Spinal Cord Injury : Functional Rehabilitation

by Somers, Martha Freeman

• ISBN13: 9780838586167
• ISBN10: 0838586163
• Edition: 3rd
• Format: Hardcover
• Copyright: 2010-01-01
• Publisher: Prentice Hall

Summary

This unique reference is an in-depth examination of the central role of the physical therapist in rehabilitation following spinal cord injury. Encompassing all of the elements involved in a successful rehabilitation program, this book presents an approach that promotes self-respect and encourages autonomy in persons with spinal cord injuries. It fosters a basic understanding of spinal cord injuries and issues relevant to disability. Additionally, it helps readers gain a grasp of the physical skills involved in functional activities and the therapeutic strategies for acquiring these skills. Spinal Cord Injury: Functional Rehabilitation is a valuable reference for both student and practicing physical therapists alike. bull; bull;Prepares readers for problem-solving in the clinical setting. bull;Includes updated clinical practice guidelines and information on the latest clinical and scientific research. bull;In-depth presentation of functional skills and functional training. bull;Presents the psychological and social aspects of spinal cord injury and strategies for growth. bull;Contains chapters on skin care, respiratory management, incomplete lesions, sexuality and sexual functioning, bowel and bladder management, architectural adaptations, and equipment.

Table of Contents

Preface	xi
A Few Words about Words	xiii
Acknowledgments	xv
Reviewers	xvii
Introduction	1	(6)
Nagi Model of Disablement	1	(1)
Rehabilitation Following Spinal Cord Injury	2	(3)
On Your Mark, Get Set, Go	5	(2)
Spinal Cord Injuries	7	(31)
Anatomy Review	7	(4)
Mechanisms of Vertebral Injuries	11	(9)
Neuropathology	20	(4)
Classification of Spinal Cord Injuries	24	(3)
Clinical Syndromes	27	(2)
Physical Effects of Spinal Cord Injuries	29	(9)
Medical and Surgical Management	38	(17)
Emergency Management	38	(2)
Fracture Management	40	(6)
Medical Management	46	(6)
Education	52	(2)
Follow-up	54	(1)
Psychosocial Issues	55	(16)
Psychosocial Impact of Spinal Cord Injury	55	(3)
Psychological Adjustment and Adaptation Following Injury	58	(2)
Community Reintegration	60	(1)
Strategies for Growth and Reintegration	61	(9)
The Bigger Picture: Our Impact on the Community	70	(1)
Sexuality and Sexual Functioning	71	(21)
Physical Aspects of Sexual Functioning	73	(11)
Therapeutic Intervention	84	(8)
Skin Care	92	(29)
Etiology of Pressure Ulcers	92	(2)
Sequelae	94	(1)
Prevention	95	(10)
Pressure Ulcer Assessment	105	(5)
Interventions	110	(11)
Respiratory Management	121	(22)
Review of Normal Breathing	121	(5)
Review of Normal Coughing	126	(1)
Impact of Spinal Cord Injury on Breathing and Coughing Ability	126	(4)
Respiratory Complications	130	(1)
Evaluation of Respiratory Function	131	(2)
Therapeutic Interventions	133	(10)
Physical Therapy Evaluation and Goal-Setting	143	(21)
Examination and Evaluation	143	(13)
Functional Potentials	156	(3)
Goal-Setting	159	(5)
Strategies for Functional Rehabilitation	164	(19)
Movement Strategies Following Spinal Cord Injury	164	(4)
Physical Prerequisites: Strength and Range of Motion	168	(3)
Strategies for Functional Training	171	(4)
Precautions	175	(4)
Equipment Selection	179	(4)
Functional Mat Skills	183	(45)
Practice on Mat and Bed	183	(1)
Precautions	183	(1)
Physical and Skill Prerequisites	184	(1)
Program Design	185	(1)
Functional Mat Techniques Following Complete Spinal Cord Injury	185	(16)
Therapeutic Strategies Following Complete Spinal Cord Injury	201	(20)
Functional Mat Techniques and Therapeutic Strategies Following Incomplete Spinal Cord Injury	221	(7)
Transfer Skills	228	(41)
Precautions	228	(1)
Physical and Skill Prerequisites	228	(2)
Program Design	230	(1)
Transfer Techniques Following Complete Spinal Cord Injury	230	(24)
Therapeutic Strategies Following Complete Spinal Cord Injury	254	(11)
Transfer Techniques and Therapeutic Strategies Following Incomplete Spinal Cord Injury	265	(4)
Wheelchairs and Wheelchair Skills	269	(80)
Precautions	269	(3)
Wheelchairs	272	(13)
Wheelchair Skills	285	(1)
Program Design	285	(1)
Wheelchair Skills Following Complete Spinal Cord Injury	286	(30)
Therapeutic Strategies Following Complete Spinal Cord Injury	316	(30)
Wheelchair Skills and Therapeutic Strategies Following Incomplete Spinal Cord Injury	346	(3)
Ambulation	349	(58)
Ambulation after Complete Injury: To Walk or Not to Walk?	349	(1)
Therapeutic Approaches to Restoration of Ambulation	350	(1)
Precautions	350	(1)
Lower Extremity Orthoses	350	(8)
Functional Potentials	358	(1)
Physical and Skill Prerequisites	358	(5)
Program Design	363	(1)
Ambulation with Knee-Ankle-Foot Orthoses Following Complete Spinal Cord Injury	364	(23)
Therapeutic Strategies for Gait Training with Knee-Ankle-Foot Orthoses	387	(13)
Ambulation and Therapeutic Strategies with Ankle-Foot Orthoses Following Complete Spinal Cord Injury	400	(1)
Ambulation and Therapeutic Strategies Following Incomplete Spinal Cord Injury	401	(4)
Functional Electrical Stimulation	405	(2)
References	407	(38)
Index	445

Excerpts

PrefaceSpinal cord injury causes a host of physical and psychosocial problems that can interfere with an individual's health, feelings of well-being, and participation in activities and relationships within the family and community. The goal of rehabilitation after spinal cord injury is to enable the person to resume and then continue a lifestyle that is healthy, fulfilling, and integrated with his or her family and community. Physical therapists play a central role in this process, working with recently injured people and their families to maximize physical capabilities and mobility, and to develop the knowledge and skills needed to remain healthy. Three major elements are required for a therapist to fulfill this role most effectively.The first requirement is a basic understanding of spinal cord injuries and issues relevant to disability. Pertinent areas of knowledge include the disablement process, pathology, mechanisms of injury, physical sequelae, medical and surgical management, the prevention and management of complications, psychosocial impact, disability-related civil rights, functional potentials, equipment options, and wheelchair-accessible architectural design. This knowledge base is needed for optimal program planning and implementation.The second requirement is a knowledge of the physical skills involved in functional activities and the process involved in acquiring these skills. It is not enough merely to know the eventual outcome, which may take months to accomplish. The therapist must know how to design and implement therapeutic programs to develop the needed strength, flexibility, and motor skills involved in functional activities. Many a therapist has been baffled when faced, on the one hand, with a text that explains the maneuvers that a person with a spinal cord injury performs during functional tasks and, on the other hand, with a newly injured person who can barely remain conscious while sitting upright, much less even begin to perform the skills shown in the book.The third major element required for effective participation in rehabilitation is an approach to the individual that promotes self-respect and encourages autonomy. Unfortunately, this element is often overlooked. Although we health professionals have as our stated goals the independent functioning of our patients, we often unwittingly encourage dependence. Many practices in health care serve to encourage "compliance" and to discourage autonomous behavior. If the rehabilitation effort is to be successful, the social environment of the rehabilitation unit must be structured in a way that fosters the development of self-reliant attitudes and behaviors.In order to prepare readers to work effectively with people who have had spinal cord injuries, a text must encompass all of the elements described above. Spinal Cord Injury: Functional Rehabilitation was written to provide such a comprehensive treatment of the subject. The reader will gain a broad knowledge base relevant to spinal cord injuries and will develop an understanding of both the physical skills required for functional activities and the therapeutic strategies for achieving these skills. As importantly, the reader will gain an appreciation for the importance of psychosocial adaptation after spinal cord injury and will develop some insight into the impact that rehabilitation professionals can have in this area. CHANGES IN THE SECOND EDITIONIn the years since the publication of the first edition, a number of developments have occurred in the area of rehabilitation after spinal cord injury. Clinical and basic science research has deepened our understanding of the neuropathological changes associated with spinal cord injury, factors associated with neurological return, and appropriate interventions for spinal cord injury and its sequelae. Several new clinical practice guidelines now exist describing optimal care in a variety of areas r