Transcript Hyperlipidemia

SPINAL CORD DISABILITIES
By Misty Hooper
Overview
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Definition
Epidemiology
Clinical Aspects
Treatment
Functional Assessment
Effect on Exercise
Effect of Medication on Exercise
Exercise Testing
Exercise Prescription
Summary and Conclusion
What are Spinal Cord
Disabilities?
Spinal Cord Disabilities are damage or trauma
to the spinal cord that results in a loss or
impaired function causing reduced mobility or
feeling.
What are Spinal Cord Disabilities?
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What are the
types of Spinal
Cord Disabilities?
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Paraplegia is an impairment or sensory
function of the lower extremities. (arms
are not affected)
Tetraplegia, also known as
quadriplegia, is paralysis caused by
illness or injury that results in the partial
or total loss of use of all the limbs and
torso.
Epidemiology: Incidence & Prevalence
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According to the CDC, about 200,000 people are
currently living with Spinal Cord Injuries in the
United States. 12,000 to 20,000 new cases are
estimated to occur annually.
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regional study conducted in 2005 found that most new
Spinal Cord Injury cases occur in persons younger than 30
years old, and an estimated 50-70% occur in those aged
15-35 years old.
Epidemiology: Incidence & Prevalence
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Causes of Spinal Cord Injuries:
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Motor Vehicle Accidents-46%
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According to the CDC, use of a seatbelt can reduce the
odds of a spinal cord injury by 60%. Use of a seatbelt and
airbag combined can reduce the odds of injury by 80%.
Falls-22%
Violence-16%
Sports-12%
Clinical Aspects
Symptoms
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Symptoms of spinal cord injury after an
accident may include:
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Extreme back pain or pressure in the neck, head
or back
Weakness, incoordination or paralysis in any part
of the body
Numbness, tingling or loss of sensation in hands,
fingers, feet or toes
Loss of bladder or bowel control
Difficulty with balance or walking
Impaired breathing after injury
Oddly positioned or twisted neck or back
Clinical Aspects
Laboratory
Testing,
Diagnosis &
Evaluation
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Conducted by a healthcare professional
 Clinic,
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lab, hospital, doctor’s office
Orthopedic Examination
 Evaluation
of Airway, Breathing,
Circulation
 Level of consciousness
 Inspection beginning from the top of the
head until the bottom of the toes.
 Palpation of the spine from the skull to the
coccyx for areas of localized tenderness.
Clinical Aspects
Laboratory
Testing,
Diagnosis &
Evaluation
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Neurological Evaluation
 Neurological
status must be evaluated
until the spinal shock period is absent
which occurs 48 hours after injury. Testing
includes sensation of pain and or light
touch, strength of upper and lower
extremity, deep tendon reflexes, plantar
reflexes, pathologic reflexes.
Clinical Aspects
Laboratory
Testing,
Diagnosis &
Evaluation
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Emergency Diagnostic Tests
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X-Rays
 X-rays reveal vertebral problems, tumors, fractures, or
degenerative changes in the spine.
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Computerized Tomography (CT) scan
 Uses computers to form a series of cross-sectional images
that can define bone, disk, and other problems.
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Magnetic Resonance Imaging (MRI)
 Helpful for looking at the spinal cord and identifying
herniated disks, blood clots or other masses that may be
compressing the spinal cord.
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Myelography
 A special dye is injected into your spinal cord to look for
herniated disks or other lesions.
Clinical Aspects
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Complications
Severity of Spinal Cord Injuries can
lead to complications or can result it:
Decubitus ulcers
 Osteoporosis
 Fractures
 Restriction in respiratory function which can
lead to pneumonia, atelectasis (collapse of a
lung), aspiration
 Spasticity
 Autonomic dysreflexia (at or above T6 level)
 Deep Vein Thrombosis
 Cardiovascular disease
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Treatment: Quadriplegia and
Paraplegia
Trauma Care
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Immobilization to prevent further injury
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Stabilization of heart rate, blood pressure, and condition
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Possible intubation to assist breathing
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Imaging tests to determine extent of injury
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Surgery may be needed to relieve pressure on the spine from bone fragments or
foreign objects. No form of surgery can repair the damaged nerves of the spinal
cord.
Nerve damage caused by initial injury has a tendency to spread. Reasons for the
spreading are not completely understood but it is related to spreading
inflammation as blood circulation decreases and blood pressure drops. Inflammation
causes nerve cells not directly in the injured area to die. A powerful corticosteroid
can help prevent the spread of this damage if given within eight hours of the
original injury.
Treatment: Quadriplegia
Rehabilitation
Consists of training to learn to deal with new limitations
 Functional neuromuscular stimulation (FNS) stimulates the
intact peripheral nerves so that the paralyzed muscles will
contract. This allows patients to ride a stationary bicycle to
improve muscle and function to prevent the muscles from
atrophying.
 Tendon transfer is a surgery that transfers a nonessential
muscle with nerve function to the shoulder or arm to help
restore function.
 Implantable FNS system to help regain use of hands. The
shoulder’s position controls the stimulation to the hand’s
nerves, allowing the individual to pick up objects at will.
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Functional Assessment
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Functional assessment is a method for
describing abilities and activities in
order to measure an individual’s use of
the variety of skills included in
performing the tasks necessary to daily
living, vocational pursuits, social
interaction, leisure activities, and other
required behaviors.
Functional Assessment
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Functional Independence Measure
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Self Care
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Sphincter Control
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Transfers
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Locomotion
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Communication
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Social Cognition
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Barthel Index
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Feeding
Bladder
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Bathing
Toilet Transfer
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Grooming
Transfers-Chair, Bed
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Dressing
Ambulation
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Bowels
Stair Climbing
Functional Assessment
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Funcional Status Index
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Gross Mobility
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Hand activities
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Personal care
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Home chores
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Social/Role Activities
Functional Status Index
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Assistance
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1 – Independent
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2 – Uses Devices
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3 – Uses Human Assistance
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4 – Uses Devices and Human Assistance
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5 – Unable or unsafe to do the activity
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Pain
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1 – No Pain
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2 – Mild Pain
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3 – Moderate Pain
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4 – Severe Pain
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Difficulty
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1 – No Difficulty
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2 – Mild Difficulty
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3 – Moderate Difficulty
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4 – Severe Difficulty
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Activity
Assistance Pain Difficulty
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Mobility
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Walking Outside ________ _____ ________
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Climbing up Stairs ________ _____ ________
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Rising from Chair ________ _____ ________
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Personal Care
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Put on Pants ________ _____ ________
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Button Shirt/Blouse ________ _____ ________
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Wash Whole Body ________ _____ ________
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Put on Shirt/Blouse ________ _____ ________
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Home Chores
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Vacuum Rug ________ _____ ________
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Reach Low Cupboard ________ _____ ________
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Do Laundry ________ _____ ________
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Do Yardwork ________ _____ ________
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Hand Activities
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Writing ________ _____ ________
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Open Container ________ _____ ________
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Dial Phone ________ _____ ________
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Social Activities
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Perform your job ________ ______ __________
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Drive a Car ________ ______ __________
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Attend meetings ________ ______ __________
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Visit Friends/Family ________ ______ __________
Effects of Spinal Cord Injury on
Exercise
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In paraplegia, the upper body must be
used for all voluntary activities of daily
living and exercise. Methods such as arm
cranking, ambulation with orthotic devices
and crutches, and wheelchair propulsion
are used.
Smaller upper body mass restricts peak
values of power output, oxygen
consumption, and cardiac output to onehalf of the normal values for those without
spinal cord injury.
Effects of Spinal Cord Injury on
Exercise
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In tetraplegia, upper body power
output, oxygen consumption, and
cardiac output are reduced to one-half
to one-third of the levels seen in
individuals with paraplegia.
Strenuous exercise can produce
dizziness, nausea, and other symptoms
due to exercise hypotension.
Peak heart rates typically do not
exceed 120 beats per minute.
Paralyzed Utah County woman to
race in Boston Marathon
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http://www.ksl.com/?sid=14917457&n
id=148
Effects of Medication on Exercise
Ditropan (oxybutynin chloride)
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Induces hypotension
Dibenzyline (phenoxybenzamine hydrochloride)
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Management of neuropathic bladder
Alcohol, Diuretics
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Diuresis
Effect of Exercise
Acute
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Improved glycemic
control
Reduced postprandial
lipemia (excess of lipids in the
blood post meal)
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Reduced serum lipids
Improved cholesterol
ratios as peak oxygen
consumption increased
Chronic
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Increase maximum oxygen
consumption
Decrease heart rate
Increase grip strength
Increase arm work capacity
Increased feelings of wellbeing
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(depression and feelings of
isolation are common in SCI)
Exercise Testing
Method
Measures
AEROBIC
•Arm ergometer
•Wheelchair
ergometer
•Wheelchair
treadmill
•Wheeling on track
or treadmill
FLEXIBILITY
•Goniometry
•Stretching tests
•Peak HR, METS or
VO2 peak
•BP
•RPE (6-20)
•Flexibility of
shoulders, elbow,
wrist, hip, and knee
Endpoints
Comments
•Serious dysrhythmia
•>2 mm ST-segment
depression/elevation
•Ischemic threshold
•T-wave inversion
with significant ST
change
•SBP >250 mmHg or
DBP >115 mmHg
•Adjust incremental power
levels to subject’s capacity.
•Peak HR will be low (110130 bpm) in tetraplegia due
to sympathetic impairment
•Persons with tetraplegia will
need gloves or hand
wrappings
•Give rest periods between
stages (stop exercise)
•Watch for hypertension
from autonomic dysreflexia
or hypotension caused by
orthostasis and exertion.
•Indicates basic exercise
tolerance and effort
•Helpful in
preventing
contractures and
injury
Exercise Prescription
GOALS:
-Aerobic
Increase active muscle mass and strength
Maximize overall strength for functional independence
Improve efficiency of manual wheelchair propulsion
-Strength
Increase active muscle mass and strength
Maximize overall strength for functional independence
Improve efficiency of manual wheelchair propulsion
-Flexibility
Avoid joint contracture
-Psychological
Enhance sense of well-being
Exercise Prescription
AEROBIC:
-Arm ergometer, wheelchair ergometer, wheelchair treadmill, free wheeling, arm
cycling, seated aerobics, swimming, wheelchair sports, electrically stimulated leg cycle
ergometry with/without arm ergometry
40-90% VO2R
3-5 days/week
20-60 min/session
4-6 months to goal
STRENGTH
-Weight machines or dumbbells, wrist weights
2-3 sets of 8-12 reps
2-4 days/week
4-6 months to goal
FLEXIBILITY
-Stretching
Before aerobic or strength activities
4-6 months to goal
Summary & Conclusion
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There are many causes that can effect the
development of Spinal Cord Injury
When the spinal cord is injured the brain cannot
properly communicate with it and so sensation
and movement are impaired.
Serious complications can result if quadriplegia
or paraplegia are not managed carefully.
Exercise is a great way for most individuals with
spinal cord injury to improve their overall health
and ability to do every day activities.
References
American Spinal Injury Association, Autonomic Standards Form, Retrieved from http://www.asiaspinalinjury.org/presentations/presentation.php#. Retrieved March 16, 2011.
Brain and Spinal Cord.org, Quadriplegia Treatment, Retrieved from
http://www.brainandspinalcord.org/spinal-cord-injury-types/quadriplegia/index.html. Retrieved March 16, 2011.
Centers for Disease Control, Spinal Cord Injury Fact Sheet, Retrieved from
http://www.cdc.gov/TraumaticBrainInjury/scifacts.html. Retrieved March 16,2011.
Collins, E.(2010). Energy Cost of Physical Activities in Persons with Spinal Cord Injury. Medicine and Science in Sports and
Exercise, 42(4), 691-700.
Durstine, J. L., et al. Spinal Cord Disabilities ACSM’s Exercise Management for Person with Chronic Diseases and
Disabilities. 3rd edition. ACSM, USA; 2009.
Figoni, S. (1993).Exercise responses and quadriplegia. Medicine and Science in Sports and Exercise, 25 (4), 433-441.
Hicks, A. (2005). Exercise Research Issues in the Spinal Cord Injured Population. Exercise and Sport Sciences Reviews, 33(1),
49-53
Hopman, M.(1997). Spinal Cord Injury and Exercise In The Heat. Sports Science Exchange, 10, 1551-1557.
 Howley, E. T., Franks, B. D. Nutrition. Fitness Professional’s Handbook. 5th edition. Human Kinetics, USA; 2007.
 Mahan, K. L., Escott-Stump, S. Medical Nutrition Therapy for Quadriplegia. Krause’s Food & Nutrition Therapy. 12th
edition. Saunders Elsevier, USA; 2007.
Mackie, J. W. (1989). Fitness and Spinal Cord Injuries. Canada Family Physician, 35, 1663-1666.
Mayo Clinic, Tests and Diagnosis, Retrieved from http://www.mayoclinic.com/health/spinal-cordinjury/DS00460/DSECTION=tests-and-diagnosis. Retrieved March 16, 2011.
National Spinal Cord Injury Association, Exercise. Retrieved from
http://www.spinalcord.org/resources/index.php?link=E&list=28. Retrieved March 16, 2011.
Simpson, S. (2005).Conditioning in Injured and Disabled Populations. National Strength and Conditioning Association, 27(6),
84-86.
SPINAL CORD DISABILITY
TESTING
Stage
0
Workload (W)
Workload (kpm)
Arm10WErgometer
60kpm
Rest
1
20W
120kpm
40W
240kpm
60W
360kpm
80W
480kpm
(12.2)
10
(14.1)
14
(19.4)
18
(24.7)
20
100W
600kpm
Rest
6
6
16
Rest
5
(6.1)
12
Rest
4
2
8
Rest
3
O2 uptake
(ml/kg/min)
4
Rest
2
Time (min)
22
(30.0)
24
120W
720kpm
26
(35.3)
Reference Values
Calculate VO2:
VO2= 3 * work rate/ body mass +3.5