Cardiopulmonary Physiotherapy in Trauma An Evidence-based Approach
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Cardiopulmonary Physiotherapy in Trauma An Evidence-based Approach Editors Heleen van Aswegen Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa Brenda Morrow Department of Paediatrics and Child Health, University of Cape Town, South Africa ICP Imperial College Press
Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Cardiopulmonary physiotherapy in trauma : an evidence-based approach / edited by Heleen van Aswegen, Brenda Morrow. p. ; cm. Includes bibliographical references and index. ISBN 978-1-78326-651-7 (hardcover : alk. paper) I. Van Aswegen, Heleen, editor. II. Morrow, Brenda, 1973, editor. [DNLM: 1. Wounds and Injuries--therapy. 2. Heart Diseases--therapy. 3. Physical Therapy Modalities. 4. Respiratory Tract Diseases--therapy. 5. Wounds and Injuries--complications. WO 700] RE831 617.7'13--dc23 2015005248 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Copyright 2015 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. Typeset by Stallion Press Email: enquiries@stallionpress.com Printed in Singapore
Preface List of Contributors Contents Chapter 1 Physiological Response to Trauma 1 Written by H. van Aswegen 1.1. Human Immunity and its Response to Injury and Inflammation 2 1.2. Shock and its Effects on the Human Body 9 1.3. Factors that Influence Blood Oxygen Content 16 1.4. Effect of Trauma on Blood Glucose Levels 17 1.5. Clinical Case Scenario 18 1.6. Classification of Patients with Traumatic Injuries 19 1.7. Conclusion 24 Bibliography 24 xi xv Chapter 2 Not Just Small Adults : Paediatric Anatomy and Physiology in Relation to Trauma 29 Written by B.M. Morrow 2.1. Introduction 30 v
vi Contents 2.2. Anatomical and Physiological Differences between the Adult and Child 31 2.3. Conclusion 45 Bibliography 45 Chapter 3 Trauma and Immunosuppressive Diseases 47 Written by H. van Aswegen and B.M. Morrow 3.1. Introduction 47 3.2. Pathogenesis of HIV and AIDS 48 3.3. HIV and AIDS and the Pulmonary System 49 3.4. Extrapulmonary Complications Associated with HIV and Antiretroviral Therapy 57 3.5. Conclusion 60 Bibliography 61 Chapter 4 Physiotherapy Modalities, Markers and Outcome Measures 65 Written by B.M. Morrow and H. van Aswegen 4.1. Early Mobilisation and Graded Exercise Therapy 65 4.2. Cardiopulmonary Physiotherapy Techniques 73 4.3. Markers and Outcome Measures 132 4.4. Conclusion 137 Bibliography 140 Chapter 5 Blunt and Penetrating Injuries 151 Written by H. van Aswegen, B.M. Morrow and E. van Aswegen 5.1. Causes and Mechanisms of Injury 152 5.2. Causes of Fatality after Abdominal or Thoracic Injuries 158 5.3. Medical and Surgical Management of Survivors of Abdominal or Thoracic Trauma 159 5.4. Physiotherapy Aims of Management 185
Contents vii 5.5. Precautions and Contraindications related to Physiotherapy Management 188 5.6. Physiotherapy Interventions 195 5.7. Clinical Case Scenarios 212 5.8. Suggested Reading Material for Further Study 219 5.9. Conclusion 220 Bibliography 220 Chapter 6 Burn Injuries 229 Written by S. Hanekom, M. Wilson, B.M. Morrow and H. van Aswegen 6.1. Causes and Mechanisms of Burn Injury 230 6.2. Types of Burn Injuries 232 6.3. Systemic Effects of a Burn Injury 237 6.4. Classification of Burn Injuries 239 6.5. Medical and Surgical Management 245 6.6. Physiotherapy Aims of Management 265 6.7. Precautions and Contraindications Related to Physiotherapy Management 268 6.8. Physiotherapy Interventions 271 6.9. Clinical Case Scenarios 295 6.10. Suggested Reading Material for Further Study 301 6.11. Conclusion 301 Acknowledgement 301 Bibliography 302 Chapter 7 Multiple Orthopaedic Injuries 309 Written by N. Plani, H. van Aswegen and B.M. Morrow 7.1. Causes and Mechanisms of Injury 310 7.2. Types of Fractures 313 7.3. Orthopaedic Injuries Commonly Encountered in the Polytrauma Patient 313 7.4. Classification of Fractures 324
viii Contents 7.5. Complications Associated with Orthopaedic Injuries 328 7.6. Mechanism of Bone Healing 331 7.7. Medical and Surgical Management 334 7.8. Physiotherapy Aims of Management 346 7.9. Precautions and Contraindications Related to Physiotherapy Management 349 7.10. Physiotherapy Intervention 352 7.11. Clinical Case Scenarios 359 7.12. Suggested Reading Material for Further Study 365 7.13. Conclusion 365 Bibliography 366 Chapter 8 Spinal Cord Injury 371 Written by W. Mudzi, H. van Aswegen and B.M. Morrow 8.1. Structure of the Spinal Cord 372 8.2. Causes and Mechanisms of Injury 376 8.3. Spinal Cord Lesions and Classification of the Level of Injury 387 8.4. Respiratory System Complications following Spinal Cord Injury and Changes in Respiratory Muscle Function 392 8.5. Complications Related to Other Bodily Systems following Spinal Cord Injury 403 8.6. Medical and Surgical Management 403 8.7. Physiotherapy Aims of Management 418 8.8. Precautions and Contraindications Related to Physiotherapy Management 421 8.9. Physiotherapy Interventions 423 8.10. Clinical Case Scenarios 438 8.11. Suggested Reading Material for Further Study 444 8.12. Conclusion 444 Bibliography 445
Contents ix Chapter 9 Traumatic Brain Injury 453 Written by R. Roos, B.M. Morrow and H. van Aswegen 9.1. Causes and Mechanisms of Injury 454 9.2. Types of Traumatic Brain Injury 456 9.3. Primary and Secondary Injury Associated with Traumatic Brain Injury 460 9.4. Severity of Injury 466 9.5. Medical and Surgical Management 467 9.6. Physiotherapy Aims of Management 477 9.7. Precautions and Contraindications Related to Physiotherapy Management 481 9.8. Physiotherapy Interventions 484 9.9. Clinical Case Scenarios 500 9.10. Suggested Reading Material for Further Study 505 9.11. Conclusion 505 Bibliography 505 Chapter 10 Quality of Life of Survivors of Trauma 511 Written by H. van Aswegen 10.1. Definition of Quality of Life 512 10.2. Assessment of Quality of Life 512 10.3. Quality of Life of Survivors of Critical Illness 516 10.4. Quality of Life of Survivors of Trauma and Critical Illness 519 10.5. Rehabilitation of Survivors of Critical Illness 533 10.6. Suggestions for Exercise Rehabilitation for Survivors of Trauma and Critical Illness 535 10.7. Potential Challenges Associated with Exercise Rehabilitation of Survivors of Trauma 541 10.8. Conclusion 542 Bibliography 543
x Contents Appendix I 551 Normal Values for Paediatrics 551 Appendix II 553 Bedside Measures to Establish the Oxygenation Status of Critically Ill Patients 553 Appendix III 555 Functional Recovery of Patients with Spinal Cord Injury 555 Bibliography 558 Index 559
Preface Trauma in its various forms remains a serious public health problem worldwide and is the leading cause of death among adults and children, particularly those between the ages of one and nine years. The Global Status Report on Road Safety (2009) states that 20 50 million people worldwide sustain injuries related to motor vehicle accidents annually. The Global Burden of Armed Violence (2011) reported that 526,000 people worldwide lose their lives due to violence each year and that many more people suffer from a range of physical and mental health problems due to violence. According to the World Health Organisation (2014), the majority of trauma occurs in low-income and middle-income countries. Burns, sustained as a result of interpersonal violence or suicidal attempt, remain a serious public health problem in some countries, and fire-related deaths rank among the 15 leading causes of death worldwide. Motor vehicle accidents and war injuries are among the top ten projected leading causes of disability-adjusted life years in 2020. In light of these facts, trauma-related injuries are likely to remain one of the leading causes of high hospital admission rates and health care costs associated with care provided to patients in acute care settings worldwide. For the purpose of this book, trauma is defined as damage to any body part as a result of physical impact or accident. Such injuries can range xi
xii Preface from mild (not requiring hospitalisation) to life threatening. The interdisciplinary health care team usually involved in the management of patients who have sustained life-threatening trauma-related injuries includes physiotherapists who work in the acute care and rehabilitation settings. In the acute care setting (intensive care unit, high care unit, hospital ward), the main roles of the physiotherapist are the prevention or management of respiratory complications or existing respiratory conditions and the prevention of musculoskeletal complications that may develop secondary to injury and immobility. This book has been written by physiotherapists for physiotherapists and physiotherapy students to encourage evidence-based cardiopulmonary physiotherapy management of adult and paediatric survivors of trauma in the acute care setting. The elements of evidence-based clinical practice are often described as a combination of: (a) best available research evidence; (b) professional expertise and judgement; and (c) the needs and preferences of the patient. In this book, information obtained from published research is shared with the reader as well as the clinical expertise of the writers in cases where evidence to support the use of certain treatment interventions in the management of patients with trauma is still lacking. This book provides information on physiological responses to trauma to provide the physiotherapist with a better understanding of the mechanisms behind muscle protein breakdown and weakness and delayed recovery, so often observed in patients who suffer critical illness due to trauma-related injuries. A chapter that describes the anatomical differences between children and adults is included to demonstrate that children are not just small adults and illustrates how their management differs. Immunosuppressive diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are prevalent worldwide; the chapter on trauma and immunosuppressive diseases describes the pulmonary and extrapulmonary complications associated with HIV and AIDS and antiretroviral therapy, and highlights important points to be considered in the management of patients with HIV or AIDS who are involved in trauma. This is followed by a chapter that provides an overview of various cardiopulmonary physiotherapy treatment interventions, subjective and objective markers and outcome measures that may be used in the care of patients with traumatic injury. The clinical chapters are dedicated to specific types of
Preface xiii life-threatening trauma commonly encountered in patients in the acute care setting. These chapters are structured in a similar format and include: an overview of causes and mechanisms of injury; medical and surgical management; physiotherapy treatment aims; suggested treatment interventions; contraindications and precautions to physiotherapy intervention; and clinical case scenarios and suggested further reading. Differences in management between adults and children involved in trauma are highlighted. Towards the end of the book, quality of life of patients who survived trauma is discussed, as well as the role of exercise therapy to aid such survivors recovery. Key messages boxes, which contain important clinical information for the reader to be aware of, appear throughout many of the chapters. The focus of this book is mainly on the physiotherapy treatment of adults, children and infants with trauma-related injuries in the acute care setting. The reader is referred to other published medical, physiological and physiotherapy texts for detailed information on the assessment of patients in the acute care setting. The reader is also referred to other published physiotherapy texts for detailed information on rehabilitation of trauma survivors in the chronic health care setting. H. van Aswegen B.M. Morrow Bibliography Global Burden of Armed Violence (2011). Chapter 2: Trends and patterns of lethal violence. [Online]. Available at: http://www.genevadeclaration.org/fileadmin/ docs/gbav2/gbav2011-ch2-summary.pdf [Accessed 13 November 2014]. World Health Organisation (2009). Global Status Report on Road Safety: Time for Action. [Online]. Available at: http://www.who.int/violence_injury_ prevention/road_safety_status/2009/en/ [Accessed 01 August 2014]. World Health Organisation (2014). Violence and injury prevention: injury-related disability and rehabilitation. [Online]. Available at: http://www.who.int/ violence_injury_prevention/disability/en/ [Accessed 13 November 2014].
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List of Contributors Heleen van Aswegen (PhD) Associate Professor Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Brenda Morrow (PhD) Associate Professor Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Susan Hanekom (PhD) Associate Professor Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. xv
xvi List of Contributors Witness Mudzi (PhD) Associate Professor Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Natascha Plani (MSc Physiotherapy) Senior Physiotherapy Clinician Sklaar, Laidler and Associates Physiotherapists, Netcare Union Hospital, Alberton, South Africa. Ronel Roos (PhD) Lecturer Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Elizna van Aswegen (MBBCh; DipPEC (SA)) Medical Doctor Head Emergency Centre, Mediclinic Bloemfontein, Bloemfontein, South Africa. Moira Wilson (Diploma in Physiotherapy) Senior Physiotherapy Clinician Netcare Milpark Hospital, Johannesburg, South Africa.