Transcript Chronic Neurologic Oct 23x

Fall 2009
Chronic Neurologic Problems
Headache
• The most common type of pain experienced
by humans
• Types
– Tension type headache
– Migraine headache
– Cluster headache
Tension-Type Headache
• Characterized by…
– Neck and shoulder muscle pain; Bilateral pain at the base
of the skull and in the forehead
• Etiology and Pathophysiology
– Exact cause is unknown
– Sometimes difficult to distinguish
– Precipitating factors may include: Stress; Hunger; Sleep
deprivation; Eyestrain; Withdrawal from caffeine
Migraine Headache
• Etiology and Pathophysiology
– …episodic familial disorder manifested by
unilateral, frontotemporal, throbbing pain in the
head which is often worse behind one eye or ear
• Clinical manifestations
– … often accompanied by sensitive scalp; Anorexia;
Photophobia; Nausea with (or without) vomiting
Migraine Headache
• Three classifications for migraine headache
• Migraines with aura
– Aura is a sensation that indicates the onset of a migraine
or seizure (develops over several minutes; does not last
more than an hour)
– Aura may consist of flashing lights; buzzing noises;
distorted vision (find out what triggers it)
• Migraines without aura
– Most are migraines without aura
Migraine Headache
• Atypical migraine (more assoc w/ teens & 20 yr olds)
– Less common
– Associated with menstrual periods
– Includes cluster headaches
• Neuroimaging recommended for persons older
than 50 years of age with new onset of
headaches When and Why? (worrisome… MRI might be test
of choice)
• MRI is gold standard for migraine, but CT scan is
much cheaper.
Stages of a Migraine Headache
• Prodrome phase (specific symptoms
including food cravings; mood changes)
• Aura phase (visual changes; diplopia
[double vision]; flashing lights)
• Headache phase: few hours to a few days
• Termination phase (intensity decreases)
• Postprodrome phase (fatigue; muscle pain;
irritable)
Cluster Headache
• Less frequent than migraines
• More common in men between 20 and 50 years
of age
• Definitive cause of headache is unknown
• May be related to hypothalamic hyperactivity
• Onset is associated with relaxation, napping, or
rapid eye movement (REM) sleep
• Pain is unilateral, oculotemporal or oculofrontal;
Excruciating, boring and non-throbbing type
Cluster Headache
• Intense pain felt deep in and around the eye (may radiate
to the ear and neck)
• Ipsilateral (same side) tearing of the eye; runny rhinorrhea
(runny nose) or congestion; ptosis (drooping eyelid);
miosis (abnormal constriction of pupils)
• Headaches occur every 8 to 12 hours, up to 24 hours a day
at the SAME TIME for 6 to 8 weeks
• Remission follows for 9 months to 1 year
• Duration of headache is usually 10 to 45 minutes
• (tearing, runny nose might be the way to tell difference
between cluster 7 migraine)
Headaches – Other Types
• Can be first symptom of a more serious illness
• Can be accompany subarachnoid hemorrhage; brain
tumors; other intracranial masses; arteritis; vascular
abnormalities; trigeminal neuroalgia (intense pain
around the eyes, lips, nose, scalp, forehead and jaw);
diseases of the eyes, nose, and teeth; and systemic
illness
Headaches
• Collaborative Care for Headaches
– Drug therapy
• Tension-type headache
– Acetaminophen and NSAIDs
• Migraine headache
– Acetaminophen and NSAIDs (Naproxen) effective for mild
migraine pain
– Abortive therapy (aura phase) and Preventative therapy (with
history of migraines 2 to 3 times/month)
• Cluster headache
– Drug therapy same as for migraine headache
Headaches:
Nursing Management
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Nursing assessment
Nursing diagnoses
Planning
Nursing Implementation
Evaluation
Headaches: Nursing Diagnoses
• Acute pain related to lack of knowledge of
pain control techniques or methods to
prevent headaches
• Disturbed energy field related to disharmony
• Ineffective management of therapeutic
regimen related to lack of knowledge,
identification and elimination of aggravating
factors
Other
Chronic Neurologic Disorders
Epilepsy
• “To be seized from a force within”
• Chronic condition characterized by recurrent
paroxysmal (sudden attack)episodes of disturbance in
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Skeletal muscle function
Sensation
Autonomic visceral function often lose bowel & bladder control
Behavior and consciousness: some have aura & may have behavioral
change… don’t lose consciousness, but may become drowsy or
stuporous
• Amount of time between varies, usually there is
repetition of activity
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“pretty important”
Can be primary disease or a symptom of a disease… learn diff types of
epilepsy & types of seizures
Don’t say grand mal any more… it is generalized or tonic clonic seizure.
Epilepsy
• A symptom of CNS irritation, excessive and
abnormal neuronal discharges
• Present as a manifestation of disease in
approximately 50 other diseases
• Epilepsy in a nutshell: Epilepsy is a common
neurological disorder characterized by
recurrent seizures
• Caused by a brief disruption of electrical
activity in the brain
Epilepsy
• Affects 2 – 4 million people*
• Not accurate*
– Not reportable
– Individuals not likely to admit to condition
Why?
Epilepsy
• Most common age groups:
– Birth to 2 years
– 5-7 years
– Early puberty (especially girls)
• 90% of all patients experience first seizure
prior to age 20
• Genetic tendency toward cerebral
dysrrhythmias
Epilepsy
• Cerebral epilepsy-cerebral lesions account for
activity, usually due to…
– Birth injuries (Example: Cerebral palsy)
– Infectious disorders (Example: meningitis… once
treated, the seizure disorder will go away… takes a long time to treat…
on antiepileptic meds while treating for meningitis)
– Circulation disorders (Example: stroke)
– Cerebral trauma (Example: TBI)
– Neoplasms (Recall prior slide!)
Epilepsy
• Biochemical epilepsy – biochemical
disorders that include epilepsy as a clinical
feature
– Alcohol ingestion/drug overdose (barbiturates, high doses, can be
a cause of a seizure disorder)
– Medications (Overdose or withdrawal. Examples:
Antidepressants, Antipsychotics, PNC in high doses, Lithium)
– Electrolyte imbalance (Example: Altered levels of sodium
magnesium; calcium)
– Vitamin deficiency
– Diabetes mellitus (Example: Hypoglycemia; Hypercalcemia)
– Pregnancy and/or menstruation
Epilepsy
• Post traumatic epilepsy – from previously
sustained cerebral injuries, few prior to 2
months or after 5 years
– Head injuries
– Birth injuries
• Idiopathic epilepsy – no identifiable cause
Seizures: Terms to Remember
• Prodromal (Early warning of impending
attack)
• Aura (Visual disturbances… can be any of the 5
senses…; buzzing sounds)
• Ictus (The event; i.e., seizure)
– Tonus (Maintained contraction r/t
bombardment of motor impulses)
– Clonus (Contraction/relaxation of muscles, wild
muscle movement)
• Postictal (Exhaustion): confusion common
Seizure Classification
• Generalized – bilaterally symmetric and
without local onset
– Tonic-clonic seizures (Type most commonly associated
with epilepsy; Generalized seizure)
– Typical absence seizures (Stares into space without
twitching; Lasts for seconds)
– Atypical absence seizures (Stares but is somewhat
responsive)
– Other types of generalized seizures (Associated with
AIDS; Acute infection; Alcohol or drug use)
Seizure Classification
• Partial-focal in nature, may become generalized
– Simple/partial: No loss of consciousness
• Focal (or local) motor or sensory: can begin in one part of the cebrum
& spread. Pt usually maintains level of consciousnesss… may report
aura or feeling of déjà vu. Odd movement, twitching of hand or
tapping of foot… may also have increase in heart rate (sypathetic
response, become flush)
• Complex partial seizure: loss of consciousness, 1 to 3 min. Aka
psychomotor seizures or temporal lobe. Often a motor response.
• Jacksonian
• Pseudoseizure: don’t see them very often; no aura, don’t lose bladder
function, won’t fall out of chair, don’t allow themselves to be harmed but
will allow themselves to have the movement seen in a tonic clonic seizure.
May be attention getting… could be the beginning of bad things that are
going to happen.
Clinical Manifestations
• Aura
• Tonic-hypertonic-clonic phase
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Loss of consciousness
Bowel and bladder incontinence
Tachycardia
Diaphoresis
Warm skin
Pallor, flushing, cyanosis
• Post-ictal phase
Epilepsy
• Complications
– Status epilepticus (life threatening, need ER &
immediate meds… valium/diazapem and ativan,
can last 5 min or longer, w/ each event it increases
in intensity
– Psychosocial
• Diagnostic Studies
– Accurate description of seizures; EEG; CT; MRI
– Rule out metabolic disorders
Epilepsy : Status epilepticus
• Life threatening
• Brain in a state of persistent seizure
• Continuous seizure lasting more than 30
minutes or recurrent seizures w/o regaining
consciousness between seizures for > 30
minutes
• May be neuron damage at 5 minutes Why?
• 911 for seizure lasting > 5 minutes
Epilepsy: Collaborative Care
• 75% can be managed successfully with
anticonvulsant medications (great list in the
book… tegretol, dilantin, phenobarbitol, kepra
[newer w/ fewer side effects],
• Medications will manage the symptoms, but
will not cure the condition
Epilepsy: Medications
• Generalized and Partial seizures
– Phenytoin (Dilantin); Side effects: gingival
hyperplasia; drug toxicity
– Carbamazepine (Tegretol)
– Phenobarbital
– Divalproex (Depakote)
– Gabapentin (Neurontin)
Epilepsy: Medications
• Absent, Akinetic
– Klonopin; Zarotin
• Status Epilepticus
– Ativan (benzodiazepine) and Valium
Epilepsy: Surgical Intervention
• Remove focus: if alcohol w/drawal is causing seizure, then
remove the problem
• Prevent spread
– Remove lobe, cortex
– Separate hemispheres at corpus callosum
– (similar to WPW ablation on heart, but done in
brain)
Immediate Seizure Management
• During Seizure
– Provide privacy
– Maintain airway (don’t put anything in mouth, maybe put them
on side if able)
– Ease to floor; protect from injury
• After Seizure
– Position on side
– Allow time to sleep
– Re-orient individual
When Observing a Seizure
• Prodromal
– Where there any warning signs?
• Ictus
– Where did it begin and how did it proceed?
– Describe movements
– How long?
– Changes in pupil size?
– Incontinence?
– LOC?
When Observing a Seizure
• Post-ictal
– Behavior after the seizure (describe)
– Any paralysis or weakness following the seizure?
– Did the individual sleep?
– After the seizure, document, do vitals, etc…
Multiple Sclerosis
• Chronic, progressive, degenerative disorder of the
CNS characterized by disseminated demyelination
and inflammation of nerve fibers of the brain and
spinal cord
• MS in a nutshell: Results from progressive
demyelination of the white matter of the brain and
spinal cord; Hard yellow plaques of scar tissue form
(gliosis); Damage to underlying axon fiber so nerve
conduction is disrupted; irreversible as disease
progresses
Multiple Sclerosis
Etiology and Pathophysiology
• Cause is unknown
• Related to infectious, immunologic, and genetic
predisposition
• Multiple genes confer susceptibility to MS
• Disease usually affects young to middle-aged
adults,= with onset between 15 and 50 years of
age
• Women are affected more than men
Multiple Sclerosis
Etiology and Pathophysiology
• Possibility that the association between
pathogenetic agents and MS is random and
there is no cause-and-effect relationship
Multiple Sclerosis
Etiology and Pathophysiology
• Possible precipitating factors include:
– Infection
– Physical injury
– Emotional stress
– Excessive fatigue
– Pregnancy
– Poor state of health
Multiple Sclerosis
Etiology and Pathophysiology
• Primary neuropathologic condition is an
autoimmune disease orchestrated by
autoreactive T-cells
– Remember “T” cells? Helper T cells and Killer T cells. Helper T cells
stimulate B cells to make antibodies, and help killer cells develop.
Killer T cells kill the body’s own cells that have been invaded by
viruses or bacteria.
• Characterized by chronic inflammation,
demyelination (damage to myelin sheath of
neurons) and gliosis (scar formation) in the CNS
Multiple Sclerosis
Etiology and Pathophysiology
• Initially triggered by a virus in a genetically
susceptible individual
• Subsequent antigen-antibody reaction leads
to demyelination of axons
Multiple Sclerosis
Etiology and Pathophysiology
• Disease process consists of loss of myelin,
disappearance of oligodendrocytes, and
proliferation of astrocytes
• Changes result from plaque formation with
plaques scattered throughout the CNS
Multiple Sclerosis
Etiology and Pathophysiology
• Initially the myelin sheaths of the neurons
in the brain and spinal cord are attacked,
but the nerve fiber is not affected
• Patient may complain of noticeable
impairment of function
• Myelin can regenerate, and symptoms
disappear, resulting in a remission
Multiple Sclerosis
Etiology and Pathophysiology
• Myelin can be replaced by glial scar tissue
• Without myelin, nerve impulses slow down
• With destruction of axons, impulses are
totally blocked
• Results in permanent loss of nerve function
Multiple Sclerosis
Clinical Presentation
• Vague symptoms occur intermittently over
months and years
• Disease may not be diagnosed until long after
the onset of the first symptom
• 1st symptoms: sensory symptoms of the
arms/legs; unilateral vision loss; slowly
progressive motor deficit
Multiple Sclerosis
Clinical Presentation
• Characterized by
– Chronic, progressive deterioration in some
– Remissions and exacerbations in others
• Motor manifestations
– Weakness or paralysis of limbs, trunk, and head
– Foot drop; pressure ulcers
– Scanning speech (slurred, stretching of words); dysarthria (motor
speech disorder/poor articulation)
– Spasticity of muscles
– Tremor
Multiple Sclerosis
Clinical Presentation: Sensory
• Numbness and tingling
• Blurred vision;diplopia (double vision)
• Vertigo and tinnitus
• Decreased hearing
• Chronic neuropathic pain
Multiple Sclerosis
Clinical Presentation: Cerebellar
• Nystagmus (Involuntary movement of the eye)
• Ataxia (Inability to coordinate muscle
movement)
• Dysarthria (motor speech disorder, i.e., slurred
speech)
• Dysphagia (Difficulty swallowing)
Multiple Sclerosis
Clinical Presentation: Emotional
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Anger
Depression
Apathy
Inattentiveness
Euphoria
Multiple Sclerosis
Clinical Presentation: Other
• Bowel and bladder functions may be
impaired
– Constipation
– Spastic bladder; small capacity for urine results
in incontinence
– Inability of sphincter to open
– Flaccid bladder; large capacity for urine and no
sensation to urinate
Multiple Sclerosis
Clinical Presentation (Other)
• Sexual dysfunction can occur in MS
- erectile dysfunction
- decreased libido
- painful intercourse
- decreased lubrication
Multiple Sclerosis:
Diagnostic Studies
• Based primarily on history, clinical
presentation, and presence of multiple
plaques over time measured by MRI
• Certain laboratory tests are used as adjuncts
to clinical exam
– CSF analysis: high lymphocytes and monocytes
(lumbar puncture, breakdown of meylin is
breakdown of protein, should not be protein in
CSF)
Multiple Sclerosis:
Collaborative Care
• Drug therapy
– Corticosteroids (maintiain stability of cell wall so it doesn’t
break down so fast & antiinflammatory effect… but you can’t stay on
them forever)
• Treat acute exacerbations by reducing edema and
inflammation at the site of demyelination
• Does not affect the ultimate outcome or degree of
residual neurologic impairment from exacerbation of
disease
Multiple Sclerosis:
Collaborative Care
• Immunosuppressive Therapy
– Potential benefits are counterbalanced against
potentially serious side-effects (even some chemo drugs
can be used to slow down the progression of the disease, often can
live a pretty normal life for a long time… 25 years)
• Immunomodulators
– Interferon ß-1b (Betaseron)
- Interferon ß-1a (Avonex, Rebif)
Multiple Sclerosis:
Collaborative Care
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Antispasmotics (any muscle, bladder, etc…)
CNS stimulants
Anticholinergics and/or cholinergics
Tricyclic antidepressants and anti-seizure
medications (unusual for anti-seizure meds)
• These are symptom relief meds
Multiple Sclerosis:
Collaborative Care
• Surgery (for patients with severe tremor)
• Dorsal-column electrical stimulation (electrodes
placed in the subdural extra arachnoid space over the center
of the thoracic spinal cord – result is increased motor/sensory
function)
• Intrathecal baclofen pump (Baclofen is a muscle
relaxant used to decrease spasticity in MS; SCI; Other
neurologic problems)
Multiple Sclerosis:
Collaborative Care
• Physical therapy helps…
– Relieve spasticity
– Increase coordination
– Trains the client to substitute unaffected muscles
for impaired ones
Multiple Sclerosis:
Collaborative Care
• Nutritional therapy includes…
– Megavitamins and diets consisting of low-fat,
gluten-free, food, and raw vegetables
– High-protein diet with supplementary vitamins is
often prescribed
Multiple Sclerosis:
Nursing Assessment
• Health history
– Viral infections or vaccinations
– Residence in cold or temperate climates
– Physical and emotional stress
– Medications
– Elimination problems
– Weight loss, dysphagia
Multiple Sclerosis:
Nursing Diagnoses
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Impaired physical mobility
Dressing/grooming self-care deficit
Risk for impaired skin integrity
Impaired urinary elimination pattern
Sexual dysfunction
Interrupted family processes
Multiple Sclerosis:
Nursing Plan of Care
• Maximize neuromuscular function
• Maintain independence in activities of daily
living for as long as possible
• Optimize psychosocial well-being
• Adjust to the illness
• Reduce factors that precipitate exacerbation
of symptoms
Multiple Sclerosis:
Nursing Implementation
• Help patient identify triggers and develop
ways to avoid them or minimize their effects
• Reassure patient during diagnostic phase
• Assist patient in dealing with anxiety caused
by diagnosis
• Prevent major complications of immobility
Multiple Sclerosis:
Nursing Implementation
• Focus teaching on building general resistance
to disease
– Avoiding fatigue; extremes of hot and cold;
exposure to infection
• Teach good balance of exercise and rest,
nutrition, avoidance of hazards of immobility
Multiple Sclerosis:
Nursing Implementation
• Teach self-catheterization if necessary
• Teach adequate intake of fiber to aid in regular
bowel habits
Parkinson’s Disease
• Disease of basal ganglia characterized by…
– Slowing down in the initiation and execution of
movement
– Increased muscle tone (no atrophy usually)
– Tremor at rest
– Impaired postural reflexes
Parkinson’s Disease:
Etiology and Pathophysiology
• Pathologic process involves degeneration of
dopamine-producing neurons in substantia nigra
of the basal ganglia
• Disrupts dopamine-acetylcholine balance in basal
ganglia (decreased acetylcholine & dopamine)
• Symptoms of the disease do not occur until 80%
of neurons in the substantia nigra (basal ganglia,
lie near the lateral ventricles, when stimulated
they release the dopamine) are lost
Parkinson’s Disease
• Diagnosis increases with age
• Peak onset in the 6th decade of life
• Onset before age 50 is likely related to genetic
defect
• More common in men: ratio is 3:1
• Other causes include hydrocephalus; hypoxia;
infections; stroke; tumor; and trauma (i.e.,
injury to the brain)
Parkinson’s Disease
• Clinical Presentations (goes from stage 1 to
stage 5… book gives good description of
stages)
– Symptoms may involve only one side of the body
initially
– Beginning stages may involve only mild tremor,
slight limp or decreased arm swing
– Later stages may show shuffling, propulsive gait
with arms flexed, loss of postural reflexes
– Never progresses to complete paralysis
Parkinson’s Disease
• Classic triad of clinical symptoms include
– Tremor
– Rigidity
– Bradykinesia (slow movement)
– (proprioception, postural instability, loosing
awareness of where their body is at all times)
Parkinson’s Disease
• Tremors
– More prominent at rest and aggravated by emotional
stress or increased concentration
– Described as “pill rolling” because thumb and
forefinger appear to move in rotary fashion
– Tremor can involve diaphragm, tongue, lips and jaw
– Benign essential tremor, which occurs during voluntary
movement, has been misdiagnosed as Parkinson’s
disease
Parkinson’s Disease
• Rigidity (2nd classic symptom)
– Caused by sustained muscle contraction and
consequently elicits:
• Complaints of soreness
• Feeling tired and achy
• Pain in the head, upper body, spine, or legs
• Rigidity is typified by a jerky-quality when the joint is
moved
• Rigidity is similar to intermittent catches in the movement
of a cogwheel (“cogwheel rigidity”)
• Inhibits the alternating contraction and relaxation in
opposing muscle groups, thus slowing movement
Parkinson’s Disease
• Bradykinesia
– Slowing down in initiation and execution of
movement-lean forward to initiate ambulation
– Evident in loss of automatic movements
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Blinking
Swinging of arms while walking
Swallowing of saliva
Self-expression with facial movements (“masked
facies”)
Parkinson’s Disease:
Complications
• Caused by progressive deterioration and loss of
spontaneity of movement
• Dysphagia can lead to malnutrition or aspiration
• Debilitation may lead to pneumonia, UTI, and skin
breakdown
• 30-40% have dementia
• Orthostatic hypotension may occur along with loss of
postural reflexes
• Falls and other injuries can result
Parkinson’s Disease:
Complications
• Side effects from drugs, particularly levodopa,
include…
– Dyskinesia (involuntary movement)
– Hallucinations
– Orthostatic hypotension
– Weakness
– Akinesia (without movement or much movement)
Parkinson’s Disease:
Diagnostic Tests
• No specific tests
• Diagnosis is based on history and clinical
features
– Firm diagnosis can be made when at least 2 of 3
characteristics of classic triad -tremor, rigidity and
bradykinesia (slowness of movement)- are present
– Ultimate confirmation of diagnosis is a positive
response to antiparkinsonian drugs
Parkinson’s Disease:
Collaborative Care
• Drug therapy –
– Aimed at correcting imbalances of
neurotransmitters within the CNS
– Enhance or release supply of dopamine
– Antagonize or blocks the effect of over-active
cholinergic neurons in the striatum
Parkinson’s Disease:
Collaborative Care
• Levodopa with carbidopa (Sinemet) is often
the first drug used
– Precursor of dopamine and crosses the
blood/brain barrier
– Converted to dopamine in the basal ganglia
– Carbidopa inhibits an enzyme that breaks down
levodopa before it reaches the brain
Parkinson’s Disease:
Collaborative Care
• Effectiveness of Sinemet can wear off after a
few years of therapy
– Initiation of therapy is with a dopamine receptor
agonist (an agonist is site specific drug) instead
(Parlodel)
• Anticholinergics are also used in the
management of Parkinson’s disease (Artane,
Cogentin)
– Decreases activity of acetylcholine
Parkinson’s Disease:
Collaborative Care
• Antihistamines with anticholinergic or betaadrenergic blockers are used to manage tremors
• Antiviral agent amantadine is effective though exact
mechanism is unknown (Symmetryl)
• As disease progresses, combination therapy is often
required
• Excessive amounts of dopaminergic drugs can lead to
paradoxical intoxication (i.e., excessive drug load)
Parkinson’s Disease:
Collaborative Care
• Surgical treatment
– Procedures aimed at relieving symptoms in patients who
are unusually unresponsive to drug therapy
• Ablation surgery
– Stereotactic ablation of areas in the thalamus, globus
pallidus, and subthalmic nucleus (unilateral pallidotomy
improves tremor and dyskinesia on one side of the body;
deep brain stimulation preferable)
Parkinson’s Disease: Collaborative Care
• Deep brain stimulation
– Involves placing an electrode in either the
thalamus, globus pallidus, and subthalmic nucleus
– Connected to a generator placed in the upper
chest
– Device is programmed to deliver specific current
to target brain location
– Is adjustable and reversible
Parkinson’s Disease:
Collaborative Care
• Transplantation of fetal neural tissue into the
basal ganglia provides dopamine producing
cells in the brains of patients
– Still experimental
– Controversial
Parkinson’s Disease:
Collaborative Care
• Nutritional therapy:
– Malnutrition and constipation can be serious
consequences
– Patients with dysphagia and bradykinesia need food that is
easily chewed and swallowed
– Adequate roughage
– Several small meals to prevent fatigue
– Provide ample time to avoid frustration
– Levodopa can be impaired by protein ingestion
Parkinson’s Disease:
Nursing Assessment/Management
• History
– CNS trauma
– Cerebrovascular disorders
– Exposure to metals (23 types of heavy metals)
– Encephalitis
– Medications such as tranquilizers,
amphetamines, methyldopa
– Excessive salivation; dysphagia; weight loss
Parkinson’s Disease:
Nursing Assessment / Management
• History, continued
– Difficulty initiating movements; falls; loss of
dexterity
– Constipation; incontinence
– Diffuse pain in head, shoulders, neck, back, arms,
legs, and hips
– Depression; mood swings; hallucinations
Parkinson’s Disease:
Nursing Diagnoses
• Impaired physical mobility
• Imbalanced nutrition: less than body
requirements
• Impaired verbal communication
• Deficient diversion activity
• Risk for falls
Parkinson’s Disease:
Nursing Management/Planning
• Maximize neurologic function (Pharm
therapy as prescribed; Pilates, which
teaches balance and control of body)
• Maintain independence in ADLs for as long
as possible
• Optimize psychosocial well-being
Parkinson’s Disease:
Nursing Management/Implementation
• Teach maintenance of good health,
independence, and avoidance of
complications
• Promotion of physical exercise and wellbalanced diet
– Specific exercises to strengthen muscles involved with
speaking and swallowing
– Healthy diet – fruits, vegetables, eggs, some cereal
Parkinson’s Disease:
Nursing Management/Implementation
• Problems secondary to bradykinesia can be
alleviated by
– Consciously thinking about stepping over a line
on the floor
– Lifting toes when stepping
– One step back and…
– Two steps forward
Parkinson’s Disease:
Nursing Management/Implementation
• Getting out of chair by using arms and
placing the back legs on small blocks
• Remove rugs and excess furniture
• Simplify clothing from buttons and hooks
• Elevated toilet seat
Myasthenia Gravis
• A chronic, progressive disease of muscular
weakness caused by a defect at the myoneural
junction (The synaptic connection of the axon of a
motor neuron with a muscle fiber)
• Etiology - possibly autoimmune
– Antibodies attack acetylcholine receptors→decreased
acetylcholine→decreased muscle contraction
• Gradual onset
• Peak onset 20 – 30 years of age
Myasthenia Gravis:
Hallmarks of the Disease
• Weakness of certain voluntary muscles
• Improvement of muscle strength at rest
• Dramatic improvement of muscle strength
with anticholinesterase drugs
Myasthenia Gravis:
Symptoms
• Muscles of the eye affected first
• Facial, masticatory, speech and neck muscles
are next
• Muscles of fine hand movements
• Intercostal muscles
• Myasthenia crisis: acute exacerbation
(breathing and throat muscle weakness)
Myasthenia Gravis:
Diagnosis
• Based on history of weakness in certain
muscle groups which improve with rest
• Tensilon test (Tensilon extends muscle stimulation, and
briefly improves strength. Muscle strength increased as a
result of Tensilon injection yields a probable diagnosis of MG)
• Serum antibodies to acetycholine
– Usually elevated in 80-90% of patients
Myasthenia Gravis:
Medical Management
• Anticholinesterase drugs facilitate impulse
across neuromuscular junctions
– Neostigmine; Pyridostigmine
• Corticosteroids make symptoms worsen prior
to improvement and remission
• Plasmapheresis
– Washes acetylcholine receptor antibodies from
plasma (also done for guillian barre… can be done
over & over…)
Myasthenia Gravis:
Nursing Management
• Assess
– Respiratory function
– Degree of strength of all muscles involved
• Observe for
– Signs and symptoms of pneumothorax (as result to
diaphragm & other intercostal muscles being affected)
– Unpredictable responses to drugs
• Patient teaching
– Re exacerbations of the disease
Myasthenia Gravis:
Nursing Diagnoses
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Ineffective breathing pattern
Impaired gas exchange
Ineffective airway clearance
Activity intolerance
Impaired verbal communication
Imbalanced nutrition
Disturbed body image
Restless Leg Syndrome
Restless Leg Syndrome
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Etiology and pathophysiology
Signs/Symptoms
Diagnostic studies
Collaborative care
Nursing management
Restless Leg Syndrome
• Etiology and pathophysiology
– Characterized by leg paresthesias (burning or
prickling sensation, “crawing-like”) associated with
a strong urge to move
– 20 million Americans affected
• Signs/Symptoms
– Worse in the evening when at rest
Restless Leg Syndrome
• Diagnostic studies
– Diagnosis based on history
– Possible associated conditions
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Vitamin and mineral deficiencies
Anemias
Polyneuropathies
Diabetes type II
Pregnancy
Peripheral nerve disease
Pinched nerves
Lumbar surgical procedures
Renal failure
Substances, i.e., caffeine, alcohol beta-blockers
Parkinson’s disease
(Ignatavicius & Workman, 2006)
Restless Leg Syndrome
• Collaborative Care
– Treatment of contributing condition
– Education on limiting caffeine, nicotine and
alcohol
– Routine bedtime
– No strenuous exercise 2-3 hours before bedtime
• Nursing Management
– Education
(Ignatavicius & Workman, 2006)
Trigeminal Neuralgia
• Pathophysiology
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Trigeminal neuralgia a/k/a tic douloreux
5th cranial nerve affected
Usually affects people > 50 years of age
Female to male ratio 2:1
Unilateral facial pain (intense spasms)
Provoked by minimal stimulation of a trigger zone
Pain described as…
• Sharp; shooting; burning; jabbing; piercing; no motor or
sensory deficits; usually life-long from onset; symptoms
improve with aging
(Ignatavacius & Workman, 2006)
Trigeminal Neuralgia
Trigeminal Nerve
(a/k/a 5th cranial nerve)
Trigeminal nerve sends
sensations of pain, touch,
pressure, temperature to the
brain from the face, jaw, gums,
forehead and around the eyes
(Gama Knife Center, 2008)
Trigeminal Neuralgia
• Collaborative Management
– Control pain
– Dilantin or Tegretol
– Neurontin
– Local anesthesia
– Microcirculation decompression
Trigeminal Neuralgia
Nursing Management
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Acute pain
Imbalanced nutrition
Anxiety
Impaired oral mucosa
Amyotrophic Lateral Sclerosis (ALS)
(Lou Gehrig’s Disease)
• Named after 1930s baseball player, Lou Gehrig
• Rapidly progressive, degenerative, fatal
disease (generally don’t live beyond 5 yrs past
diagnosis).
• Destruction of motor cells in the anterior grey
horns of the spinal cord
• Unknown etiology (no known cause, cure,
treatment)
Lou Gehrig’s Disease:
Classic Pattern
• Weakness, atrophy, fasciculation (twitching) of
muscles of the hands and arms
• Converts to spastic paralysis of the limbs
(contractures)
• Sensory changes are not present (generally
mentally they are completely fine)
Lou Gehrig’s Disease:
Symptoms
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Muscle weakness, wasting and atrophy
Muscle spasticity and hyperreflexia
Fasciculations
Fatigue
Dyspnea
Brain-stem signs (atrophy of tongue)
Lou Gehrig’s Disease: Symptoms
• History and neuro exam
• Electromyelogram (EMG) (a/k/a a nerve
conduction study)
• CPK (also called creatinine kinase) elevated
• (CPK found in muscle and brain cells)
• Myelogram (contrast x-ray) to rule out other
conditions
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Lou Gehrig’s Disease (Amyotrophic Lateral
Sclerosis):
Management
No known treatment or cure (symptomatic)
PT; OT
Gastrostomy tube
Ongoing counseling for patient and family
(teaching)
Drug therapy – Rilutek (specific for ALS, will help slow the
progression of the disease)
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Lou Gehrig’s Disease (Amyotrophic Lateral
Sclerosis):
Management
Assist patient to remain independent
Limit complications
Prepare for discharge and crisis
Provide emotional and psychological support
Depression is common
Referral to community resources
Bell’s Palsy
• Etiology and Pathophysiology
– CN VII (facial)
– Cause is unknown, but reactivation of herpes
simplex virus may be implicated
• Clinical manifestation
– Maximum paralysis evident within 48 hours for
half of those affected; within 5 days for others
Bell’s Palsy
• (Clinical manifestation, continued)
• Drawing sensation and paralysis on affected
side
• Inability to close eyes, smile, grimace, wrinkle
forehead
• Face is mask-like and sags
• Impaired taste
Bell’s Palsy
• Diagnostic tests
– No specific test
– Exclusion diagnosis…
• Collaborative care
– Prednisone; Zovirax
– Management of neurological deficits
– Psychosocial support
Bell’s Palsy:
Nursing Diagnoses
• Acute pain related to inflammation of CN VII
• Imbalanced nutrition related to inability to
chew
• Risk for injury – corneal abrasion related to
inability to blink
• Disturbed body image related to change in
appearance related to facial muscle weakness
Bell’s Palsy:
Nursing Planning
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Warm-moist heat
Analgesics as prescribed
Dark glasses
Protect from cold
Artificial tears
Tape eyelids at night
Guillain-Barre Syndrome
• Etiology and Pathophysiology
– Cell mediated immunologic reaction
– Acute inflammatory polyneuropathy
– Incidence of 1.7 per 100,000
– Progressive disorder that affects the motor
component of the peripheral nerves
– Demyelination (myelin around axons is destroyed… pt has had
some type of infection to set it off, auto-immune problem), edema
and inflammation
Guillain-Barre Syndrome:
Three Stages
• Initial
– Onset until no further deterioration (usually occurs
about 3 wks after viral infection) (1-3 weeks)
• Plateau
– Little change (several days to 2 weeks) (if caught
• Recovery
– Coincides with myelination and axonal
regeneration (4-6 months)
Guillain-Barre Syndrome:
Types
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Ascending
Descending
Pure Motor
Miller-Fisher variant
Guillain-Barre Syndrome:
Ascending
• Most common type
• Weakness and numbess begin in legs
• Paresthesia (numbness; tingling), hypotonia
(abnormally low muscle tone), areflexia
(absence of neurologic reflexes)
• Respiratory function – insufficiency occurs in
50% of patients
Guillain-Barre Syndrome:
Descending
• Weakness progresses downward
• Motor deficits – initial deficitis in the brainstem,
cranial nerves, sternocleidomastoid muscle
• Sensory deficits – numbness occurs distally, more
often in the hands than in the feet
• Paresthesia, hypotonia, and areflexia
• Rapid respiratory involvement
Guillain-Barre Syndrome:
Pure Motor
• Identical to ascending GBS, except sensory
signs and symptoms are absent (they have
weakness & paralysis, but no numbness or
tingling)
• May be a mild form of ascending GBS
• Muscle pain is generally not present
Guillain-Barre Syndrome:
Miller-Fisher Variant
• Opthalmoplegia (paralysis or weakness in
muscle(s) that control the eye) (CN 3, 4 & 6
affected)
• Areflexia
• Severe ataxia
• Normal motor strength
• Intact sensory function
Guillain-Barre Syndrome:
Clinical Presentation
• Recent history of viral infection
• 80% to 90% will have little or no residual
disability
• GBS is characterized by muscle weakness and
areflexia
• Symptoms tend to be symmetrical and
ascending from legs to trunk and arms
Guillain-Barre Syndrome:
Clinical Presentation
• Respiratory failure attributed to mechanical
failure and fatigue of intercostals and
diaphragm
• If cranial nerves are involved the facial (VII)
is most common
• GBS does not affect level of consciousness,
cognitive function, or pupillary signs
• Diagnosis is based upon clinical picture
Guillain-Barre Syndrome:
Collaborative Management
• Immunotherapy
• Plasmaphoresis
• Respiratory support – frequently elective
intubation
• Supportive treatment
Guillain-Barre Syndrome:
Nursing Diagnoses
• Ineffective breathing pattern: Ineffective
airway exchange; Impaired gas exchange
• Impaired physical mobility
• Self-care deficit
• Impaired verbal communication
• Anxiety; Anticipatory grieving
Spinal Cord Problems
• Etiology and Pathophysiology
– Primary injury
• Usually compression type injury; rarely dura is
punctured
– Secondary injury
• Edema related to inflammatory response→cascade of
events→tissue hypoxia
Spinal Cord Trauma
• Mechanisms of injury
– Flexion
– Hyperextension
– Flexion-rotation
– Flexion/extension rotation
– Compression
Spinal Cord Injury Classification
Incomplete Spinal Cord Injury
Anterior Cord Syndrome
May result in loss or impaired
ability to sense pain,
temperature or touch below the
level of injury
Central Cord Syndrome
Usually results in loss of
function in the arms, but some
leg movement remains; May
have some control over bladder
and bowel. Some recovery is
possible starting in the legs and
moving up
(Apparelyzed, 2009)
Incomplete Spinal Cord Injury
Posterior Cord Syndrome
Muscle power; pain; temperature
sensations are preserved.
May have difficulty coordinating
movement of limbs
Brown Séquard Syndrome
Pain and temperature sensations may be
preserved; has impaired or lost movement
on the injured side. Opposite side of injury
will have normal movement, but pain and
temperature sensation will be impaired or
lost.
(Apparelyzed, 2009)
Spinal Cord Trauma
• Complete or incomplete
• Mechanisms of Injury
– Flexion
– Hyperextension
– Flexion/rotation
– Flexion/extension/rotation
– Compression
Spinal Cord Trauma
• Clinical manifestations
– Respiratory system
– Cardiovascular system
– Urinary system
– GI system
– Integumentary system
– Thermoregulation
– Metabolic needs
– Peripheral vascular problems
Spinal Cord Trauma
• Diagnostic tests
– X-ray; CT; MRI (gold standard… CT scan is waste of
time); neurologic exam; possibly angiogram
• Collaborative care
– Non-operative stabilization
– ABCs! (always critical)
– Stabilized; immobile; trach (+ halo); oxygen; maintain
heart rate (atropine); blood pressure (dopamine)
– UA catheter; NG
– DVT Prevention; stress ulcer prevention;
– Temperature control
Spinal Cord Trauma
• Drug therapy: Large doses of prednisone
– Side effects may include UGI bleeding (stress
ulcer)
• Surgical therapy
– Cervical immobilization – halo
– Decompression laminectomy
SCI: Nursing Management / Diagnoses
• Impaired gas exchange R/T diaphragmatic fatigue; paralysis;
retained secretions; as evidenced by (AEB) decreased PO2;
adventitious breath sounds; decreased respiratory rate;
respiratory fatigue or distress
• Decreased cardiac output R/T venous pooling of blood;
bradycardia; immobility; AEB hypotension, restlessness;
pulmonary edema
• Altered (spinal cord) tissue perfusion
• Impaired skin integrity
Spinal Cord Injury:
Nursing Diagnoses
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Impaired urinary elimination
Impaired physical mobility
Constipation
Imbalanced nutrition: less than body
requirements
• Disturbed body image
• Interrupted family processes
• Risk for ineffective coping
Spinal Cord Injury:
Nursing Diagnoses
• Risk for autonomic dysreflexia R/T stimulated sympathetic
nervous system after spinal shock resolves as evidenced by
severe headache, hypertension, bradycardia, nasal stuffiness,
flushing, sweating above the level of injury, feeling of
apprehension related to noxious stimulation (i.e., distended
bladder, fecal impaction, tactile stimulation)
– Interventions: remove noxious stimulation
– Antihypertensive meds, reverse Trendelenburg or sitting
upright
– Patient teaching on prevention, recognition, treating
Spinal Cord Injury:
Nursing Diagnoses
• Rehabilitation and Home Care
– Respiratory rehabilitation
– Neurogenic bladder
– Neurogenic bowel
– Neurogenic skin
– Sexuality
– Grief and depression
– Long term adaption of patient and family
Affects of Spinal Cord Injury
Segmental Spinal Cord Level and Function
Cl-C6 Neck flexors
Cl-Tl Neck extensors
C3, C4, C5 Supply diaphragm (mostly C4)
C5, C6 Shoulder movement, raise arm (deltoid); flexion of elbow (biceps);
C6 externally rotates the arm (supinates)
C6, C7 Extends elbow and wrist (triceps and wrist extensors); pronates
wrist
C7, T1 Flexes wrist
C7, T1 Supply small muscles of the hand
T1 -T6 Intercostals and trunk above the waist
T7-L1 Abdominal muscles
L1, L2, L3, L4 Thigh flexion
L2, L3, L4 Thigh adduction
L4, L5, S1 Thigh abduction
L5, S1, S2 Extension of leg at the hip (gluteus maximus)
L2, L3, L4 Extension of leg at the knee (quadriceps femoris)
L4, L5, S1, S2 Flexion of leg at the knee (hamstrings)
L4, L5, S1 Dorsiflexion of foot (tibialis anterior)
L4, L5, S1 Extension of toes
L5, S1, S2 Plantar flexion of foot
L5, S1, S2 Flexion of toes
(Wikipedia, 2009)
(Won’t be tested on this)
Spinal Cord Injury: Functionality of C1, C2, C3
Quadriplegic
Mobility & Movement
Limited head and neck movement depending on muscle strength.
Complete paralysis of arms, body and legs.
Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.
Electric wheelchair may possibly be controlled by either a chin or "sip and puff" controller, this
will vary depending on dexterity.
The person will require total assistance when transferring from a bed to a wheelchair and from a
wheelchair into a car. A hoist will have to be used, possibly by two assistants for safety.
Complete assistance required during mealtimes.
Respiratory System
Inability to breathe using chest muscles or diaphragm, therefore the person will be dependant on
a ventilator to breathe. A portable ventilator can be attached to the back of a wheelchair during
transport.
Oxygen and humidification may be required.
Assistance required to clear secretions from trachea, and assistance in coughing will be required.
Personal Care
Complete personal assistance is required. The person will need assistance with washing, dressing,
and assistance with bowel and bladder management.
Domestic Care
Complete domestic care is required, such as household cleaning, washing of clothes and kitchen
duties, preparation of meals and general household duties.
Communication
A computer may be operated using iris recognition, mouth stick or voice recognition. Telephone
can be used using voice recognition and headset.
(Apparelyzed, 2009)
Spinal Cord Injury:
Functionality of C4 Spinal Cord Injury
Mobility & Movement
Full head and neck movement depending on muscle strength. Limited shoulder movement.
Complete paralysis of body and legs. No finger, wrist or elbow flexion or extension.
Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.
Electric wheelchair may be controlled by either a chin or "sip and puff" controller, this will vary
depending on dexterity.
The person will require total assistance when transferring from a bed to a wheelchair and from a
wheelchair into a car. A hoist will have to be used, possibly by two assistants for safety.
Complete assistance required during mealtimes.
Respiratory System
Able to breathe without a ventilator using diaphragm.
Assistance required to clear secretions and assistance in coughing will be required.
Personal Care
Complete personal assistance is required. The person will need assistance with washing, dressing, and
assistance with bowel and bladder management.
Domestic Care
Complete domestic care is required, such as household cleaning, washing of clothes and kitchen
duties, preparation of meals and general household duties.
Communication
A computer may be operated using iris recognition, mouth stick or voice recognition. Telephone can
be used using voice recognition and headset. (Apparelyzed, 2009)
Spinal Cord Injury: Functionality of C5
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with good muscle strength. Good shoulder movement.
Complete paralysis of body and legs. No finger or wrist movement. No elbow extension, good
elbow flexion.
Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.
Electric wheelchair can be controlled with a hand control for uneven surfaces. A manual
wheelchair may be used for short distances on flat surfaces.
The person will require total assistance when transferring from a bed to a wheelchair and from a
wheelchair into a car. A hoist will have to be used, possibly by one to two assistants for safety.
Ability to feed self using feeding strap and fork or spoon during mealtimes. Food will need
cutting.
Respiratory System
Able to breathe without a ventilator using diaphragm. Low stamina.
Assistance required to clear secretions and assistance in coughing will be required.
Personal Care
Complete personal assistance is required. The person will need assistance with washing,
dressing, and assistance with bowel and bladder management.
Ability to shave and brush hair may be possible with palm straps.
Domestic Care
Complete domestic care is required, such as household cleaning, washing of clothes and kitchen
duties, preparation of meals and general household duties.
Communication
A computer may be operated using a typing stick or voice recognition. Telephone can be used
using voice recognition and headset. (Apparelyzed, 2009)
Spinal Cord Injury: Functionality of C6
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with good muscle strength. Good shoulder movement.
Complete paralysis of body and legs. No finger movement, no elbow extension, no wrist flexion. Good wrist extension,
good elbow flexion.
A passive key grip may be present by flexing the wrist backwards, but will be weak.
Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.
Electric wheelchair can be controlled with a hand control for uneven outdoor surfaces. A manual wheelchair may be
used for short distances on flat surfaces.
The person will require total assistance when transferring from floor to chair. Assistance will vary for transfer from bed
to wheelchair, and wheelchair to car. A sliding board may be used in assisting with the transfer
Ability to feed self using feeding strap and fork or spoon during mealtimes. Food will need cutting. Able to make hot
drinks with adapted kettle using a "kettle tipper".
Respiratory System
Able to breathe without a ventilator using diaphragm. Low stamina.
Assistance required to clear secretions and assistance in coughing may be required. Additional coughing techniques
can be applied to assist in coughing by leaning forward whilst exhaling.
Personal Care
Personal assistance is required. The person will need assistance with washing, dressing, and assistance with bowel and
bladder management. Ability to empty own legbag will depend on dexterity and strength.
Ability to partially dress upper body, however, assistance may be required to dress lower body.
Ability to shave, brush hair and brush teeth is possible with palm straps.
Domestic Care
Complete domestic care is required, such as household cleaning, washing of clothes and kitchen duties.
Ability with adapted equipment to prepare simple meals and simple general household duties.
Communication
A computer may be operated using a typing stick or voice recognition. Telephone can be used using voice recognition
and headset. (Apparelyzed, 2009)
Spinal Cord Injury: Functionality of C7 - C8
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with good muscle strength. Good shoulder movement.
Complete paralysis of body and legs. Partial finger movement,full elbow extension and flexion, full wrist extension
and flexion.
A C7 injured person will have movement in the thumb.
Sympathetic nervous system will be compromised, possibility of Autonomic Dysreflexia.
May use an electric wheelchair for long independent travel or uneven outdoor surfaces. A manual wheelchair may
be used for short distances on flat surfaces.
Ability to transfer independently from bed to chair, and chair to car. Car transfers may need assistance depending
on upper body strength.
Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair into car
independently.
Ability to feed self independently during mealtimes. Food may need cutting. Able to make hot drinks , may require
an adapted kettle using a "kettle tipper".
Respiratory System
Able to breathe without a ventilator using diaphragm. Low stamina.
Assistance required to clear secretions and assistance in coughing may be required. Additional coughing techniques
can be applied to assist in coughing by leaning forward whilst exhaling.
Personal Care
Ability to manage bladder and bowel independently will vary depending on strength and dexterity.
Independent in upper body showering and dressing, lower body dressing and showering may need assistance.
Independent in grooming, usually without palm straps.
Domestic Care
Partial domestic assistance is required, such as heavy household cleaning, home maintenance, and complex
preparation of meals.
Ability to prepare simple meals and simple general household duties independently.
Communication
A computer may be operated using a typing stick or voice recognition. Telephone can be used using voice
recognition and headset.
Spinal Cord Injury: Functionality of T1 - T4
Paraplegic
Mobility & Movement
Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use
of arms, wrists and fingers.
Complete paralysis of lower body and legs. Upper body strength will vary depending on level of
injury, but the lower the level, the stronger the upper body strength and balance.
A T4 injured person will have good strength in the chest muscles, however this will get
progressively weaker the higher up the injury.
Sympathetic nervous system may be compromised, possibility of Autonomic Dysreflexia.
May use an electric wheelchair for long distance independent travel or uneven outdoor surfaces. A
manual wheelchair may be used for everyday living, with the ability to go over uneven ground for
short distances.
Ability to transfer independently from bed to chair, and chair to car. Car transfers may need
assistance depending on upper body strength.
Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair
into car.
Ability to feed self independently during mealtimes.
Respiratory System
Ability to breathe normal, although respiration capacity and endurance may be compromised.
Personal Care
Should be independent in personal care as long as no other factors are involved, ie, additional
injuries, severe spasticity etc.
Domestic Care
Partial domestic assistance is required, such as heavy household cleaning and home maintenance.
Ability to prepare complex meals and general household duties independently.
Communication
Normal communication skills apply.
Spinal Cord Injury: Functionality of T5 - T9
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use
of arms, wrists and fingers.
Complete paralysis of lower body and legs. Upper body strength will vary depending on level of
injury, but the lower the level, the stronger the upper body strength and balance.
A manual wheelchair may be used for everyday living, with the ability to go over uneven ground.
Ability to transfer independently from bed to chair, and chair to car. Car transfers may need
assistance depending on upper body strength.
Ability to drive a car adapted with hand controls. Assistance may be required to load wheelchair
into car.
Respiratory System
Ability to breathe normal, although respiration capacity and endurance may be compromised.
Personal Care
Should be independent in personal care as long as no other factors are involved, ie, additional
injuries, severe spasticity etc.
Domestic Care
Partial domestic assistance is required, such as heavy household cleaning and home maintenance.
Ability to prepare complex meals and general household duties independently.
Communication
Normal communication skills apply. (Apparelyzed, 2009)
Spinal Cord Injury: Functionality of T10 - L1
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with normal muscle strength. Normal shoulder movement. Full use
of arms, wrists and fingers.
Partial paralysis of lower body and legs. Upper body strength and balance will vary depending on
level of injury, but the lower the level, the stronger the upper body strength and balance.
A manual wheelchair may be used for everyday living, with the ability to go over uneven ground.
Ability to transfer independently from bed to chair, and chair to car. It may be possible to transfer
from floor to chair depending on upper body strength. It may also be possible to transfer from
sitting position to standing frame independently.
Ability to drive a car adapted with hand controls. Ability to load wheelchair into car
independently.
Respiratory System
Normal respiratory system.
Personal Care
Should be independent in personal care as long as no other factors are involved, ie, additional
injuries, severe spasticity etc.
Domestic Care
Partial domestic assistance is required, such as heavy household cleaning and home maintenance.
Ability to prepare complex meals and general household duties independently.
Communication
Normal communication skills apply. (Apparelyzed, 2009)
Spinal Cord Injury: Functionality of L2 - S5
Spinal Cord Injury
Mobility & Movement
Full head and neck movement with normal muscle strength. Normal shoulder movement.
Full use of arms, wrists and fingers.
Full upper body control and balance.
Some hip, knee and foot movement depending on the level of injury. The lower the
injury, the more control over movement.
A manual wheelchair may be used for everyday living, with the ability to go over uneven
ground.
Ability to transfer independently from bed to chair, and chair to car. It may be possible to
transfer from floor to chair depending on upper body strength.
Depending on the level of injury, walking may be possible with assistance or aids.
Walking will be slow and difficult though.
Ability to drive a car adapted with hand controls. Ability to load wheelchair into car
independently.
Respiratory System
Normal respiratory system.
Personal Care
Should be independent in personal care as long as no other factors are involved, ie,
additional injuries, severe spasticity etc.
Domestic Care
Partial domestic assistance is required, such as heavy household cleaning, home
maintenance.
Ability to prepare complex meals and general household duties independently.
Communication
Normal communication skills apply. (Apparelyzed, 2009)