Falls in individuals with incomplete spinal cord injury
The purpose of this study was to examine the incidence, circumstances, consequences, and factors associated with falls among a sample of ambulatory person with incomplete SCI. Falls have potentially serious consequences such as heat trauma, tissue damage, fractures, and dislocations. People may also develop a fear of falling which will restrict activity for them. Understanding the consequences and related factors for falling with individuals with incomplete SCI can help health care professionals identify people at risk for falling and implement interventions to prevent falls.
This study took 221 traumatic SCI from outpatient files in a specialty hospital. The participants needed to have a traumatic incomplete SCI, ability to independently ambulate for a minimum of 10 meters with or without assistive devices, be a minimum of one year post SCI, and 18 or older during time of study. The participants completed a questionnaire. A fall was defined as an unplanned, unexpected contact with the supporting surface. The questionnaire consisted of items from the performance based test of the timed up and go, berg balance scale, performance oriented mobility assessment, falls assessment questionnaire and the behavioral risk factor surveillance. The participants were asked to rate items associated with fall on a scale of 1-5 (1 indicated not related to fall, 5 indicating entirely fall related).
The participants were mostly Caucasian male who sustained injury in a motor vehicle. Most participants lived with spouse or other caregiver and reported that they ambulate in the community. Seventy five percent of participants sustained at least one fall over the previous year and the majority was in the home, during the afternoon and evening time. Forty five percent reported that their falls restricted their ability to get out into the community and engage in productive activity. The factors that were perceived to contribute to the falls were decreased strength in trunk and lower extremity, loss of balance, and hazards in the environment.
The study concluded that falls are an important consideration for ambulatory individuals with incomplete SCI in both frequency and the consequences. The incidence of falls was higher among the SCI population than in healthy individuals 65 and older. The incidence of falls was higher in people with incomplete SCI then those with neurological disease such as Parkinson’s disease. Majority of falls occurred in the home with increased fall throughout the day. There was a higher incidence of fractures suggesting a greater consequence among the incomplete SCI population. Half the participants reported that the ability to engage in community and productive activities declined after a fall.
Ambulation is a goal after a SCI and rehabilitation may not always fully address the safety issues involved. In order to better examine the factors that contribute to falls among the population with incomplete SCI thorough assessments need to be implemented.
Brotherton, S. S., Krause J. S., and Nietert, P.J. (2007). Falls in individuals with incomplete spinal cord injury. Spinal Cord, 45, 37-40.
How occupational therapy helps in the process of rehab
Evaluations:
1. Sensory evaluatins of the extremeties to test for parlysis, paresis, etc. Such as the semmes-weinstein monofilament test. This will test the dermatomes impacted and the level of injury. It will allow the therapist to develop a treatment plan as to waht the client will be functionally able to perform. It will also allow the therapist and client to know what precautions to be aware of, and safety issues.
2. The FIM can be use to monitor and evaluate progress associated with daily activities in the area of self care, mobility, locomotion, communication, and social cognition. Determines whether person is either dependent or independent in activities such as eating, toileting, and dressing. This will determine how much a person with SCI can do on their own and how much they may need assistance on.
3. Home evaluations to detect hazards for falls, make the home more accessible for a SCI client.
4. Life satisfaction inventory
Treatment:
A client with C6 SCI causing quadriplegia will benefit from OT intervention to regain function with activtiies of daily living. An OT can develop an intervention to develop a more functional grip using the naturally occuring wrist tenodesis. OT's can educate the clients on the use of splints and other adaptive equipment to make the use of wrist tenodesis more functional in daily activities such as dressing, transfers, eating, etc.
1. Sensory evaluatins of the extremeties to test for parlysis, paresis, etc. Such as the semmes-weinstein monofilament test. This will test the dermatomes impacted and the level of injury. It will allow the therapist to develop a treatment plan as to waht the client will be functionally able to perform. It will also allow the therapist and client to know what precautions to be aware of, and safety issues.
2. The FIM can be use to monitor and evaluate progress associated with daily activities in the area of self care, mobility, locomotion, communication, and social cognition. Determines whether person is either dependent or independent in activities such as eating, toileting, and dressing. This will determine how much a person with SCI can do on their own and how much they may need assistance on.
3. Home evaluations to detect hazards for falls, make the home more accessible for a SCI client.
4. Life satisfaction inventory
Treatment:
A client with C6 SCI causing quadriplegia will benefit from OT intervention to regain function with activtiies of daily living. An OT can develop an intervention to develop a more functional grip using the naturally occuring wrist tenodesis. OT's can educate the clients on the use of splints and other adaptive equipment to make the use of wrist tenodesis more functional in daily activities such as dressing, transfers, eating, etc.
abilities and goals of C6
ABILITIES:
Individuals with C6 quadreplegia have movement in head, neck, shoulders, arms, and wrist. Can shrug shoulders, bend elbows, turn palms up and down and extend wrist. This wrist extension allows for tendodesis and passive thum adduction which helps with grasp/release.
FUNCTIONAL GOALS:
Highest level where patient can sill function independently without an aid. Can perfrom tasks such as feeding, bathing, grooming, personal hygeine and dressing with greater ease with specialized equipment. They can independently perform skin checks, turn in bed, and do pressure relief. Can independenltly do transfers but require a sliding board. Can use a manual wheelchair for daily activities but can use a power wheelchair for greater independence.
Individuals with C6 quadreplegia have movement in head, neck, shoulders, arms, and wrist. Can shrug shoulders, bend elbows, turn palms up and down and extend wrist. This wrist extension allows for tendodesis and passive thum adduction which helps with grasp/release.
FUNCTIONAL GOALS:
Highest level where patient can sill function independently without an aid. Can perfrom tasks such as feeding, bathing, grooming, personal hygeine and dressing with greater ease with specialized equipment. They can independently perform skin checks, turn in bed, and do pressure relief. Can independenltly do transfers but require a sliding board. Can use a manual wheelchair for daily activities but can use a power wheelchair for greater independence.
psychosocial impacts
After a SCI a person's physical status is not the only thing impacted. A SCI impacts the family and friends of the person with the SCI as well as the mental state of the person injured. A person with a SCI may experience depression which can be associated with the loss of function. After a SCI the outcome is typically a change in body image, lifestyle, and relationships with others. Grief is a symptom of newly injured SCI client's. In the grieving process professionals and people supporting the client (family, friends, etc) will need to help the client adjust to the injury during the grieving process.
Outcomes
Currently there is no cure for SCI, but tons of research being done. The edema that follows spinal cord injury may cause changes in almost all the body systems. When the edema subsides people regain some functions back. People can regain functioning as long as a year following the injury but regaining full functioning is rare. There are medical advances that allow people with SCI to live longer, but compared to the general population people with SCI have a shorter lifespan, partly due to the secondary complications.
Incomplete SCI have a better prognosis then complete SCI. Depedning on the level of injury determines the extent of disability.
Poor prognosis is indicated by hemorrhages and not following treatment/life style changes to prevent secondary complications.
Incomplete SCI have a better prognosis then complete SCI. Depedning on the level of injury determines the extent of disability.
Poor prognosis is indicated by hemorrhages and not following treatment/life style changes to prevent secondary complications.
the complications you may encounter and how to prevent them
Some complications to be aware of are.....
-> Autonomic dyreflexia (blood pressure changes)
-> loss of bladder and bowel control
-> developing capral tunnel
-> paralysis and decrease sensation causing an increase chance of injury to certain areas impacted
-> fractures
-> hetertopic ossification leading to joint problems
-> osteoporosis
-> cancers
-> cardiovasuclar isses (blood clots, heart disease, edema)
-> dehydration
-> diabetes
-> fatigue and shock
-> gastrointestinal problems
-> increase risk of urinary tract infection
-> infections
-> medication side effects
-> pain
-> pressure ulcers (decubiti)
-> respiratory issues
-> loss of sexual functioning
-> skin breakdown
-> sleep apnea
-> spasticity
Good ways to prevent these secondary conditions is by:
- eating a well balanced diet for healthy skin, urinary tract, and bowel function
- changing positions in the wheelchair or bed to prevent pressure sores
- exercise to improve respiratory function, increase bone strength, regulate bodily function, and improve spasticity
- drink water throughout the day
- do not smoke because it can constrict blood vessels and make it harder for blood to flow. Smoking also impacts respiratory health
- having regular skin examination
-> Autonomic dyreflexia (blood pressure changes)
-> loss of bladder and bowel control
-> developing capral tunnel
-> paralysis and decrease sensation causing an increase chance of injury to certain areas impacted
-> fractures
-> hetertopic ossification leading to joint problems
-> osteoporosis
-> cancers
-> cardiovasuclar isses (blood clots, heart disease, edema)
-> dehydration
-> diabetes
-> fatigue and shock
-> gastrointestinal problems
-> increase risk of urinary tract infection
-> infections
-> medication side effects
-> pain
-> pressure ulcers (decubiti)
-> respiratory issues
-> loss of sexual functioning
-> skin breakdown
-> sleep apnea
-> spasticity
Good ways to prevent these secondary conditions is by:
- eating a well balanced diet for healthy skin, urinary tract, and bowel function
- changing positions in the wheelchair or bed to prevent pressure sores
- exercise to improve respiratory function, increase bone strength, regulate bodily function, and improve spasticity
- drink water throughout the day
- do not smoke because it can constrict blood vessels and make it harder for blood to flow. Smoking also impacts respiratory health
- having regular skin examination
Diagnosis and treatment
Requires immediate attention. In order to reduce long term effect, immediate treatment is necessary.
how is it diagnosed?
*Physical exam
*A CT scan and MRI may be needed to detect the location of injury and extent of damage (it may also detect blood clots)
*Somatosensory evoked potentional test (SSEP) can show if a nerve signal passes through the spinal cord
*Neurological exam a few days following injury to determine level and completeness of injury. Involves testing muscle strength and sense of light touch
Typical treatments:
*Corticosteriods to reduce swelling and avoid SC compression. Corticosteriods should be used as soon as possible following an injury.
*Surgery may be needed. Surgery can be used to remove fluid or tissue that may be pressing against SC, as well as removing bone fragements or other foregin objects that can puncture the SC.
*Spinal traction can reduce amount of dislocation as well as immobilize the spine so realignment can occur
*Spasticity treatment can be reduced by oral medication, injecting medicide in spinal canal, or botulinum toxin into muscle
*Pain should be treated with analgesics and muscle relaxants
how is it diagnosed?
*Physical exam
*A CT scan and MRI may be needed to detect the location of injury and extent of damage (it may also detect blood clots)
*Somatosensory evoked potentional test (SSEP) can show if a nerve signal passes through the spinal cord
*Neurological exam a few days following injury to determine level and completeness of injury. Involves testing muscle strength and sense of light touch
Typical treatments:
*Corticosteriods to reduce swelling and avoid SC compression. Corticosteriods should be used as soon as possible following an injury.
*Surgery may be needed. Surgery can be used to remove fluid or tissue that may be pressing against SC, as well as removing bone fragements or other foregin objects that can puncture the SC.
*Spinal traction can reduce amount of dislocation as well as immobilize the spine so realignment can occur
*Spasticity treatment can be reduced by oral medication, injecting medicide in spinal canal, or botulinum toxin into muscle
*Pain should be treated with analgesics and muscle relaxants
Precautions
- in a car wear a seat belt, never drive under the influence of drugs or alcohol, never drive with someone under the influence
- to prevent falls secure banisters and handrails, use grab bars, non slip mats, exercise to keep muslce tone, wearing non slip shoes, home safety checks, window guards
- in sports wear a helmet, don't dive into shallow water headfirst, wear safety gear, avoid head first moves (tackling, sliding into base, etc), and have spotters during activities such as weight lifing
- keep firearms stored and unloaded in a safe, and store bullets secured in separate location
- to prevent falls secure banisters and handrails, use grab bars, non slip mats, exercise to keep muslce tone, wearing non slip shoes, home safety checks, window guards
- in sports wear a helmet, don't dive into shallow water headfirst, wear safety gear, avoid head first moves (tackling, sliding into base, etc), and have spotters during activities such as weight lifing
- keep firearms stored and unloaded in a safe, and store bullets secured in separate location
Who gets SCI and what are the causes
Approximately 10,000 people are injured each year in the United States. It can happen to anyone at any age but men between 15-35 years old are more susceptible. There is about 450,000 people who live with SCI in the United States.
Who is more at risk? Men, being between the ages of 16-30 years old, being active in certain sports, and people having and underlying bone or joint disorder.
Direct injury that occurs if bones or discs of vertebrae are damaged. Bone fragments can cut or damage the SC. Compression, pulling, and sideways pressing of spinal cord can cause direct damage. Bleeding and fluid accumulation can cause spinal compression therefore damage.
-Motor Vehicle Accidents (leading cause of SCI for people under 65 years old)
-Falls
-Sport or recreation injuries
-Industrial Accidents
-Gunshot Wounds (and other acts of violence)
-Alcohol and drug related accidents
-Weakened spinal cord from RA, osteoporosis, or other minor injuries
Who is more at risk? Men, being between the ages of 16-30 years old, being active in certain sports, and people having and underlying bone or joint disorder.
Direct injury that occurs if bones or discs of vertebrae are damaged. Bone fragments can cut or damage the SC. Compression, pulling, and sideways pressing of spinal cord can cause direct damage. Bleeding and fluid accumulation can cause spinal compression therefore damage.
-Motor Vehicle Accidents (leading cause of SCI for people under 65 years old)
-Falls
-Sport or recreation injuries
-Industrial Accidents
-Gunshot Wounds (and other acts of violence)
-Alcohol and drug related accidents
-Weakened spinal cord from RA, osteoporosis, or other minor injuries
The signs/symptoms associated with a C6 injury
Complete injury: All sensory and motor function is lost below the neurological level
Incomplete injury: Having some motor or sensory function below affected area
Quadriplegia (tetraplegia): arms, trunk, legs, and pelvic organs affect by SCI.
Signs and symptoms vary depending on the location and severity of the trauma. A SCI may present with; loss of movement, loss of sensation, loss of bowel and bladder control, exaggerated reflex activities or spasms, changes in sexual function, difficulty regualating heart rate, body temperature, blood pressure, pain, autonomic dysreflexia (increase in blood pressure, sweating, and other autonomic response due to pain or sensory distrubance), muscle atrophyand difficulty breathing and clearing secretions from lungs.
Specifically a C6 SCI will show signs of sensory loss beginning from the dermatomes coving the forearm and thumb side of hand. Motor loss will be present at the wrst extensors. Therefore people with C6 injuries will show limited wrist control and complete loss of hand functions.
Incomplete injury: Having some motor or sensory function below affected area
Quadriplegia (tetraplegia): arms, trunk, legs, and pelvic organs affect by SCI.
Signs and symptoms vary depending on the location and severity of the trauma. A SCI may present with; loss of movement, loss of sensation, loss of bowel and bladder control, exaggerated reflex activities or spasms, changes in sexual function, difficulty regualating heart rate, body temperature, blood pressure, pain, autonomic dysreflexia (increase in blood pressure, sweating, and other autonomic response due to pain or sensory distrubance), muscle atrophyand difficulty breathing and clearing secretions from lungs.
Specifically a C6 SCI will show signs of sensory loss beginning from the dermatomes coving the forearm and thumb side of hand. Motor loss will be present at the wrst extensors. Therefore people with C6 injuries will show limited wrist control and complete loss of hand functions.
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