Medical-and-Psychosocial-Aspects-of-Rehabilitation-Counseling康復(fù)咨詢醫(yī)療和心理方面(53)課件

RCS6080

MedicalandPsychosocialAspectsofRehabilitationCounselingSpinalCordInjuryRCS6080

MedicalandPsychosoc1AnatomyoftheSpineVertebraeBodyFrontsection,shapedlikedrumSupportsweightLaminaTowardsthebackBoneyarchsurroundsspinalcanalSpinousprocessBoneyprocessfromarchPointsofattachmentformusclesandligamentsDiscsCushionsbetweenvertebraeAnatomyoftheSpineVertebrae2

3AnatomyoftheSpineVertebrae:7CervicalFlexion,extension,bendingandturningofhead12ThoracicChestregion,allowsmostlyforrotation5LumbarLargerboneystructurestosupportaddedwgt5SacralFusedtogetherCoccyxAnatomyoftheSpineVertebra4

5AnatomyoftheCordCervicalCordC1-C2:C3-4:PhrenicnucleusC4:DeltoidsC4-5:BicepsC6:WristextensorsC7:TricepsC8:WristextensorsC8-T1:HandmusclesAnatomyoftheCordCervicalCo6AnatomyoftheCordThoracicCordIntercostalmusclesandassociateddermatonesLumbarsacralStartsatT9andcontinuestoL2Innervateships,legs,buttocksandanalregionCaudaEquina(horsestail)SpinalcordendsatL2Tipcalledconus,belowconusasprayofspinalrootsAnatomyoftheCordThoracicCo7

8Dermatomes/SensoryLevelDermatome:patchofskininnervatedbyagivenspinalcordlevelDermatomes/SensoryLevel9

C2toC4.TheC2dermatome

10Myotomes/MotorLevelMyotome:SpinalnerverootswhichinnervatesmusclesgroupsMostmusclesareinnervatedbymorethanonerootMyotomes/MotorLevel11

12Medical-and-Psychosocial-Aspects-of-Rehabilitation-Counseling[康復(fù)咨詢醫(yī)療和心理方面](53)課件13ASIAImpairmentScaleASIAA:Complete:nomotororsensoryfunctionispreservedinthesacralsegmentsS4-S5ASIAB:Incomplete:sensorybutNOTmotorfunctionispreservedbelowtheneurologicallevelandincludesthesacralsegmentsASIAC:Incomplete:motorfunctionispreservedbelowtheneurologicallevelandmorethanhalfofkeymusclesbelowtheneurologicallevelhaveamusclegrade<3ASIAD:Incomplete:motorfunctionispreservedw/musclegrade>3ASIAE:NormalASIAImpairmentScaleASIAA:C14DefinitionofDisabilityTetraplegia(preferredtoquadriplegia)Referstoimpairmentorlossofmotor/sensoryfunctionincervicalsegmentsofthespinalcordImpairmentoffunctioninarms,trunk,legsandpelvicorgansASIAScalevsquadriparesisDefinitionofDisabilityTetrap15DefinitionofDisabilityParaplegiaReferstoimpairmentorlossofmotor/sensoryfunctioninthoracic,lumbarorsacralsegmentsofthespinalcordArmfunctionsparedPossibleimpairmentoffunctionintrunk,legsandpelvicorgansASIAScalevsparaparesisDefinitionofDisabilityParapl16ClinicalSyndromesCentralCordSyndrome:lesionoccurringalmostexclusivelyinthecervicalregionSacralsensorysparingWeakness>UEvsLEBrown-SequardSyndrome:Lesionthatproducesipsilateral,proprioceptiveandmotorlossandcontralaterallossofsensitivitytopainandtempClinicalSyndromesCentralCord17ClinicalSyndromesAnteriorCordSyndrome:LesionthatproducesvariablelossofmotorfunctionandofsensitivitywhilepreservingproprioceptionCaudaEquinaSyndrome:Injurytothelumbosacralnerverootsw/intheneurocanalresultinginareflexivebladder,bowelandlowerlimbsClinicalSyndromesAnteriorCor18AchievementofFunctionalGoalsAgeBodytypeComorbiditiesPriorathleticsenseFatiguelevelTypeofstabilizationHXHO/POASpasticityPsychosocialfactorsNutritionAchievementofFunctionalGoal19FunctionalOutcomesMotor/sensoryrecoveryAbilitytoperformordirectADLsSocialreintegrationQualityoflifeFunctionalOutcomesMotor/senso20FunctionalOutcomesLEVELC1-C3Limitedhead/neckmovementRotate/flexneck(sternocleidomastoid)Extendneck(cervicalparaspinals)Speechandswallowing(neckaccessories)Totalparalysisoftrunk,UEandLEFunctionalOutcomesLEVELC1-C321LEVEL:C1-324hrcareneedsAbletodirectcareneedsADLsVentilatordependentImpairedcommunicationDependentforallcareneedsMobilityPowerwheelchairHoyerliftLEVEL:C1-324hrcareneeds22LEVEL:C1-C3EquipmentNeedsAdaptedcomputerBedside/portableventilatorSuctionmachineSpecialtybedHoyerRecliningshowerchairLEVEL:C1-C3EquipmentNeeds23FunctionalOutcomesLEVEL:C4Headandneckcontrol(cervparaspinals)Shouldershrug(uppertraps)Inspiration(diaphragm)Lackofshouldercontrol(deltoids)Paralysisoftrunk,UEandLEInabilitytocough,lowrespiratoryreserveFunctionalOutcomesLEVEL:C424LEVEL:C424hrcareneedsAbletodirectcareneedsADLsMayormaynotbeventdependentImprovedcommunicationAssistedcoughDependentforallcareneedsMobilityPowerwheelchairHoyerliftLEVEL:C424hrcareneeds25LEVEL:C4EquipmentNeedsAdaptedcomputerBedside/portableventilatorasneededSuctionmachineSpecialtybedHoyerRecliningshowerchairLEVEL:C4EquipmentNeeds26FunctionalOutcomesLEVEL:C5Shouldercontrol(deltoids)Elbowflexion(biceps/elbowflexors)Supinatehands(brachialisandbrachioradialis)LackelbowextensionandhandpronationParalysisoftrunkandLEFunctionalOutcomesLEVEL:C527LEVEL:C510hrspersonalcareneed6hrshomemakingassistanceADLsSet-up/equipment:eating,drinking,facewashandteethAssistedcoughDependentforbowel,bladderandlowerbodyhygiene Dependentforbedmobilityandtransfers

LEVEL:C510hrspersonalcaren28LEVEL:C5MobilityHoyerorstandpivotPowerwheelchairw/handcontrolsManualwheelchairDrivemotorvehiclew/handcontrolsEquipmentNeedsPowerandmanualwheelchairsAdaptivesplints/bracesPageturners/computeradaptationsLEVEL:C5Mobility29FunctionalOutcomesLEVEL:C6Wristextension(extensorcarpiulnarisandextensorcarpiradialislongus/brevis)Armacrosschest(clavicularpectrocialis)Lackelbowextension(triceps)LackwristflexionLackhandcontrolParalysisoftrunkandLEFunctionalOutcomesLEVEL:C630LEVEL:C66hrspersonalcareneeds4hrshomemakingassistanceADLsAssistedcoughSet-upforfeeding,bathinganddressingIndependentpressurerelief,turnsandskinassessmentMaybeindependentforbowel/bladdercareLEVEL:C66hrspersonalcaren31LEVEL:C6 Mobility IndependentslideboardtransferManualwheelchairDrivewithadaptiveequipmentLEVEL:C6 32FunctionalOutcomes LEVEL:C7Elbowflexionandextension(biceps/triceps)Armtowardbody(sternalpectoralis)LackfingerfunctionLacktrunkstabilityFunctionalOutcomes 33LEVEL:C7 6hrspersonalcareneeds2hrshomemakingassistanceADLsMoreeffectivecoughFeweradaptiveaidsIndependentw/allADLsMayneedadaptiveaidsforbowelcareLEVEL:C7 6hrspersonalcaren34LEVEL:C7MobilityManualwheelchairTransferswithoutadaptiveequipmentLEVEL:C735FunctionalOutcomesLEVEL:C8-T1IncreasedfingerandhandstrengthFingerflexion(flexordigitorum)Fingerextension(extensorcommunis)Thumbmovement(policuslongisbrevis)Separatefingers(introssiseparates)FunctionalOutcomes36LEVEL:C8-T14hrspersonalcareneeds2hrshomemakingassistanceADLsIndependentw/orw/oassistivedevicesAssistw/complexmealprepandhomemanagementMobilityManualwheelchairLEVEL:C8-T14hrspersonalcare37FunctionalOutcomesLEVEL:T2-T6Normalmotorfunctionofhead,neck,shoulders,arms,handsandfingersIncreaseduseofintercostalsIncreasetrunkcontrol(erectorspinae)FunctionalOutcomes38LEVEL:T2-T63hrspersonalcareneeds/homemakingADLsIndependentinpersonalcareMobilityManualwheelchairMayhavelimitedwalkingwithextensivebracingDrivewithhandcontrolsLEVEL:T2-T63hrspersonalcare39FunctionalOutcomesLEVEL:T7-T12AddedmotorfunctionIncreasedabdominalcontrolIncreasedtrunkstabilityFunctionalOutcomes40LEVEL:T7-T122hrspersonalcareneeds/homemakingADLsIndependentImprovedcoughImprovedbalancecontrolMobilityManualwheelchairMayhavelimitedwalkingwithbracingDrivingwithhandcontrolsLEVEL:T7-T122hrspersonalca41FunctionalOutcomesLEVEL:L2-L5AddedmotorfunctioninhipsandkneesL2Hipflexors(iliopsas)L3Kneeextensors(quadriceps)L4Ankledorsiflexors(tibialisanterior)L5Longtoeextensors(exthallucislongus)FunctionalOutcomes42LEVEL:L2-L5Mayneed1hrpersonalcare/homemakingADLsIndependentMobilityManualwheelchairMaywalkshortdistancewithbracesandassistivedevicesDrivingwithhandcontrolsLEVEL:L2-L5Mayneed1hrperso43FunctionalOutcomesLEVEL:S1-S5Ankleplantarflexors(gastrocnemius)Variousdegreesofbowel,bladderandsexualfunctionLowerlevelequalsgreaterfunctionFunctionalOutcomes44LEVEL:S1-S5NopersonalorhomemakerneedsADLsIndependentMobilityIncreasedabilitytowalkwithlessadaptive/supportivedevicesManualw/cfordistanceLEVEL:S1-S5Nopersonalorhom45FunctionalOutcomesAchievingmaximumfunctionaloutcomesprovidestheopportunitytoreachthehighestlevelofindependenceandqualityoflifeFunctionalOutcomesAchievingm46SpinalCordInjuryEpidemiology30-40millionperyear10,000newcasesperyearEtiologyMotorvehicleaccident:44.5%Falls:18.1%Violence:16.6%(andincreasing)SpinalCordInjuryEpidemiology47SpinalCordInjuryClassificationParaplegia/TetraplegiaASIAImpairmentScaleASIAMotor/SensoryFIM–functionallimitationsAcuteCareManagementImmediatespinalimmobilizationMethylprednisolonewithin8hoursofinjurySpinalCordInjuryClassificati48SpinalCordInjuryEconomicConsequencesBetween$7.3billionand$8.3billionperyearApersonwithahighcervicalinjuryatage25incurslifetimecostsofmorethan$3millionRehabilitationTreatmentSystematic,intensive,coordinatedteamapproachSpinalCordInjuryEconomicCon49SpinalCordInjuryPotentialComplicationsDeepvenousthrombosis(47-100%)Pulmonaryembolism(3-15%)Pressureulcers(25%annualincidence)PneumoniaAutonomicdysreflexia(usuallyaboveT6)Spasticity(78%)andSpasms(95%)Heterotopicossification(16-53%)Gastrointestinalcomplications(e.g.,impactions–33%)SpinalCordInjuryPotentialCo50SpinalCordInjuryPotentialComplicationsUrinarytractinfectionsChronicpain(69%,severe33%)Overusesyndrome(35-68%)Post-traumaticsyringomyelia(1-5%)SpinalCordInjuryPotentialCo51AdditionalResourcesandInformationfromtheWebAmericanSpinalCordInjuryAssociation() TIRRSpinalCordInjuryResearchProgram(/research/?page=54) SpinalCordInjuryInformationNetwork(/show.asp?durki=19679)AmericanParaplegiaSociety() AdditionalResourcesandInfor52AdditionalResourcesandInformationfromtheWebNationalSpinalCordInjuryAssociation() Christopher&DanaReeveParalysisResourceCenter() ParalyzedVeteransofAmerica() AmericanAssociationofSpinalCordInjuryPsychologistsandSocialWorkers() AdditionalResourcesandInfor53RCS6080

MedicalandPsychosocialAspectsofRehabilitationCounselingSpinalCordInjuryRCS6080

MedicalandPsychosoc54AnatomyoftheSpineVertebraeBodyFrontsection,shapedlikedrumSupportsweightLaminaTowardsthebackBoneyarchsurroundsspinalcanalSpinousprocessBoneyprocessfromarchPointsofattachmentformusclesandligamentsDiscsCushionsbetweenvertebraeAnatomyoftheSpineVertebrae55

56AnatomyoftheSpineVertebrae:7CervicalFlexion,extension,bendingandturningofhead12ThoracicChestregion,allowsmostlyforrotation5LumbarLargerboneystructurestosupportaddedwgt5SacralFusedtogetherCoccyxAnatomyoftheSpineVertebra57

58AnatomyoftheCordCervicalCordC1-C2:C3-4:PhrenicnucleusC4:DeltoidsC4-5:BicepsC6:WristextensorsC7:TricepsC8:WristextensorsC8-T1:HandmusclesAnatomyoftheCordCervicalCo59AnatomyoftheCordThoracicCordIntercostalmusclesandassociateddermatonesLumbarsacralStartsatT9andcontinuestoL2Innervateships,legs,buttocksandanalregionCaudaEquina(horsestail)SpinalcordendsatL2Tipcalledconus,belowconusasprayofspinalrootsAnatomyoftheCordThoracicCo60

61Dermatomes/SensoryLevelDermatome:patchofskininnervatedbyagivenspinalcordlevelDermatomes/SensoryLevel62

C2toC4.TheC2dermatome

63Myotomes/MotorLevelMyotome:SpinalnerverootswhichinnervatesmusclesgroupsMostmusclesareinnervatedbymorethanonerootMyotomes/MotorLevel64

65Medical-and-Psychosocial-Aspects-of-Rehabilitation-Counseling[康復(fù)咨詢醫(yī)療和心理方面](53)課件66ASIAImpairmentScaleASIAA:Complete:nomotororsensoryfunctionispreservedinthesacralsegmentsS4-S5ASIAB:Incomplete:sensorybutNOTmotorfunctionispreservedbelowtheneurologicallevelandincludesthesacralsegmentsASIAC:Incomplete:motorfunctionispreservedbelowtheneurologicallevelandmorethanhalfofkeymusclesbelowtheneurologicallevelhaveamusclegrade<3ASIAD:Incomplete:motorfunctionispreservedw/musclegrade>3ASIAE:NormalASIAImpairmentScaleASIAA:C67DefinitionofDisabilityTetraplegia(preferredtoquadriplegia)Referstoimpairmentorlossofmotor/sensoryfunctionincervicalsegmentsofthespinalcordImpairmentoffunctioninarms,trunk,legsandpelvicorgansASIAScalevsquadriparesisDefinitionofDisabilityTetrap68DefinitionofDisabilityParaplegiaReferstoimpairmentorlossofmotor/sensoryfunctioninthoracic,lumbarorsacralsegmentsofthespinalcordArmfunctionsparedPossibleimpairmentoffunctionintrunk,legsandpelvicorgansASIAScalevsparaparesisDefinitionofDisabilityParapl69ClinicalSyndromesCentralCordSyndrome:lesionoccurringalmostexclusivelyinthecervicalregionSacralsensorysparingWeakness>UEvsLEBrown-SequardSyndrome:Lesionthatproducesipsilateral,proprioceptiveandmotorlossandcontralaterallossofsensitivitytopainandtempClinicalSyndromesCentralCord70ClinicalSyndromesAnteriorCordSyndrome:LesionthatproducesvariablelossofmotorfunctionandofsensitivitywhilepreservingproprioceptionCaudaEquinaSyndrome:Injurytothelumbosacralnerverootsw/intheneurocanalresultinginareflexivebladder,bowelandlowerlimbsClinicalSyndromesAnteriorCor71AchievementofFunctionalGoalsAgeBodytypeComorbiditiesPriorathleticsenseFatiguelevelTypeofstabilizationHXHO/POASpasticityPsychosocialfactorsNutritionAchievementofFunctionalGoal72FunctionalOutcomesMotor/sensoryrecoveryAbilitytoperformordirectADLsSocialreintegrationQualityoflifeFunctionalOutcomesMotor/senso73FunctionalOutcomesLEVELC1-C3Limitedhead/neckmovementRotate/flexneck(sternocleidomastoid)Extendneck(cervicalparaspinals)Speechandswallowing(neckaccessories)Totalparalysisoftrunk,UEandLEFunctionalOutcomesLEVELC1-C374LEVEL:C1-324hrcareneedsAbletodirectcareneedsADLsVentilatordependentImpairedcommunicationDependentforallcareneedsMobilityPowerwheelchairHoyerliftLEVEL:C1-324hrcareneeds75LEVEL:C1-C3EquipmentNeedsAdaptedcomputerBedside/portableventilatorSuctionmachineSpecialtybedHoyerRecliningshowerchairLEVEL:C1-C3EquipmentNeeds76FunctionalOutcomesLEVEL:C4Headandneckcontrol(cervparaspinals)Shouldershrug(uppertraps)Inspiration(diaphragm)Lackofshouldercontrol(deltoids)Paralysisoftrunk,UEandLEInabilitytocough,lowrespiratoryreserveFunctionalOutcomesLEVEL:C477LEVEL:C424hrcareneedsAbletodirectcareneedsADLsMayormaynotbeventdependentImprovedcommunicationAssistedcoughDependentforallcareneedsMobilityPowerwheelchairHoyerliftLEVEL:C424hrcareneeds78LEVEL:C4EquipmentNeedsAdaptedcomputerBedside/portableventilatorasneededSuctionmachineSpecialtybedHoyerRecliningshowerchairLEVEL:C4EquipmentNeeds79FunctionalOutcomesLEVEL:C5Shouldercontrol(deltoids)Elbowflexion(biceps/elbowflexors)Supinatehands(brachialisandbrachioradialis)LackelbowextensionandhandpronationParalysisoftrunkandLEFunctionalOutcomesLEVEL:C580LEVEL:C510hrspersonalcareneed6hrshomemakingassistanceADLsSet-up/equipment:eating,drinking,facewashandteethAssistedcoughDependentforbowel,bladderandlowerbodyhygiene Dependentforbedmobilityandtransfers

LEVEL:C510hrspersonalcaren81LEVEL:C5MobilityHoyerorstandpivotPowerwheelchairw/handcontrolsManualwheelchairDrivemotorvehiclew/handcontrolsEquipmentNeedsPowerandmanualwheelchairsAdaptivesplints/bracesPageturners/computeradaptationsLEVEL:C5Mobility82FunctionalOutcomesLEVEL:C6Wristextension(extensorcarpiulnarisandextensorcarpiradialislongus/brevis)Armacrosschest(clavicularpectrocialis)Lackelbowextension(triceps)LackwristflexionLackhandcontrolParalysisoftrunkandLEFunctionalOutcomesLEVEL:C683LEVEL:C66hrspersonalcareneeds4hrshomemakingassistanceADLsAssistedcoughSet-upforfeeding,bathinganddressingIndependentpressurerelief,turnsandskinassessmentMaybeindependentforbowel/bladdercareLEVEL:C66hrspersonalcaren84LEVEL:C6 Mobility IndependentslideboardtransferManualwheelchairDrivewithadaptiveequipmentLEVEL:C6 85FunctionalOutcomes LEVEL:C7Elbowflexionandextension(biceps/triceps)Armtowardbody(sternalpectoralis)LackfingerfunctionLacktrunkstabilityFunctionalOutcomes 86LEVEL:C7 6hrspersonalcareneeds2hrshomemakingassistanceADLsMoreeffectivecoughFeweradaptiveaidsIndependentw/allADLsMayneedadaptiveaidsforbowelcareLEVEL:C7 6hrspersonalcaren87LEVEL:C7MobilityManualwheelchairTransferswithoutadaptiveequipmentLEVEL:C788FunctionalOutcomesLEVEL:C8-T1IncreasedfingerandhandstrengthFingerflexion(flexordigitorum)Fingerextension(extensorcommunis)Thumbmovement(policuslongisbrevis)Separatefingers(introssiseparates)FunctionalOutcomes89LEVEL:C8-T14hrspersonalcareneeds2hrshomemakingassistanceADLsIndependentw/orw/oassistivedevicesAssistw/complexmealprepandhomemanagementMobilityManualwheelchairLEVEL:C8-T14hrspersonalcare90FunctionalOutcomesLEVEL:T2-T6Normalmotorfunctionofhead,neck,shoulders,arms,handsandfingersIncreaseduseofintercostalsIncreasetrunkcontrol(erectorspinae)FunctionalOutcomes91LEVEL:T2-T63hrspersonalcareneeds/homemakingADLsIndependentinpersonalcareMobilityManualwheelchairMayhavelimitedwalkingwithextensivebracingDrivewithhandcontrolsLEVEL:T2-T63hrspersonalcare92FunctionalOutcomesLEVEL:T7-T12AddedmotorfunctionIncreasedabdominalcontrolIncreasedtrunkstabilityFunctionalOutcomes93LEVEL:T7-T122hrspersonalcareneeds/homemakingADLsIndependentImprovedcoughImprovedbalancecontrolMobilityManualwheelchairMayhavelimitedwalkingwithbracingDrivingwithhandcontrolsLEVEL:T7-T122hrspersonalca94FunctionalOutcomesLEVEL:L2-L5AddedmotorfunctioninhipsandkneesL2Hipflexors(iliopsas)L3Kneeextensors(quadriceps)L4Ankledorsiflexors(tibialisanterior)L5Longtoeextensors(exthallucislongus)FunctionalOutcomes95LEVEL:L2-L5Mayneed1hrpersonalcare/homemakingADLsIndependentMobilityManualwheelchairMaywalkshortdistancewithbracesandassistivedevicesDrivingwithhandcontrolsLEVEL:L2-L5Mayneed1hrperso96FunctionalOutcomesLEVEL:S1-S5Ankleplantarflexors(gastrocnemius)Variousdegreesofbowel,bladderandsexualfunctionLowerlevelequalsgreaterfunctionFunctionalOu