilitynManual wheelchairFunctional OutcomesnLEVEL:T2-T6nNormal motor function of head,neck,shoulders,arms,hands and fingersnIncreased use of intercostalsnIncrease trunk control(erector spinae)LEVEL:T2-T6n3hrs personal care needs/homemakingnADLsnIndependent i

22、n personal carenMobilitynManual wheelchairnMay have limited walking with extensive bracingnDrive with hand controlsFunctional OutcomesnLEVEL:T7-T12nAdded motor functionnIncreased abdominal controlnIncreased trunk stabilityLEVEL:T7-T12n2 hrs personal care needs/homemakingnADLsnIndependentnImproved co

23、ughnImproved balance controlnMobilitynManual wheelchairnMay have limited walking with bracingnDriving with hand controlsFunctional OutcomesnLEVEL:L2-L5nAdded motor function in hips and kneesnL2 Hip flexors(iliopsas)nL3 Knee extensors(quadriceps)nL4 Ankle dorsiflexors(tibialis anterior)nL 5 Long toe

24、extensors(ext hallucis longus)LEVEL:L2-L5nMay need 1hr personal care/homemakingnADLsnIndependent nMobilitynManual wheelchairnMay walk short distance with braces and assistive devicesnDriving with hand controlsFunctional OutcomesnLEVEL:S1-S5nAnkle plantar flexors(gastrocnemius)nVarious degrees of bow

25、el,bladder and sexual functionnLower level equals greater functionLEVEL:S1-S5nNo personal or homemaker needsnADLsnIndependentnMobilitynIncreased ability to walk with less adaptive/supportive devicesnManual w/c for distanceFunctional OutcomesnAchieving maximum functional outcomes provides the opportu

26、nity to reach the highest level of independence and quality of lifeSpinal Cord InjurynEpidemiologyn30-40 million per yearn10,000 new cases per yearnEtiologynMotor vehicle accident:44.5%nFalls:18.1%nViolence:16.6%(and increasing)Spinal Cord InjurynClassificationnParaplegia/TetraplegianASIA Impairment

27、 ScalenASIA Motor/SensorynFIM functional limitationsnAcute Care ManagementnImmediate spinal immobilizationnMethylprednisolone within 8 hours of injurySpinal Cord InjurynEconomic ConsequencesnBetween$7.3 billion and$8.3 billion per yearnA person with a high cervical injury at age 25 incurs lifetime c

28、osts of more than$3 millionnRehabilitation TreatmentnSystematic,intensive,coordinated team approachSpinal Cord InjurynPotential ComplicationsnDeep venous thrombosis(47-100%)nPulmonary embolism(3-15%)nPressure ulcers(25%annual incidence)nPneumonianAutonomic dysreflexia(usually above T6)nSpasticity(78

29、%)and Spasms(95%)nHeterotopic ossification(16-53%)nGastrointestinal complications(e.g.,impactions 33%)Spinal Cord InjurynPotential ComplicationsnUrinary tract infectionsnChronic pain(69%,severe 33%)nOveruse syndrome(35-68%)nPost-traumatic syringomyelia(1-5%)Additional Resources and Information from

30、the WebnAmerican Spinal Cord Injury Association(www.asia-spinalinjury.org)nTIRR Spinal Cord Injury Research Program(www.tirr.org/research/?page=54)nSpinal Cord Injury Information Network(www.spinalcord.uab.edu/show.asp?durki=19679)nAmerican Paraplegia Society(www.apssci.org)Additional Resources and Information from the WebnNational Spinal Cord Injury Association(www.spinalcord.org)nChristopher&Dana Reeve Paralysis Resource Center(www.paralysis.org)nParalyzed Veterans of America(www.pva.org)nAmerican Association of Spinal Cord Injury Psychologists and Social Workers(www.aascipsw.org)