Functional abnormalities after spinal cord injury: sensory impairment, motor function impairment, urinary and digestive function, sexual dysfunction, neuropathic pain, spasm of the skeletal musculoskeletal system, etc., the patient's quality of life and happiness are greatly reduced.
overview
1. Psychiatric classification of spinal cord injury,
2. ASIA residual grading of spinal cord injury
3. Rehabilitation of spinal cord injury and quadriplegia
Spinal cord muscle function control partition
C is the cervical spine \ T is the abbreviation of the thoracic spine
ASIA rating (A = complete injury, B, C, D = incomplete injury, E = normal)
Causes of death from cervical spinal cord injury: 1 Early respiratory failure leads to death 2. Complications of the respiratory system.
Importance of the diaphragm: the diaphragm nerve originates from the C3-C5 nerve root, and the innervation of the diaphragmatic muscle contraction accounts for 60%-80% of the respiratory effect
The level of injury is located below C5 The diaphragmatic function remains partially or completely intact, the injury level is located above C4, and the diaphragm paralysis causes dyspnea leading to respiratory failure and eventual death.
Paraplegia and quadriplegia
First, high paraplegia relies on ventilator survival injury sites C1, C2, C3
2. High quadriplegia C4, C5, C6
Third, low C7, C8
4. High paraplegia T1 to T9
5. Low paraplegia T10-T12, L1-L5, S1-S5
High quadriplegia requires mechanical ventilation
1. The nerve plane is located in C1\C2\C3
2. The chance of survival is low, and most of them die when they are injured
3. Completely or partially dependent on ventilators
4. Daily life requires the help of others
5. With the help of the head mouth, use the computer to communicate and entertain
rehabilitation
1. Respiratory function training: deep breathing, respiratory function trainer, speech function training
2. Passive exercise and electric standing bed training (prevention of limb joint stiffness, osteoporosis, etc.)
3. Intraoral tongue function training
4. Mouth stick head stick training, used to operate the instrument or write and turn the book, etc.
High quadriplegia
C5 plane
1. Diaphragmatic function is present, lung capacity is greater than 1000 ml, so there is no need for a ventilator
2.Health tolerance difference
3. The trunk and lower limbs have no function
4. The upper limb forearm, wrist and hand are lost, and only the deltoid muscles and biceps muscles are still functional.
C6 plane
1. The patient can flex his elbow and extend his wrist, but the upper limb hand function is lost, and he cannot extend his elbow and flex his wrist
2. Complete paralysis of the lower limbs and trunk
3. The diaphragmatic muscle function is normal, the intercostal muscle is affected, and the respiratory reserve decreases
4. Already able to complete the body transfer, through training it is possible to learn to live independently and more skills
4. The patient is partially self-reliant and requires moderate help
Low quadriplegia
C7
1. The upper limbs or forearms function normally, but the flexibility of the hands is not good
2. Complete paralysis of the lower limbs, weakness of the trunk, low respiratory reserves
3. The upper limb muscles have innervation, which is easy to learn and perform many movements, so the patient can operate the wheelchair independently on the flat ground
4. In bed, you can turn over, sit up, move, you can dress and eat by yourself, etc
C8
1. The patient's shoulder, elbow and wrist function is intact, and he can grasp with a fist
2. Paralysis of the lower limbs and weakness, no control of the trunk
3. Can be moved independently in bed, self-care, simple housework, etc
4. Appropriate professional activities can be engaged
High paraplegia
T1--T9
ADL is completely self-conscious
Spinal cord rehabilitation staging
1. Bed rest period (4 weeks after injury)
2. Out of bed (4-10 weeks)
3 Reintegration Preparation Period (11-16 weeks)
4. Family and social rehabilitation period (after 16 weeks)
Rehabilitation for spinal cord injury
Bed rest period
1. ROM training in bed
2. Muscle strengthening training on the bed
3. Respiratory function training
4. Bladder function training
5. Positional conversion in bed
Out of bed
1.ROM training muscle strength is strengthened
2. Bladder function training
3. Seated balance training
4. Electric standing bed training
5. Wheelchair use, wheelchair --- bed transfer training, daily living ability training
The basic rehabilitation goal of spinal cord injury, the type of wheelchair that requires the use of braces
C2,34
Reducing the dependence on ventilators Preventing respiratory complications, increasing the range of motion, electric wheelchairs
C5
The table moves independently, relies heavily on the help of electric wheelchairs, and can use manual wheels on the flat floor
chair
C6
ADL is partially self-reliant, requires moderate assistance in manual electric wheelchairs, and can be used in a variety of self-propelled
Aids
ADL basically self-reliant, wheelchair mobility manual wheelchair, handicapped car
C8-T4
ADL stand-alone, wheelchair mobility brace standing manual wheelchair, disabled person-only car
Rehabilitation is not the same as recovery, rehabilitation is the maximum recovery, does not guarantee that the recovery as before, the article for reference only does not constitute a treatment recommendation