RESUMEN
INTRODUCTION: Dual lesion spinal cord injury (SCI) is the presence of two distinct regions of injury to the spinal cord, which can occur simultaneously or as a sequela of initial injury. Dual lesion SCI appears to be a rather rare occurrence with a paucity of cases described. As such, there is limited information available regarding presentation, evaluation, long-term rehabilitation management, and prognostication of these patients. CASE PRESENTATION: Presented is a case of a 25-year-old woman with a gunshot wound injury to the T5 vertebra with associated cord damage, initially classified as T6 ASIA Impairment Scale (AIS) B. A subsequent cervical spinal stroke, in the setting of cord edema, resulted in a motor incomplete cervical SCI. As such, she underwent additional functional decline. DISCUSSION: Patients with dual lesion SCI present with unique challenges in evaluation and management. This case highlights key factors for the acute care and rehabilitation teams to consider when addressing these challenges.
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Traumatismo Múltiple , Traumatismos de la Médula Espinal , Heridas por Arma de Fuego , Adulto , Femenino , Humanos , Traumatismos de la Médula Espinal/diagnóstico , Vértebras TorácicasRESUMEN
OBJECTIVE: To examine the role of race on rehabilitation outcomes for a matched sample of patients with spinal cord injury (SCI). DESIGN: African Americans and whites with SCI were matched based on age group, level and completeness of injury, and sponsor of care to retrospectively analyze the impact of race. SETTING: Eighteen medical centers in the federally sponsored Model Spinal Cord Injury Systems project. PARTICIPANTS: A total of 628 adults with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Medical procedures and complications; American Spinal Injury Association motor index, and FIMT instrument scores at admission and discharge; and discharge dispositions. RESULTS: Analysis revealed race-related differences in spinal surgeries, laparotomies, traction during acute care, and method of bladder management at discharge. In most cases, these were explained by cause of injury rather than direct affects of race. No differences were found with regard to medical complications functional outcomes, or discharge disposition. CONCLUSIONS: Although differences exist in the medical procedures given to African Americans and whites with SCI, they are generally accounted for by cause of injury rather than the direct affects of race.
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Negro o Afroamericano , Traumatismos de la Médula Espinal/etnología , Traumatismos de la Médula Espinal/rehabilitación , Población Blanca , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Institucionalización , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicaciones , Resultado del TratamientoRESUMEN
BACKGROUND: Nontraumatic spinal cord injury (NT/SCI) has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. Although medical complications of patients with traumatic SCI (T/SCI) have been well studied, there is a paucity of literature regarding those with nontraumatic SCI. Our objective was to compare the incidence of secondary SCI medical complications in patients with nontraumatic and traumatic SCI. DESIGN: A 2-year prospective data comparison of 117 patients with SCI admitted to a regional SCI rehabilitation unit and tertiary university medical center was undertaken. NT/SCI was defined as spinal stenosis, tumorous compression, vascular ischemia, and infectious etiologies. METHODS: Outcome measures included secondary SCI medical complications, injury characteristics, demographics, and rehabilitation outcomes. Statistical analyses were conducted between the 38 NT/SCI and 79 T/SCI who met admission criteria for acute inpatient rehabilitation. RESULTS: Statistically significant differences (P<.05) between nontraumatic and traumatic SCI were noted for deep venous thrombosis (7.9% vs 22.8%), pressure ulcers (21.1% vs 41.8%), autonomic dysreflexia (0% vs 24.1%), pneumonia (2.6% vs 26.6%), orthostatic hypotension (5.3% vs 36.7%), spasticity (21.1% vs 44.3%), and wound infections (16% vs 3%). Similar incidences were found for depression (23.7% vs 26.6%), urinary tract infections (52.6% vs 67.1%), heterotopic ossification (2.6% vs 7.6%), pain at admission (55.3% vs 62.0%), and gastrointestinal bleed (2.6% vs 2.5%). In addition, significant differences were noted between NT/SCI and T/SCI for age (55 years vs 39 years), rehabilitation length of stay (26.4 days vs 43.0 days), and neurologically complete injury (5.3% vs 45.6%). CONCLUSION: This study indicates that patients with NT/SCI present with different incidences of secondary SCI medical complications when compared with individuals with T/SCI. These data, along with differences in demographics, clinical presentation, and rehabilitation outcomes, have important implications for the medical, rehabilitation management, and long-term outcome of individuals with NT/SCI.
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Evaluación de Resultado en la Atención de Salud , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitación , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/rehabilitación , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Índices de Gravedad del TraumaRESUMEN
OBJECTIVE: Nontraumatic spinal cord injury (NT/SCI), which can occur secondary to spinal stenosis, has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. The objective of this study was to compare demographics and outcomes of patients with spinal stenosis-induced SCI (SS/SCI) with those with traumatic spinal cord injury (T/SCI) following inpatient rehabilitation. DESIGN: This 7-year prospective review compared 81 patients with SS/SCI and 102 patients with T/SCI admitted to an SCI rehabilitation unit with similar levels and completeness of injury. Main outcome measures included rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, rehabilitation charges, and discharge rates to home. RESULTS: Results indicate that, when compared with the T/SCI, patients with SS/SCI had a significantly (P < .05) higher mean age (64.1 years vs 44.4 years), were more often female (39% vs 20%), and tended to present with paraplegia vs tetraplegia (69% vs 46%) and with motor incomplete SCI vs incomplete SCI (100% vs 49%). When comparing etiologies of SCI within tetraplegic and paraplegic groups, results showed that individuals with tetraplegic SS/SCI had a significantly (P < .05) shorter rehabilitation LOS (25.7 vs 35.9 days), and lower FIM change (24.5 vs 32.5) and FIM efficiency (1.0 vs 1.3); however, no statistical differences were noted for discharge FIM scores and discharge to home rates. Individuals with paraplegic SS/SCI also had significantly lower FIM change (20.2 vs 28.7); however no significant differences were noted for rehabilitation LOS, charges, FIM efficiency, or discharge-to-home rates. CONCLUSIONS: The findings indicate that patients with SS/SCI present with less severe clinical impairments (motor incomplete and paraplegia) in comparison with patients with T/SCI. Clinically similar SS/SCI groups were noted to achieve rates of functional gain and community discharge comparable with T/SCI patients. Although patients with T/SCI achieved greater overall functional improvement, patients with SS/SCI had shorter rehabilitation LOS and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with NT/SCI.
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Demografía , Evaluación de Resultado en la Atención de Salud , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/rehabilitación , Estenosis Espinal/complicaciones , Estenosis Espinal/rehabilitación , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función/fisiología , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/fisiopatología , Estenosis Espinal/fisiopatología , Factores de TiempoRESUMEN
UNLABELLED: This self-directed learning module highlights basic management and approaches to intervention-both established and experimental. The revised American Spinal Injury Association classification (2000) of spinal cord injury (SCI) further defines the examination and classification guidelines. The incidence of traumatic SCI remains at approximately 10,000 cases per year, with 32 years the average age at injury. Initial management includes establishment of oxygenation, circulation (mean blood pressure >85 mm Hg), radiographic evaluations for spine instability, intravenous methylprednisolone, and establishment of spinal alignment. Prevention measures for medical complications include pressure relief for skin, thromboembolism prophylaxis, prevention of gastric ulcers, Foley catheter drainage to prevent urine retention, and bowel care to prevent colonic impaction. Nontraumatic SCI from spinal stenosis, neoplastic compression, abscess, or multiple sclerosis becomes more common with aging. Experimental treatments for SCI include antibodies to block axonal growth inhibitors, gangliosides to augment neurite growth, 4-aminopyridine to enhance axonal conduction through demyelinated nerve fibers, and fetal tissue to fill voids in cystic spinal cord cavities. Early comprehensive rehabilitation at a SCI center prevents complications and enhances functional gains. OVERALL ARTICLE OBJECTIVE: To summarize the comprehensive evaluation and management of a newly injured individual.
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Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/clasificaciónRESUMEN
UNLABELLED: This is a self-directed learning module that reviews medical complications associated with spinal cord injury (SCI). It is part of a chapter on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of common medical complications that impact rehabilitation and long-term follow-up for individuals with SCI. Issues addressed include the rehabilitation approach to SCI individuals with pressure ulcers, unilateral lower-extremity swelling (deep venous thrombosis, heterotopic ossification, fractures), along with the pathophysiology, assessment, and treatment of spasticity, autonomic dysreflexia, orthostatic hypotension, and pain. OVERALL ARTICLE OBJECTIVE: To describe diagnostic and treatment approaches for medical complications common to individuals with SCI.
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Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Adulto , Disreflexia Autónoma/etiología , Disreflexia Autónoma/fisiopatología , Disreflexia Autónoma/terapia , Edema/etiología , Edema/fisiopatología , Edema/terapia , Femenino , Humanos , Hipotensión Ortostática/etiología , Hipotensión Ortostática/fisiopatología , Hipotensión Ortostática/terapia , Masculino , Espasticidad Muscular/etiología , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/terapia , Dolor/etiología , Dolor/fisiopatología , Manejo del Dolor , Úlcera por Presión/etiología , Úlcera por Presión/fisiopatología , Úlcera por Presión/terapia , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
UNLABELLED: This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home. OVERALL ARTICLE OBJECTIVE: To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.
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Evaluación de Resultado en la Atención de Salud , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Anciano , Femenino , Humanos , MasculinoRESUMEN
UNLABELLED: This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.
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Adaptación Fisiológica/fisiología , Adaptación Psicológica/fisiología , Participación del Paciente/psicología , Calidad de Vida , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medio Social , Traumatismos de la Médula Espinal/economíaRESUMEN
UNLABELLED: This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention. OVERALL ARTICLE OBJECTIVE: To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI.