SCI: Best Ways for Recovery Phuricha Chaivirach, MD Rehabilitation Department, Nan hospital

Goals of rehabilitation Prevention of secondary complications Maximization of physical functioning Reintegration into the community

Common medical problems Pressure sore Atelectasis +/- Pneumonia Autonomic Dysfunction DVT , PE (rare) UTI Spasticity Neurogenic bowel & bladder Neuropathic pain Heterotopic ossification Osteoporosis

Multidisciplinary, team-based approach Doctors : Ortho / Rehab Physical therapists : LE function and mobility Occupational therapists : UE function and ADL Rehabilitation nurses : bowel and bladder dysfunction and pressure ulcers Psychologists : emotional and behavioral concerns + cognitive dysfunction Speech-language pathologists : communication and swallowing Case managers and social workers

When rehab program start? General health is STABLE : no major medical issues Physically able to participate in rehabilitation : the strength and endurance to be up in a wheelchair for at least 2 hours at a time must be able to attend a therapy session for at least 30 minutes, twice a day. want to participate in the rehabilitation program + willing to do your best to reach your potential.

Prognosis & Recovery in Traumatic SCI : Complete SCI Most UE recovery occur in 6 mo 2-3% of ASIA A at 1 wk post SCI  to ASIA D by 1 yr Complete tetraplegia 95% of key muscles in ZPP with gr1-2 at 1 mo  gr 3 at 1yr 25% of most cephalad gr 0 muscles at 1 mo + PPS+ve  gr 3 at 1yr Motor level most correlate with function Complete paraplegia After 1 wk – neurological level of injury at 1 yr NOT change 73% Improve 1 level 18% Improve 2 level 9%

Prognosis & Recovery in Traumatic SCI : Incomplete SCI At 1 yr Tetraplegics 46% recover motor function to ambulate Paraplegics 80% regain hip flexors + knee extensors (gr>/= 3) Initially sensory incomplete below zone if injury –predict for functional ambulation

Prognosis & Recovery in Traumatic SCI 72 hr post SCI neuro exam  more reliably than 1st day Bulbocavernosus reflex –ve  LMN lesion + bowel/bladder/sexual fn MRI : hemorrhage + edema  independent negative predictor of motor fn at 1 yr Motor of Hip flex + Knee ext > gr 3/5  community ambulation

Best ways to recovery Level of injury : functional outcome Proper management and continuity : acute , sub acute, long term care : surgery – nursing – rehab (multidisciplinary team) Care giver Complications Facility Opportunity