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Spinal Cord Info 2

Precautions/Complications/OT interventions

Precaution/ComplicationDefinitionOT Intervention
Autonomic Dysreflexia ANS disorder, results in high BP. Sit pt, make sure urinary catheter/ drainage bag are flowing, check 4 skin irritations, notify nursing staff
Orthostatic Hypotension Pts usually immobilized in supine or prone & when 1st attempting to sit up, BP suddenly drops. Recline. OT should collaborate on slow intro of moving from bed lying to sitting.
Respiratory Impairment pt w/tetraplegia has respiratory difficulties. Those w/ tracheostomies often have difficulty coughing to clear respiratory passageways & will need suction @ various times. Be alert for signs of need 4 suctioning. Either learn to perform suctioning or get appropriate personnel to do it.
Sensory Losses sensory loss below lesion, high risk for decubiti. Encourage vision use 2 compensate 4 loss. During trfs & bed mobility: avoid shearing stress or friction injuries 2 skin by lifting body away from surfaces. 4 WC/sittng: use cushions/weight shift every 15-20min. 4 bed: repositn evry 2hr, inspect skin daily
Hypo-Hyperthermia SCI's w/orthostatic hypotension may have impaired thermal control. Keep environment mild. Discont. ex if no A/C is avail. Be alert for signs of overheating or abnormal body temp.
Heterotopic Ossification the presence of bone in soft tissue where bone normally does not exist. Report to pts physician
Spinal Shock/Spasticity Pts experience flaccid paralysis immediately post-SCI, may last up 2 a few months.Once reduced a pt w/ T12 or above may experience mild-mod spasticity. Must (A) in spasticity mangmnt. Teach pt 2 use positioning & other techs to inhibit spasticity. Pt must also do regular ROM ex to prevent contractures.
Skin breakdown, Decubitus Ulcers When sensory loss increases risk of skin breakdown. Pressure causes loss of blood supply to area=necrosis below skin surface. Be aware of signs. Can be releived by eliminating pressure points/protecting vulnerable area from excessive shearing, moisture, heat. Routinely turn bed, use pressure relieving seat cushions or mattresses, protect bony prominences, perform weight shifts.
Osteoporosis Due to disuse of long bones. Can cause pathological fractures. More common in LEs. Implement a "standing program" while in rehab and upon D/C.
ROM Restrictions Pts w/ PROM past 90 deg @ shoulder, nor should MMT or strengthening ex be provided. Let wrist ext/fingr flexors be allowed to tighten to provide power for tenodesis. Never extend/flex wrist & digits @ same time. ROM ex 4 full flexion of digits only done w/wrist extended. 4 full finger ext wrist should be flexed.
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