Escolar Documentos
Profissional Documentos
Cultura Documentos
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C2-3 Sternomastoid
C3-5 Diaphragm
C5 Elbow Flexors
C6 Wrist Extensors
C8 Long Fingers Flexors
T1 Small Finger Abductors
Cervical
Thoracic
Conus
medullaris
Lumbar
Sacral
Cauda
equina
T1-11 Intercostals
T7-L1 Adbominals Muscle
T11-L2 Ejaculation
L2 Hip Flexors
L3 Knee Extensors
L4 Ankle Dorsiflexors
L5 Long Toe Extensor
S1 Ankle Plantarflexors
S2-3 Bowel/Bladder
S2-4 Penile Erection
Coccygel
Fig. 1: Functions at different spinal levels
*
Peripheral changes.
Cortical reorganization.
Completeness of injury
The completeness of injury is generally based on the American
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Nursing
Physical therapy
Occupational therapy
Respiratory management
Medical management
Vocational counseling
Driver training
Nutritional services
Speech pathology
Social worker
Pharmaceutical service
Goals of Rehabilitation
The goals of rehabilitation are as follows:
Types of rehabilitation
Rehabilitation can be classified into early or intermediate
based on the timing.
Early rehabilitation
The rehabilitation does not have to wait for the person to
be discharged home. It has to begin very early. A predischarge
home visit for modification and community inclusion would
definitely benefit the patients. Patients with viable phrenic nerves
and adequate diaphragm and lung function can be freed from
Role of counseling
Psychological adjustment and life satisfaction are also
important aspects, which have to be addressed. Psychological
and psychiatric support and the use of antidepressants as and
when required must be initiated without fail. The significance
of counseling is that it can prevent depression and reduce the
risk of death due to suicide. Peer counseling is also extremely
important in this regard.
Education and employment
Persons with spinal cord injuries in many instances have to be
educated and allowed to find suitable employment. Surprisingly,
the average education level at 5 years following injury is below
that of the general population, but by 10 and 15 years, it exceeds
that average.
Different components of rehabilitation
Nutrition
Necessarily, nutrition has to be started very early. Early
endoscopic gastrostomy has to be initiated to drive in nutrition
as these patients tend to waste away rapidly and as a result it
tends to become difficult to rehabilitate them. The nutritional
requirements are definitely less than that of an ambulatory
person. The requirements are fat <30%, carbohydrates 60% and
the rest comprising of proteins. The bottom line is that the weight
of the patient has to be preserved, otherwise he/she tends to
waste and this would hinder the rehabilitation process.
Autonomic dysfunction
Autonomic dysreflexia has to be taken care of as and when
it happens due to the associated problems like autonomic
hyperreflexia (bladder/bowel distension), bradycardia with
hypotension and asystole with autonomic stimulation like
tracheal suction.
Bladder management
Although the patient ends up in self-catheterization or an
indwelling catheter, there are certain things which are important
in bladder management as discussed below.
Voiding under low vesical pressures:
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Oral medications.
40 cm of water.
Urethral stenting.
Implanting ureters.
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The life duty cycle will be lower for assisting robots than
industrial robots.
Move books from the book shelf to a reader board and back
again.
Discard documents.
Staple documents.
Insert CD-ROMs.
hope for rehabilitation and would not want to loose their limb
permanently. Robot-assisted arm prototypes are available.
Similarly, exercising robots are now available, which can
facilitate different types of recoveries.
Speaking valves
The speaking valve facilitates communication in a person
undergoing permanent tracheostomy. Different types of valves
are available, which can again be connected, and enable the
person to speak. Ultimately, a tetraplegic can achieve a lot of
things. They can communicate verbally, they can write using
mouthsticks. They can use computers through mouthsticks or
pneumatic switches or even verbal commands. This approach
would allow them to integrate themselves with the environment.
This is how these patients can be rehabilitated rather than leaving
them to their fate with providing any help.
Sexual functioning
Sexual functions for men can be facilitated. Reflex erection
can be achieved. Oral drugs like phosphodiesterase type 5
inhibitors and viagra can be used. Medicated urethral system
erection (MUSE) systems, penile injections, vacuum pumps and
permanent prosthesis can be used. However, fertility remains a
problem, because anterograde ejaculation with sperms is often
a problem.
The common sexual problems identified in females include
lack of vaginal sensations, lack of muscular tone, lack vaginal
secretions. Also in females, the sexual functions can be facilitated
by a number of ways that are now available and as structured
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Conclusion
While research pursues the goals of preventing and reversing
neurological deficits, work must continue to remove barriers
impeding the return of person with spinal cord injuries to achieve
active roles in the community through efficient rehabilitation
programs.
References
1.
2.