The Role of Occupational Therapy in Acute Spinal Cord Injury
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Top Contributors - Ewa Jaraczewska, Jess Bell, Tarina van der Stockt, Aminat Abolade and Jorge Rodríguez Palomino
Introduction[edit | edit source]
Rehabilitation process in the spinal cord injury (SCI) is usually divided into acute, subacute and chronic phase.[1] The definition of each of the phases varies, however it is commony accepted that the natural neurorecovery process sets the timing for each phase. The acute and subacute periods lasts around 18 months post-injury, and is followed by the chronic stage when the neurorecovery has plateaued. [2] During the acute spinal cord injury phase the focus is on:[1]
- preventing secondary complications
- promoting and enhancing neurorecovery
- maximizing function
- initiating activities leading to long-term maintenance of health and function.
The Occupational Therapists (OT) belong to the multidisciplinary team in spinal cord injury. Their role in the rehabilitation of the spinal cord injury patients include enhancing patients' daily life activity execution and fine movement, teaching how to use compensatory strategies, finding solutions for the patients' environment adaption to fulfil the common goal of achieving total social inclusion.[3]
The Acute Phase of SCI[edit | edit source]
The acute phase of spinal cord injury takes place immediately after the injury and is the result of initial trauma . [4] During this traumatic event the spinal cord can become compressed, sheared, lacerated, stretched, distracted. Its vascular supply can also haemorrhage or become constricted. Therefore the first response in SCI includes resuscitation, stabilization, and critical care to determinate and localise specific injuries. [5] Patient is initially immobilised and rehabilitation begins when stabilisation of the spinal cord is obtained, which occurs with patient still on the intensive care unit (ICU). Secondary complications occurring in the acute phase of spinal cord injury include:[6]
- Disruption of the blood spinal cord barrier leading to the infiltration of inflammatory cells
- The release of inflammatory cytokines
- Initiation of proapoptotic signaling cascades
- Release of excitatory neurotransmitters causing excitotoxicity, and ischemia.[6]
Regardless of the patient's receiving initial intervention in a specialised SCI unit or in a non-specific unit, the intervention provided by all members of the team should remain the same.[7]Clinical strategies in the management of the acute spinal cord injury are as follows:
- Surgical decompression to provide relief from mechanical pressure[6]
- Inhibition of the inflammatory response contributing to secondary damage in SCI[6]
- Blood pressure management to decrease the affect of hypotension leading to spinal cord ischemia and secondary damage[6]
- Variety of pharmacological management (most of them in clinical trials) to reduce neuronal loss, minimise lesion size, promotes tissue sparing, reduction of inflammation and excitotoxicity, stimulation of axonal regeneration, facilitation of survival of injured neurons, and promoting neural regeneration and axonal growth.[6]
- Cell-Based therapies to modulate the inflammatory response, providing trophic support, axon remyelination, and neuronal regeneration.[6]
- The use of biomaterials to guide axonal regrowth (clinical trial)
- Physiological approaches including:[6]
- Therapeutic hypotermia to inhibit the systemic inflammatory response
- Cerebrospinal fluid (CSF) drainage to improve spinal cord perfusion
Occupational Therapists[edit | edit source]
The Role of the OT in SCI[edit | edit source]
“Regardless of the physical ability of a person with SCI, he or she can still be in control of directing others to assist in this task unless the person with the SCI is cognitively or intellectually impaired” (Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals, 2000.)
Preventing Secondary Complications[edit | edit source]
Skin Management[edit | edit source]
Respiratory Complications[edit | edit source]
Joint Contractures[edit | edit source]
Mobilisation[edit | edit source]
Retraining for Activities of Daily Living[edit | edit source]
Psychological Support[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, Mihalovich KE, Fehlings MG. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep;7(3 Suppl):175S-194S.
- ↑ Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol. 2012;109:47-62.
- ↑ Rodríguez-Mendoza B , Santiago-Tovar PA , Guerrero-Godinez MA , García-Vences E. Rehabilitation Therapies in Spinal Cord Injury Patients. In: Arias, J. J. A. I. , Ramos, C. A. C. , editors. Paraplegia [Internet]. London: IntechOpen; 2020 [cited 2022 Aug 25]. Available from: https://www.intechopen.com/chapters/72439
- ↑ Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Front Neurol. 2019 Mar 22;10:282.
- ↑ Ashammakhi N, Kim HJ, Ehsanipour A, Bierman RD, Kaarela O, Xue C, Khademhosseini A, Seidlits SK. Regenerative therapies for spinal cord injury. Tissue Engineering Part B: Reviews. 2019 Dec 1;25(6):471-91.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Donovan J, Kirshblum S. Clinical trials in traumatic spinal cord injury. Neurotherapeutics. 2018 Jul;15(3):654-68.
- ↑ Oelofse W. The Role of Occupational Therapy in Acute Spinal Cord Injury Course. Plus 2022
