1.What is spinal cord injury?
Spinal cord injury is a transverse damage to the spinal cord caused by various pathogenic factors (trauma, inflammation, tumor, etc.), resulting in impairment of spinal cord nerve function (motor, sensory, sphincter and vegetative nerve function) below the plane of damage.
2, the etiology of spinal cord injury?
Spinal cord injury is actually not uncommon, and its causes are mainly twofold: one is traumatic, and traumatic injuries of various causes, as long as they involve the spinal cord, causing the spinal cord to be shocked, may cause spinal cord injury. The most common type of injury is a fall from a height; the second is a traffic accident or direct impact; the third type is a smash, for example, caused by a coal mine collapse or a house collapse. In addition to traumatic spinal cord injuries, there are also a large number of non-traumatic spinal cord injuries, and there is a tendency to increase them, such as myelitis, spinal cord tumors, spinal cord vascular disease, spinal cord lateral sclerosis, etc. Of the two causes of spinal cord injury, traumatic injuries occur more frequently, but both are on the rise. According to a recent Beijing statistics, in the 1980s, the rate of spinal cord injury due to trauma was 6.8 per million, while now it is 60 per million, an increase of many times.
3.How should I deal with the first aid scene in case of spinal cord injury?
If there is a wound, should be emergency bandage, and should not easily turn the casualty, there is cerebrospinal fluid leakage to thicken the bandage.
For those with breathing difficulties and coma, oral secretions should be cleared in time to keep the airway open.
First aid handling process, must pay attention to keep the casualty’s head and neck and torso straight position, never make the spine flexion and twisting. Especially cervical spine injuries, should be carried more carefully, and fixed. Do not lift the head, torso or sit up. It is best to use a flat stretcher or door plate.
When there is a wound or possible infection, antibiotics should be applied reasonably. Also, prevent and treat other site injuries and prevent urinary tract infections and respiratory complications.
In cases of high paraplegia, tracheotomy should be performed early if necessary; when carrying for a longer period of time on the way, hard objects in the casualty’s coat pocket, etc., should be removed to prevent pressure from decubitus ulcers.
After emergency treatment, the patient should be sent to hospital immediately for treatment.
4.What is the main function of the normal spinal cord?
The spinal cord is a link between the brain and peripheral nerves. The brain’s commands are transmitted to peripheral nerves through the spinal cord, thus completing the body’s motor, sensory, and bowel control functions.
5.What happens after spinal cord injury?
After spinal cord injury, its ability to transmit brain-controlled motor and sensory commands is reduced or even lost, resulting in corresponding pathological changes such as sensory and motor impairment, abnormal reflexes, and urinary and fecal incontinence or retention below the plane of injury, which are often referred to as “quadriplegia” (referring to cervical spinal cord injury) and “paraplegia “(refers to the thoracic and lumbar spinal cord injury).
6.What is incomplete spinal cord injury and what is complete spinal cord injury?
Incomplete injury: If it is found that some sensory and motor functions are retained in the sacral segment below the plane of the injured nerve including the lowest position, this injury is incomplete damage, and the sacral sensation includes the anal mucosal skin junction and the deep anal sensation. Motor function is examined by anal examination with a finger to determine whether there is active contraction of the external anal sphincter.
Complete injury: refers to the complete loss of sensory and motor functions of the sacral segment.
7.What is the age distribution of spinal cord injury patients in China in terms of morbidity?
The average age of traumatic spinal cord injury is probably around 30 years old most often. One is young adults, who are more involved in sports, and the other is people aged 50-60, who mostly suffer from spinal cord injuries due to falls. Therefore, the age span of spinal cord injury jumps from young adults to the elderly, with relatively few middle-aged people and fewer children.
8.What is the incidence of spinal cord injury?
The incidence of traumatic spinal cord injury is about 60 per million. In total, the literature reports a rate of 6 to 20 per 100,000. In China, about 70,000 to 80,000 new spinal cord injuries occur each year. Combined with an average life expectancy of about thirty years after injury, the cumulative number of spinal cord injury patients is a significant number.
9.Why should special emphasis be placed on rehabilitation for spinal cord injury patients?
Once the spinal cord is stabilized, there will be primary dysfunction, such as paralysis, and secondary dysfunction, such as stones in the kidney system, pressure sores, joint dysfunction, sexual dysfunction, and fertility problems, because there are fewer opportunities to promote spinal cord nerve regeneration. fertility problems, etc. These cannot be solved simply by medication or surgery, but must be improved, compensated and replaced by certain rehabilitation training, so that spinal cord injury patients can regain their self-care ability and improve their quality of life as much as possible, which is very important.
10, the purpose of rehabilitation of spinal cord injury?
Rehabilitation treatment can largely prevent or reduce a series of serious complications caused by spinal cord injury, such as pulmonary infections, urinary tract infections, pressure sores, joint stiffness and contractures, postural hypotension, deep vein thrombosis, mental depression’s, etc.. And through the assembly and use of assistive devices to maximize the patient’s ability to restore activities of daily living and work, learning and recreation.
11.When does the rehabilitation treatment of spinal cord injury usually start?
The earlier the rehabilitation treatment is, the better. It can be started as soon as the clinical situation is stable, for example, after spinal surgery and not in the process of resuscitation. The early rehabilitation process is not taking very complicated measures or strenuous exercise, and can prevent the occurrence of some comorbidities, so the earlier the better.
12.The relationship between spinal cord injury plane and functional prognosis?
Plane force Mobility Ability to live
Cervical spine 1-4 Dependent on diaphragmatic pacing to maintain respiration, with acoustic control to manipulate certain activities Fully dependent
Cervical spine 4 Uses a powered high back wheelchair, sometimes requires assisted breathing Highly dependent
Cervical spine 5 Hand-driven high-back wheelchair on a flat surface, requires upper extremity aids Mostly dependent
Cervical spine 6 Can drive wheelchair by hand, wears tops independently, can drive specially adapted cars Moderately dependent
Cervical spine 7-8 Wheelchair functional, independent bed-wheelchair/toilet/bathroom transfer Mostly self-care
Thoracic 1-6 Wheelchair independent, walks short distances with long-legged orthotic support crutches Mostly self-care
Thoracic spine 12 Walking with long-legged orthosis with crutches, wheelchair required for long-distance mobility Basic self-care
Lumbar spine 4 Short-legged orthosis walking with crutches, no wheelchair required Basic self-care
13.How to carry out some effective rehabilitation training in the early stage?
The earliest training can be done shortly after surgery or after a traumatic injury. One is to protect all joints, at least once or twice a day to do the whole range of joint activities, the range should be complete, each joint should be moved to avoid joint contracture, the other is to prevent postural hypotension, because long-term bed rest will make you dizzy when you stand up, let the patient gradually elevate the head of the bed, from 30 degrees, 40 degrees, 50 degrees, 60 degrees, gradually elevate, of course, elevation can not Let the patient sit up by himself, to use the rocking bed, because the spine does not have any movement, so raising the head of the bed is early can do.
14.How to do muscle training and exercise?
The muscle strength training in the acute period is to prevent muscle strength loss and muscle atrophy during the bed rest period; the muscle strength training in the recovery period is to help obtain various movements and functions, and the methods are: upper limb muscle strength strengthening training and lower limb active assistance training with iron dumbbells etc. for thoracic and lumbar medullary injuries, training with weights, pulleys, rubber bands or freehand resistance method for cervical medullary injuries, and more importantly, sitting training and support movements. In addition to muscle strength training, joint mobility must be maintained to prevent contractures. The acute period is mainly performed passively, while the recovery period is left to the patient’s own activities.
15.How to train the tetraplegic patient to turn over?
(1) Without aids: Straighten both upper limbs, swing the head and trunk to both sides in concert, and when the swinging amplitude is large enough, swing again with force to the side you wish to turn over, so as to achieve the purpose of turning over.
(2) With the aid of aids: aids can be bed rails and handrails, one upper limb fixed on the turning side, the other upper limb swinging to the same side, head and trunk swinging in concert can achieve the purpose. Patients with normal function of both upper limbs and hands can also use the above method to turn over.
16.How to sit up from the flat position for tetraplegic patients?
(1) Use the rope ladder at the end of the bed to sit up from the horizontal position. ①Start position. (2) Lift the upper body by pulling the rope ladder and bending the elbow joint. (3) Gradually move your elbow joint on the bed towards the end of the bed while pulling the rope ladder with the other hand to help lift your upper body.
(2) Sit up from the flat position using the overhead suspension belt. ①Start position. ②Pass one upper limb through the sling. (3) Raise the upper body from the bed. ④The other elbow is propped up on the bed. ⑤Pass the upper limb into the second sling. (6) Raise the upper body and extend the other hand straight back. ⑦The upper limb is put into the third sling. ⑧Support
17.How to perform four-point gait exercise?
Use double crutches and knee-ankle-foot brace (long lower limb brace) for four-point gait training. ①Stand in a balanced position. (②Forward with one side of the crutches. ③Lift the opposite leg by lifting the hip, lowering the head and twisting to the opposite side of the swinging leg. ④Once the leg is lifted, the leg is swung forward like a pendulum. ⑤Stand in a balanced position with one leg forward. Repeat the above actions to complete the walk.
18.What is the swing to step and swing over step?
(1) Exercise of swing to step.
①Balance stance. (2) Double crutch front. (3) Lift the pelvis and legs by extending the elbows, depressing and extending the scapulae, and lowering the head. ④Swing the legs to but not over the crutches to re-establish a balanced stance. ⑤ The crutches are quickly fronted to gain greater stability. The swing to step consumes less energy and poses less risk of falling compared to the swing over step.
(2) Exercises for the swing-over step.
① Balanced standing position. ② Double abduction front. ③Extend both elbows, depress and extend the scapulae, and lower the head to lift the legs and pelvis. ④Once lifted, the torso and legs swing forward like a pendulum. ⑤ The feet follow the ground. (6) By raising the head, contracting the shoulder blades and pushing the pelvis forward, regain a balanced standing position.
19.How to use crutches to go up and down stairs?
(1) You can use the backward method to go up and down the stairs.
①Stand balanced a few inches away from the lowest level of stairs. (2) Place the crutches on the stairs. (3) Extend your elbows, depress your shoulder blades, rely on the crutches, and lift your feet up the steps. ④ regain a balanced standing position.
(2) Hold the railing with one hand and use the crutches to go down the stairs with the other crutch in your hand.
20.How to go up and down the slope when walking with double crutches?
The biggest problem for patients walking on slopes is to avoid slipping. When wearing a fixed ankle brace on a slope, the patient’s hip joint and brace are inclined downward. To improve the patient’s walking ability on slopes, patients should practice on steep slopes as much as possible.
Upward slope: When going up the slope, the double crutches should be placed in front of the feet, and in order to increase stability, the body should be made at a certain angle to the slope, the pelvis should be tilted forward, and the swing to step should be used instead of swing over step.
Downward slope: When going downhill, the slope tends to put the patient in a stable position, at which time the pendulum can be used.
21.How to fall and get back up safely with crutches?
When a person walking with crutches falls, there are two things that can be done to reduce the risk of injury. First, move away from the crutches to avoid falling on them. Second, when the patient falls, he or she should land on the palms of the hands, tuck the upper extremities in front of the chest, and cushion them with the elbows and shoulders, which should prevent the upper extremities from stiffening during the fall and causing a fall injury.
The method of re-standing. ①Start position, prone position with legs, double crutches placed in the right place, palms propped on the ground. ②Position the body in a plantar row position. (③) Fully lift the pelvis. ④Grab the first crutch. ⑤ Balance with one crutch while grasping the second crutch. ⑥Place the forearm collar. ⑦Push the torso straight. ⑧Stand up straight.
22.Selection of wheelchair
The vast majority of people with spinal cord injuries may need to rely on a wheelchair to get through the years ahead. The type and use of wheelchairs should vary according to the extent of the injury. A wheelchair should be selected with the guidance and advice of a rehabilitation professional to suit your condition. Some aspects to consider are that the wheelchair should be lightweight, foldable and portable; the cushion should be soft, breathable and evenly pressurized; and should it be used primarily indoors? Or outdoor? Can the armrests be disassembled; choose the driving device according to the ability. Wheelchairs for spinal cord injury patients are lifelong mobility tools, so it is important to choose the right wheelchair.
First of all, for patients with high spinal cord injuries, patients with cervical 5 or higher, they need to choose a wheelchair with a high lean and a chest fixation belt because they cannot move their hands. This type of wheelchair will be pushed by family members, and the patient cannot control the wheelchair by himself. Therefore, the wheelchair brake gate must be reliable and strong to prevent the danger of sliding and slipping with no one around. In addition, the armrests should be wide, soft, and able to fix both hands, equipped with anti-pressure sore pads, and the footrests should be long enough to prevent bruises on both feet. Patients with cervical 6 to thoracic 1 spinal cord injury should be equipped with a good quality and lighter wheelchair when available. When the hands are down, they should be in a vertical line with the axle of the big wheel, so that there is friction when driving, and they should be equipped with a palm and half-finger gloves to prevent hand abrasion and easy driving of the wheelchair. The front wheels must be flexible, and likewise, the footrest should be long enough. In addition, the footrests should be able to separate to the sides so that it is easier to move to the bedside with a skateboard. If the patient is frail, old or heavy, and it is difficult to drive the wheelchair with both hands, it can also be equipped with an electric wheelchair (manual type), which can be charged once a day to drive more than ten kilometers, and the range of activities can be significantly increased. Of course, the price is also higher. For patients with low to moderate spinal cord injury, or incomplete spinal cord injury, if you can stand and move with double lower limb braces and crutches, you should strengthen this training more to prevent osteoporosis of the lower limbs, the general condition and physical ability will be improved, so it is better to use a wheelchair less. However, for more distant activities, a wheelchair is still required, otherwise physical exertion is too great and cannot be sustained.
23.How to transfer from the wheelchair to other places in the same plane?
When performing this training, care should be taken to place the feet on the floor so that the feet are perpendicular to the ground, so that the maximum amount of weight can be put on the legs during the transfer.
(1) Transfer without assistive devices.
(1) Start position. Head down, reverse swing toward the bed, support the bed with one hand and the wheelchair with the other (brake in advance), and lift the hips to move toward the bed.
(2) Transfer with assistive devices.
① Start position. Twist the hips toward the slide and sit out of the wheelchair and move toward the bed.
24.How to practice lifting the front wheels of the wheelchair and maintaining balance with the rear wheels?
This is a basic wheelchair skill and is performed in two ways.
(1) Instruct the patient to maintain balance with the rear wheels.
(1) Instruct the patient to put the patient in the balance position. When driving forward, the wheelchair is tilted back. When pulling the wheelchair backward, the wheelchair returns to the upright position. Non-contact protection allows the patient to repeatedly experience and master the balancing essentials
(2) With the safety device, the patient alone practices to keep balance with the rear wheel.
Same method
25.How to get on and off the roadside stones when riding a wheelchair?
(1) From a stationary position on the roadside stones.
Start with the front wheels a few centimeters from the steps, facing the steps. Lift the front wheel and place it on the step. Back the front wheel to the edge of the step. Place both hands in the proper position of the driving hand wheel. Complete the step.
(2) Step backwards down the roadway edge stone.
Start position and back the wheelchair to the edge of the step. Control wheelchair descent. Turn the wheelchair under the control seal and lower the front wheels off the steps.
26.How to perform rehabilitation care?
Especially in the early stage, rehabilitation care is a most important element. For example, the patient has to choose the right bed and mattress. The bed board is to be hard, but there must be a softer mattress on top, which cannot arc down, but must be flat. The extra padding is to prevent pressure sores from occurring. Turn over regularly, at least once every two hours. Long-term patients can be turned gradually for longer periods of time, but care must be taken that the skin is not pressed out and red. If there is, it must be recoverable in a short time. There must also be a proper position to sleep properly, otherwise it can cause some limb dysfunction or deformity. Also personal hygiene should be paid special attention because there will be incontinence, which can cause local infection or pressure sores, and to ensure breathing, which may affect the life of the patient if it is a high level injury.
Rehabilitation care for spinal cord injury.
1, choose the right bed and mattress
2.Turn over regularly
3, maintain the appropriate body position
4, pay attention to personal hygiene
5.Ensure smooth airway
27.How to maintain the correct position of the limbs?
Keep the paralyzed hand in the correct position: a soft object similar to a hand towel can be placed on the palm of the hand; the legs are straight, flat and slightly separated; the toes are up and the back of the foot is bent upward to about 90 degrees from the bed. Use several pillows of different thicknesses under the body to achieve this position.
28.What are the common complications of spinal cord injury
Spinal cord injury can cause lifelong disability, and many people are unable to take care of themselves and require care, and many comorbidities can arise from it. For example, pressure sores (commonly known as bedsores) caused by prolonged bed rest and local skin pressure, urinary tract infections caused by urinary incontinence, osteoporosis and even fractures caused by prolonged non-standing, contracture fixation and muscle atrophy caused by prolonged bone and joint immobility, and spasms (commonly known as “cramps”) and pain caused by spinal cord nerve damage, hip The treatment of spinal cord injury is currently based on the following factors In addition, because there is no effective medical treatment for spinal cord injury, the above-mentioned serious consequences can cause great psychological trauma to patients, resulting in psychological imbalance, pessimism, disappointment, anxiety, depression may arise.
29.Skin care (prevention of pressure sores)
Check the skin of the whole body twice a day after waking up and before going to bed;
Avoid prolonged local pressure. You should change position every two hours by yourself or with the help of others. Raise your buttocks every 30 minutes and hold them for at least 30 seconds while in a wheelchair;
Keep the skin dry and lubricated to avoid stimulation by urine and feces
Avoid rubbing and massaging the pressurized area, and have adequate and reasonable nutrition.
30.Care of urination
Patients with spinal cord injury often lose the ability to control urination on their own. In order to safely, effectively and regularly expel urine from the bladder, patients need to perform bladder training with the help of medical personnel.
Establish a water-voiding-catheterization schedule with a total water intake of no more than 2000 ml in 24 h. Common methods.
(1) Suprapubic area tapping method: the patient taps the lower abdomen with his hand to produce urination ;
(2) breath-holding method: the patient leans forward, takes 3 to 4 quick breaths, then takes a deep breath, holds the breath and makes a downward forceful defecation movement until the urine flow stops;
(3) Squeeze method: first use the fingertips to massage the bladder deeply, then use the fingers to make a fist and place it 3cm below the umbilicus and apply pressure to the lower abdomen until the flow of urine stops. Be careful not to apply pressure from the bottom upward to prevent the backflow of urine to the kidneys.
31.Care of stool
The ability to control bowel movements may be lost after spinal cord injury. With appropriate training and treatment, most patients’ bowel function can be improved.
Commonly used defecation training methods are.
(1) use fingers (wearing disposable latex or plastic gloves plus paraffin oil) to stimulate the anus, and use both hands to point outward to expand the anus to enhance stimulation
(2) anal plugs with drugs
(3) Manual elimination
Usually, defecation training (daily or every other day) is done by one of the above methods depending on the patient’s needs. Some patients also need to take some laxative medication to assist with bowel movements. Drink a drink half an hour before a bowel movement to stimulate bowel movements. As far as possible, use the toilet or stool chair, plus right-to-left abdominal massage to increase intra-abdominal pressure, also helps defecation.
32.How should the housing of spinal cord injury patients be modified?
In order to enable paraplegic or quadriplegic patients to successfully complete daily life at home, their housing should be modified.
(1) Install a bidet in the toilet and adjust the height of the bed and bidet to suit the height of the wheelchair, so as to facilitate the transfer of patients from the bed to the wheelchair and to the bidet.
(2) The width of the toilet door should be able to pass the width of the wheelchair and hands holding the turning rim, and there should be no steps, in general, should be installed in the commode 30 degrees intersection angle, both sides of the commode to support the body to do the transfer action, facing the door to sit on the commode.
(3) In addition to the above-mentioned toilet installation handrails, in the bedside, kitchen, sofa, dining table can be installed handrails, in order to facilitate the completion of the transfer action.
(4) The door of the kitchen should be widened, and the door should preferably be a horizontal sliding door without steps. The stove must be low, so that you can fry and see the bottom of the pot while sitting in the wheelchair, and the sink, sink, and countertop should be lowered so that the patient can operate easily. Faucets should be long-handled, easy to switch, easy to reach.
(5) There should be a ramp to enter and exit the door, with an angle of no more than 15 degrees, otherwise there will be difficulties in pushing the wheelchair up the slope by hand.
(6) There should be a bathing position for the patient at home, and it is generally more appropriate to sit in the wheelchair and take a shower.
(7) Try to buy various electrical appliances with remote control devices, such as TVs, VCRs, air conditioners, fans, and lights. Patients with tetraplegia can use the specially designed “environmental control system”.
33.Psychological treatment of spinal cord injury
The weight of psychological treatment is extremely large, and may even be the most important part, because if the patient does not have the confidence to overcome his disability and dysfunction, or does not cooperate, there is no way to talk about all the treatment. And we do have a lot of patients who just don’t achieve the function they should because of psychological barriers, give up and stop trying, and the impact is huge. What we always say to patients is: everyone should always keep a hope, hope that one day in the future there will be some progress, this progress may not be the recovery of the original paralyzed nerve function, but the original life can not do things, now can do, this is progress, should always keep this hope.
34.Recreational activities (spare time life)
With the help of medical staff and through your own efforts, you can develop some interests in life, such as planting flowers, doing some small crafts, reading books, listening to music, etc. You can also be trained to participate in some cultural and sports activities, such as sitting volleyball. You can train to use computers to increase your chances of employment and work. They can also establish a wide range of contacts with the world through the Internet.
35.Notice for patients and families
(1) Pay attention to the general condition of the patient. If in the acute stage, the patient should stay in the hospital (usually within 1 to 4 weeks). Patients should be observed for breathing, note whether they have fever, trembling, sweating, irritability, and whether their urine and stool are clear. If fluids are given, more attention should be paid to whether urine output increases. If there is a wound, pay attention to whether the dressing is dry, whether there is blood and exudate, and if there is drainage, pay attention to the flow of fluid, and notify the doctor or nurse of any abnormalities in a timely manner.
(2) Turn every 2 hours. Patients with neck injury or surgery should be turned axially (i.e., head and torso should be turned at the same time, not causing head rotation during turning). To prevent pressure sores, the bony prominence should be padded (posterior occipital region of the head, scapular region, sacrococcygeal region, both hips, both internal and external ankles, ankles, and both knee joints), but be careful not to use round air cushions, because such cushions can cause poor venous blood flow. The bony prominence should be gently massaged by hand, and any color change should be shown to the doctor.
(3) If the patient needs to transfer to a bed or go out to a wheelchair, 3 to 4 people need to work together to lift the patient flat (standing on one side) to complete the transfer, and if the transfer will not be done by itself, 2 people need to lift the patient from the bedside to the wheelchair. In case of insufficient manpower, one person can also transfer the patient in a special position, i.e., with both knees against the patient’s knees, move the upper body behind the patient, pull the patient’s back side belt or trouser edge with both hands, force the upper body backward, lean the patient’s upper body against the back side of the assistant’s upper body, move slowly with two points, one in front and one behind (when turning left, the right foot is in front, when turning right, the left foot is in front), and one person can also complete the transfer action. Of course, patients who cannot sit in a stable position should not perform this kind of transfer. After regular rehabilitation training, if patients can transfer on their own, they should be protected at an early stage to prevent falling and trauma.
(4) Eat more nutritious food and fruits, pay attention to the stool situation, more than 3-7 days without stool, to quickly inject 2 pieces of cork in the anus, too dry to wear gloves (latex) to dig out, the hand should be gentle to prevent anal fissures, and at the same time can take some oral honey, slow laxative (such as senna leaf infusion or Chinese medicine hemp Ren Runyun pill, etc.).
(5) Move all joints, especially the joints below the paralyzed part need to move, gently, each joint activity for 2 times a day, 1 to 2 minutes each time, to move according to the normal range of joint activity.
(6) Pay attention to the swelling of both lower limbs. If the swelling is due to deep vein thrombosis and bleeding, do not move around, elevate the affected limbs slightly and ask the doctor to check.
(7) If the limbs are swollen and bruised after activity, there is a possibility of tendon laceration or fracture, stop the activity and ask the doctor for examination.
(8) The patient should be comforted to recuperate at ease and encouraged to have confidence in overcoming the disability.
(9) When covered, put a soft pillow under the foot so that the ankle joint is kept at 90°, and do not use the quilt to press the foot to prevent causing foot drop.
(10) The patient’s position is usually side-lying, supine, or prone if there are pressure sores on the sacrococcygeal area. Of course, sitting position can also be used after the patient’s condition is stabilized. Any change of position must be carried out under the guidance of a doctor or nurse. Generally speaking, the head, neck, chest and waist should not be twisted, and all positions should be supported by soft cushions, and the protruding bone should be protected, and the posture should be made stable.