9780838586167

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.

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

What is included with this book?

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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

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Spinal Cord Injury : Functional Rehabilitation

Spinal Cord Injury : Functional Rehabilitation

0838586163

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