Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · Aug 2020
ReviewUpdates of the International Standards for Neurologic Classification of Spinal Cord Injury: 2015 and 2019.
The International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) are the most widely used classification system in spinal cord injury medicine. The purpose of the ISNCSCI is to ensure accurate and consistent communication among patients, clinicians, and researchers. ⋯ The updates were incorporated into the 2019 ISNCSCI worksheet and booklet, and the International Standards Training e-Learning Program. This article details the ISNCSCI update from 2015 and revision in 2019.
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Phys Med Rehabil Clin N Am · Aug 2020
ReviewConventional Respiratory Management of Spinal Cord Injury.
Respiratory complications often result from acute spinal cord injury. Ventilatory assistance/support is often required 12 hours to 6 days after admission and is typically delivered via translaryngeal tubes. ⋯ This renders the oximeter ineffective as a gauge of alveolar ventilation, airway secretion management, and residual lung disease, and can exacerbate hypercapnia. Thus, hypoventilation and airway secretions must be effectively treated to prevent lung disease and to maintain normal O2 saturation and CO2 levels without supplemental O2.
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Phys Med Rehabil Clin N Am · Aug 2020
ReviewManagement Strategies for Spinal Cord Injury Pain Updated for the Twenty-First Century.
Traumatic spinal cord injury (SCI) often results in several life-altering impairments, including paralysis, sensory loss, and neurogenic bowel/bladder dysfunction. Some of these SCI-related conditions can be accommodated with compensatory strategies. ⋯ In addition to the expected challenges in treating any chronic pain condition, treatment of SCI-related pain has the added difficulty of disruption of normal neural pathways that subserve pain transmission and attenuation. This article reviews selected treatment strategies for SCI-associated neuropathic pain.
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Phys Med Rehabil Clin N Am · Aug 2020
ReviewNoninvasive Respiratory Management of Spinal Cord Injury.
Intubated ventilator-dependent patients with high-level spinal cord injury can be managed without tracheostomy tubes provided that they have sufficient cognition to cooperate and that any required surgical procedures are completed and they are medically stable. Intubation for a month or more than extubation to continuous noninvasive ventilatory support (NVS) can be safer long term than resort to tracheotomy. ⋯ Noninvasive interfaces include mouthpieces, nasal and oronasal interfaces, and intermittent abdominal pressure ventilators. NIV/NVS should never been used without consideration of mechanical insufflation-exsufflation for airway secretion clearance.