The journal of spinal cord medicine
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Practice Guideline Guideline
Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals.
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Review
Shoulder pain in chronic spinal cord injury, Part I: Epidemiology, etiology, and pathomechanics.
Review of the literature. ⋯ With a better understanding of the epidemiology, etiology, and basic pathomechanics of shoulder pain in SCI, physicians are in a better position to evaluate, treat, and prevent these disorders.
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Of new spinal cord injuries (SCIs) throughout North America, up to 14% occur in children younger than 15 years of age. The purpose of this paper is to present several aspects unique to the evaluation and treatment of a child with SCI. ⋯ The differences between children and adults with acute SCI are significant enough that caregivers cannot evaluate and treat a child with SCI as they would a small adult.
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Children less than 15 years of age comprise approximately 3% to 5% of all new spinal injuries each year. Approximately one third of these children sustain injuries to the cervical spine. Respiratory complications of spinal cord injuries at the level of C5 and above may include diaphragm dysfunction, retained airway secretions, recurrent aspiration, nocturnal hypoventilation, and respiratory failure. ⋯ Despite their ability to breathe without mechanical support, these children often develop ongoing issues associated with respiratory compromise, which interfere with daily activities and can negatively affect quality of life. Poor endurance, failure to thrive, recurrent pneumonia, and sleep-disordered breathing all may be indications of significant respiratory dysfunction. This article describes assessment tools and management strategies aimed at supporting optimal health and preventing recurrent complications associated with unrecognized or untreated respiratory dysfunction.
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Hypertension alone or in the presence of autonomic dysreflexia (AD) may be underdiagnosed and consequently mismanaged in people with chronic spinal cord injury (SCI). Blood pressure (BP) derangements caused by AD are characterized by labile BP, in addition to episodic hypertension. Consequently, random BP readings often prove insufficient, which makes traditional outpatient evaluation and management suboptimal. Because elevated BP is common to essential hypertension (EH) and AD, distinction between the 2 entities proves challenging. The distinction is imperative because the treatments differ. Conventional BP monitoring in the office may miss labile BP patterns and episodic BP elevations. Ambulatory BP monitoring (ABPM) is used in the general population to improve the diagnosis and management of hypertension. ABPM provides the average BP level, circadian rhythm, and short-term BP variability. There is a paucity of ABPM studies in persons with SCI. ⋯ Because conventional office BP monitoring may miss labile BP patterns and episodic BP elevations, it is limited in the SCI population. ABPM may improve the outpatient management of blood pressure abnormalities in individuals with chronic SCI by clarifying mechanisms and patterns of BP in this patient population.