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

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

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

9. 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

10. 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.

11. 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%

12. 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

13. 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

16. 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