1.What is spinal cord injury?
Spinal cord injury (SCI) refers to damage to the structure and function of the spinal cord caused by various reasons, resulting in motor, sensory, and autonomic dysfunction below the plane of injury. Injuries to the cervical spinal cord that cause paralysis of the limbs are called tetraplegia; injuries to the spinal cord below the thoracic segment that cause paralysis of the trunk and lower extremities without accumulating the upper extremities are called paraplegia. Statistics from various countries show that spinal cord injuries are mainly in young adults, with about 80% of those under the age of 40 and about four times as many men as women. The main causes of spinal cord injury in China are falls from height, smashes, traffic accidents, etc.
2.How should a casualty suspected of having a spinal cord injury be transported?
Patients with spinal injuries such as suspected spinal cord injury should be immediately braked and stabilized, there are two braking positions.
① keep the posture of the injury braking, transport;
② keep the casualty in a lying position, braking, transport. The former can prevent secondary injury to the spinal cord due to changes in position, braking and fixation should be immediately transferred to the hospital as soon as possible to start the rescue work.
3.What kind of rehabilitation programs can be carried out in the acute phase after spinal cord injury?
The acute phase is generally referred to when the patient is hospitalized in spinal surgery (orthopedics) after the injury, when the clinical rescue work is over, the patient’s vital signs are stable, and the spine is stable enough to start rehabilitation training. The acute phase mainly adopts bedside training methods, and the training content mainly includes.
(1) good limb position;
②Passive joint movement, passive joint movement of the paralyzed limb, 1-2 times/day, to prevent joint contracture and deformity;
③Change of body position, bedridden patients should change their position regularly, usually turning every 2 hours to prevent the formation of pressure sores;
④Early sit-up training should be started early for those with good spinal stability after spinal cord injury, twice a day for 30 minutes-2 hours each time. At the beginning, the head of the bed will be swung up 30°, and if there is no adverse reaction, the head of the bed will be raised 15° every day until 90°, and the training will be maintained.
⑤ Standing training, patients can consider standing training after sitting up training without adverse reactions such as postural hypotension. The stability of the spine should be maintained during training, and the patient should wear a lumbar brace to train standing up and standing activities, such as standing up on a bed.
(6) Respiratory and sputum evacuation training. Patients with respiratory muscle paralysis due to cervical cord injury should be trained in abdominal breathing, coughing and sputum coughing as well as postural sputum evacuation training to prevent and treat respiratory complications and promote respiratory function.
(7) The treatment of urine and stool is mostly done by indwelling catheterization within 1-2 weeks after spinal cord injury. The amount of water intake should be 2500-3000ml per day, and the amount of water intake and output should be recorded. After that, intermittent clean catheterization can be used. Constipation can be treated with lubricants, laxatives and enemas.
4.What is the content of rehabilitation training during the recovery period after spinal cord injury?
Rehabilitation training during the recovery period refers to the patient entering the rehabilitation medicine department as an inpatient or outpatient, when the fracture site is stable, the nerve damage or compression symptoms are stable, and the patient can enter the recovery treatment after the breathing is stable. The main contents include
① Muscle strength training: muscle strength training for patients with complete spinal cord injury focuses on the muscles of the shoulder and scapular girdle, especially the latissimus dorsi, adductors, upper limb muscles, and abdominal muscles. Incomplete spinal cord injury, then the residual muscles are trained together.
②Mat training mainly includes turning training, stretching training, mat movement training, hand and knee weight-bearing and mobility training.
③Sitting training can be done on the mat or on the bed. Before sitting training, the patient should have certain control and muscle strength of the trunk and a certain range of motion of the bilateral lower limb joints, especially the range of motion of the bilateral hip joints should be close to normal.
④Transfer training, transfer is a skill that patients with spinal cord injury must master, mainly including transfer between bed and wheelchair, transfer between wheelchair and toilet, transfer between wheelchair and car and transfer between wheelchair and ground.
The goals of walking training for spinal cord injury patients with different injury planes are different, mainly therapeutic walking for patients with T6-T12 plane injury, functional walking at home for patients with L1-L4 plane injury, and functional walking in the community for patients with L4 or less plane injury.
(6) Training of activities of daily living, especially for tetraplegic patients with spinal cord injury, it is especially important to train their activities of daily living, mainly including self-care activities, such as eating, grooming, upper limb dressing, etc. Bathing can be done in bed or on a bathing chair or with the help of some self-help appliances.
(7) Functional electrical stimulation, the lower limbs are prone to deep vein thrombosis after spinal cord injury, electrical stimulation of calf muscles can reduce the risk of occurrence and promote functional activities of the lower limbs such as standing and walking.
5, spinal cord injury patients often occur in the urinary tract infection is how?
What are the preventive measures? Urinary tract infection and its sequelae are the most frequent complications in patients with spinal cord injury. Patients with long-term indwelling catheterization or suprapubic fistula almost always have bacteriuria. The occurrence of bacteriuria is significantly reduced in patients with intermittent catheterization, and recurrent urinary tract infections are associated with the biological layer of the bladder on the bladder wall. Patients wearing an external penile drainage bag with a voiding pressure <50 mm H2O, especially after transurethral sphincterotomy, are at relatively low risk of urinary tract infections, but need to clean the external drainage bag and drainage tube with 6% bleach. Thorough daily cleaning of the device, bathing to maintain personal hygiene, washing the perineum and daily cleaning of the cushion will reduce bacterial colonization of the pelvic floor, bacterial colonization of the anterior urinary tract and infection.
6.What are the common methods of follow-up observation of the urinary system in patients with spinal cord injury?
Annual ultrasound of the kidney, ureter and bladder to check for decreased renal parenchyma, hydronephrosis and stones in patients with spinal cord injury. The incidence of bladder stones is 4% per year with indwelling catheterization, and blood urea nitrogen and creatinine levels are compared to previous years. Radiological nuclear perfusion imaging of the kidney is performed to evaluate glomerular filtration and renal blood flow and is indicated for further quantification of renal function.