Monday, June 18, 2018

PT Pathologies: Complete C7 Tetraplegia

A complete C7 tetraplegia suffers primary damage to the spinal cord and surrounding tissues at the C7 level.  This occurs through disruption of the membrane of the spinal cord, displacement or compression of the spinal cord, and subsequent hemorrhage and vascular damage.  This type of spinal cord injury can occur in a few different ways.  The most common cause is trauma, such as a sports injury or motor vehicle accident.  It can also occur by a disease, like polio, or by a congenital disorder, such as muscular dystrophy.  All of these causes result from compression, flexion, or extension of the spine with or without rotation.  When dealing with a complete C7 tetraplegia, the first symptom is motor or sensory impairment to the arms and legs.  Sensory loss can manifest itself as numbness, reduced sensation, or sore burning pain.  This results in spinal shock, which is total depression of all nervous system function below C7, and occurs immediately after the injury has occurred.  In addition, they will also present with an altered breathing pattern, impaired cough and ability to clear secretions, and poor endurance.  They also might experience some loss, or  complications in controlling their bowel and bladder, orthostatic hypotension, pressure sores, spastic muscles autonomic dysreflexia, sexual function, and digestion issues.  Once they symptoms have been noticed, an x-ray will confirm the involved vertebrae and rehabilitation will begin immediately.

The acute rehabilitation phase begins right after the injury occurred.  This phase includes treating the spinal cord injury and medically stabilizing the patient.  The spinal cord will be immobilized to prevent further damage, while medical personnel stabilize the patient's heart rate, blood pressure and their overall condition.  In addition, Methylprednisolone, is given to the patient to help prevent the spread of damage and improve the neurological damage.  Surgery may also be needed to relieve pressure on the spine from bone fragments or foreign objects.  Additionally, surgery may be used to stabilize the spine.  Once these interventions have taken place and the patient is stable, physical therapy takes place.

Physical therapy for complete C7 tetraplegia focuses on range of motion, strengthening, pressure relief, wheelchair and transfer skills, and integration of the patient to society.  Passive range of motion exercises are important because they maintain the lower extremities to be compatible with the C7 level.  The also prevent contractures and maintain functional capacity.  Range of motion exercises should be done at least once a day and if the patient is experiencing spasticity then perform the exercises 2-3 times per day.  When it come to strengthening, it is important that the patient is doing exercises for their upper extremities and prescribed as soon as possible.  Doing these upper extremity exercises will assist the patient in performing independent transfers.

In addition, you will have to teach the patient to move in bed independently to prevent pressure ulcers.  Pressure ulcers mos frequently develop on the sacrum, ischium, trochanter, and superior aspect of the heel.  Most of these can be prevented by changing position frequently and performing range of motion exercises.  Wheelchairs are important tools for a complete C7.  The therapist needs to educate the patient on stability and strength for sitting and transfers to the wheelchair from bed.  Range of motion and stretching exercises are performed first and the once the patient can tolerate sitting up then they can begin static and dynamic balance training.

Lastly, the therapist is responsible in making sure the patient can integrate into society.  They must make sure the patient has maximum independence related to the C7 level.  Typical outcomes of physical therapy include independence in feeding, upper extremity dressing, bathing, bed mobility, transfers, and manual wheelchair mobility.  Although the majority of people will experience ongoing musculoskeletal and cardiopulmonary deficits, engaging in physical therapy will greatly assist in the patient's independence.

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