Spinal Trauma Management

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Management of the paraplegic patient

After spinal cord injury, transfer to a spinal injury centre with medical and nursing staff skilled in the management of the paraplegic patient provides optimal daily care and rehabilitation.

Important features include:

1. Skin care - requires meticulous attention. Two-hourly turning should prevent pressure sores. Attempt to avoid contact with bony prominences or creases in the bed sheets. Air or water beds or a sheepskin may help.

2. Urinary tract - long-term catheter drainage or intermittent self-catheterisation is required. Infection requires prompt treatment. Eventually, training may permit automatic reflex function (in cord lesions) or micturition by abdominal compression (in root lesions). In some, urodynamic studies may indicate possible benefit from bladder neck resection.

3. Limbs - intensive physiotherapy helps prevent flexion contractures (in cord injury) and plays an essential role in rehabilitation.

OUTCOME FOLLOWING SPINAL CORD OR ROOT INJURY

Patients with high cervical cord lesions seldom survive without immediate ventilatory support. \

Patients who survive a lesion above C7 usually [ remain dependent on others for daily care.

Sparing of the C7 segment retains elbow and wrist extension and enables transfer from wheel chair >

to bed, providing a /

degree of independence. ,'

Patients with thoraco-lumbar injuries usually / regain full independence. /

A mixed cord and lumbar root lesion may occur at this level. Fortunately roots are more resistant to injury - 'root escape' - and the outlook is more favourable.

vertebral level

SPINAL CORD DAMAGE

ROOT DAMAGE

'complete': if no sign of motor or sensory function within 24 hours, then recovery will not occur. (The early return of anal and penile reflexes is not necessarily a good sign.)

After a few days or weeks, tone returns to the flaccid limbs and reflexes become brisk. Flexor spasms may follow with the risk of contractures. A reflex bladder develops with automatic emptying.

v 'incomplete': any retention of motor or sensory function indicates an incomplete lesion with the potential for recovery.

Recovery may theoretically occur as the roots regenerate, perhaps only after many months delay. The limbs remain flaccid throughout.

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