Medical Complications after SCI Sara Kate Frye MS OTR/L ATP

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1 Topic List Medical Complications after SCI Sara Kate Frye MS OTR/L ATP Upper Extremity Health Heterotopic Ossification Autonomic Dysfunction Bladder Care Bowel Care Skin Care Sexual Function Wheelchair Strain on The UE UE Health Fingers/Hand Wrist Elbow Shoulder Pain syndromes prevalent Emphasize Scapular Therex Train on Self- Stretching Avoid Overhead Activities Avoid Repetitive Activities Avoid Bicep Curls Examine Bed and Wheelchair Positioning Discuss Benefits of Power Mobility Consider Transfer Techniques, Frequency & Equipment Minimize High Stress Activities such as Stair Bumping and Floor Transfers (PVA 2005) Heterotopic Ossification Autonomic Nervous System Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. Management includes medication, range of motion, and surgical excision 6 1

2 Autonomic Changes after SCI Autonomic Dysreflexia Temperature Regulation Cardiovascular Regulation Bladder Function Bowel Function Sexual Function Seen in SCI T6 and above Symptoms include pounding headache, red face, anxiety, goose bumps, congestion, sweating above level of injury, nausea, slow pulse, cold/clamminess below level of injury, and increased blood pressure Look for Cause Evaluate Bladder, Bowel, Skin integrity, Feet and toenails Additional causes- Sexual activity, Menstrual cramps, Labor and delivery Additional causes- Heterotopic ossification (HO), GI problems, Skeletal Fx, Wounds Manage Increase in Blood Pressure- Sit up, remove binder/teds, ER if necessary! Medical Emergency! Check out AD Info at to learn more Orthostatic Hypotension Bladder Function Orthostatic or postural hypotension is a sudden drop in blood pressure caused by moving from a lying to a sitting or standing position. It often occurs after spending a long time in bed and then suddenly getting up. Although orthostatic hypotension can happen to anyone, it is more common following a spinal cord injury (SCI). This is because of the loss of autonomic control which works to keep the blood pressure stable, as well as loss of muscle tone which helps to return blood to the heart. Bladder Management Urologic Management Intermittent Catheterization Program Nursing lead with OT involvement to promote independence as needed Adaptive Equipment Pants Holder Catheter Clip (with u-cuff PRN) Penis Holder/ Labia Spreader Leg Spreader Mirror Consider type of Catheter Clean Technique versus Sterile Talk to your Urologist! Clinical Assessment Medical Management Oral Medications Botox Urodynamics Supplies Patient and Family Education (PVA, 1999) 2

3 Intermittent Catheterization Bladder Devices Males- Typically independent self cathing early unless other barriers exist Females- consider training at bed, wheelchair and toilet level. What are the quality of life factors? # of transfers Cosmetics Power vs. Manual Alternative options House Hold Penis Holder Betty Hook/Pants Holder Catheter Inserter Catheter Options- Lofric Lofric Commercially Available Catheter Options- MTG Catheter Options- Hollister 3

4 Catheter Options- Coloplast Do I have to cath at night? Bed level cathing Setup of kit or basket with supplies Access to light Plan for disposal Neurogenic Bowel Bowel Management Bowel Program Diet Fluid Intake Activity Medications Manual Techniques Upper Motor Neuron (reflexive bowel) Cervical/Thoracic SCI BTP typically every other day 1. Disimpaction 2. Insert stimulant medication and wait 3. Digital stimulation at intervals Lower Motor Neuron (areflexive bowel) Lumbar SCI BTP typically every day Disimpaction Stimulant medications may be used Digital stimulation may be used Valsalva maneuver effective Your Bowel Program-Your Life Bowel Equipment What is the best bowel program? The one that works! Goal is no involuntaries! Skin preservation is key Padded surfaces Bare bottom transfers Code Brown Preparedness Clothes, hygiene, when to give up the diaper 4

5 Bowel Equipment Peristeen Suppository Inserter Digital Stimulator Skin Integrity Common Pressure Areas Stages of Pressure Ulcers Skin Inspection Complete every morning and night as part of ADL s Have a plan for action if skin integrity is a concern 5

6 Pressure Relief- Wheelchair Pressure Relief- Bed Pressure Relief every minutes. Utilize pressure relieving cushion. Turning every two hours is recommended Protecting the Skin During Daily Activities Burn Prevention Clothing Selection Driving Leisure Activities Toileting Education on Burn Awareness and Skin Checks Common Causes of Burns after SCI Holding a hot cup of coffee or soup in hand or carrying in lap Carrying food on lap in kitchen Space Heaters, Camp Fires, and Fire Places Placing feet on hot cement or in hot sand Letting feet sit in water of tub Un-insulated pipes under sinks Heating pads Addressing Sexuality After SCI Female Sexuality and Fertility after SCI P LI SS IT Model Education for clients and partners Individual vs. Group Team Approach Urology, Medical, Therapy Relationships are also affected Communication is key Caregiving versus being an intimate partner Loss of role fulfillment after SCI Adapted positioning during intercourse Potential for decreased lubrication during intercourse Fertility unchanged after SCI Medical complications of birth control including DVT risk Vaginal childbirth possible Assistance may be needed Pain may cause Autonomic Dysreflexia Concerns about identifying when labor begins Concerns related to women s health care Knowledge of providers Accessibility of treatment spaces 6

7 Male Sexuality after SCI Options for Erectile Dysfunction after SCI Erectile dysfunction Reflexive vs. Psychogenic Erection Reflexive Erection typically possible above T12 Concerns Achieving and Maintaining an Erection Adapted Positioning & Techniques Fertility commonly impacted Referral to fertility specialist Medication Examples: Viagra, Cialis Concern for individuals with cardiac histories Penis Pumps Rings Maintain Erection Commonly used with other methods Limit of 30 minute use Injections Suppositories- Muse Concerns for partner s health Implantable Devices Sex after SCI- Get Creative Questions? Intimate Rider 7