| Pharmacology | Epidemiology | ADLs | Inpatient Management | Outpatient Management |
|---|---|---|---|---|
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Answer: (c)
Commentary: According to the Clinical Practice Guidelines, venous thromboembolic prophylaxis for uncomplicated motor-complete tetraplegia and AIS C injuries should be comprised of low molecular weight heparin or adjusted dose unfractionated heparin for 8 weeks. However, in the presence of complicating factors (eg, lower limb fractures, advanced age, obesity, heart failure, cancer) prophylaxis with low molecular weight or unfractionated heparin should continue for a total of 12 weeks or until discharge from Rehabilitation. Individuals with AIS D paraplegia without other complications require chemoprophylaxis with unfractionated heparin only until the rehabilitation discharge. Prophylactic intravenous chemotherapy filter placement is recommended only if there are contraindications or high risk associated with anticoagulation, and prophylaxis should be initiated as soon as hemostasis is achieved or contraindications resolved. Ref: Consortium for Spinal Cord Medicine Clinical Practice Guidelines. Prevention of thromboembolism in spinal cord injury, 2nd ed. DC: Paralyzed Veterans of America; 1999.
A 24 year-old man sustains an acute, traumatic C5 American Spinal Injury Association
Impairment Scale (AIS) A tetraplegia and a proximal left femur fracture following a motor vehicle crash. His hemoglobin has remained stable. Based on the Consortium for Spinal Cord Medicine’s Clinical Practice Guidelines, venous thromboembolic prophylaxis should include sequential compression devices for a minimum of 2 weeks and (a) coumadin for 4 weeks. (b) low molecular weight heparin for 8 weeks. (c) low molecular weight heparin for 12 weeks. (d) prophylactic inferior vena cava placement. |
Answer: (b)
Commentary: The National Spinal Cord Injury (SCI) Statistical Center database states that at the time of injury, 63% of people injured were employed, 19% were students, and 17% were unemployed. While unemployment at the time of injury is a negative predictor for post injury employment, education has been found to be the factor most strongly associated with post injury employment, with only 5% of persons with less than 12 years of education being employed, and 69% of persons with doctoral degrees being employed. Overall, only about 25% of all persons with SCI were employed. African Americans and Hispanics with SCI fared worse in employment outcomes compared to Caucasians with SCI. Employment status increased over time, with the odds of being employed at 1, 5 and 10 years after injury being 1.58, 2.55, and 3.02, respectively. Reference: (a) Bryce TN, Ragnarsson KT, Stein AB. Spinal cord injury. In: Braddom RL, editor. Physical medicine and rehabilitation. 3rd ed. Philadelphia: Saunders Elsevier; 2007. p1315. (b) Arango-Lasprilla JC, Ketchum JM, Francis K, Lewis A, Premuda P, Wehman P et al. Race, ethnicity, and employment outcomes 1, 5, and 10 years after spinal cord injury: a longitudinal analysis. PM R 2010;2:901-10.
In persons with traumatic spinal cord injury (SCI), which statement regarding employment is TRUE?
(a) The majority of patients are unemployed at the time of injury. (b) Education is most strongly associated with postinjury employment. (c) Employment status is similar between different ethnic groups. (d) Employment status is highest within the first 5 years postinjury. |
Answer: D
Commentary: The C7 level is considered the key level for becoming independent in most activities at a wheelchair level. Persons with a C7 motor level who are in good health are usually independent for weight shifts, transfers between level surfaces, feeding, grooming, and upper body dressing. Some assistance may be required for wheelchair propulsion on uneven terrain. Bathing can be performed independently with the appropriate adaptive equipment. Ref: Kirshblum S, Ho CH, House JG, Druin E, Nead C, Drastal S. Rehabilitation of spinal cord injury. In: Kirshblum S, Campagnola DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 275-98.
What function would be expected in a 24-year-old healthy woman with C7 ASIA A tetraplegia?
(a) Requires minimal assistance for level transfers (b) Requires minimal assistance for side-side weight shifts (c) Independent manual wheelchair use on uneven terrain (d) Independent dressing and bathing with adaptive equipment |
Answer: (b)
Commentary: The PLISSIT model is a framework for educational interventions related to sexuality. It is an acronym for 4 levels of intervention: Permission, Limited Information, Specific Suggestions, and Intensive Therapy. “Permission” is the first level of intervention and refers to creating an atmosphere in which it is clear that discussion about sex will be well received. In this case, answer (b) is most consistent with this level of intervention. Reference: Consortium for Spinal Cord Injury Medicine. Sexuality and reproductive health in adults with spinal cord injury: A clinical practice guideline for health-care professionals. Washington (DC): Paralyzed Veterans of America; 2010.
A 45-year-old man with T4 paraplegia secondary to transverse myelitis is in acute inpatient rehabilitation. Your physical therapist reports to you that the patient is asking whether he will ever be able to have sexual intercourse with his wife again. The next day you decide to address sexuality with your patient on morning rounds. What is the best way to approach this patient?
(a) Explain that there are important medical needs that should be addressed first. (b) Offer to answer any questions that he has about his injury and sexual function. (c) Provide him with specific examples of how to treat erectile dysfunction. (d) Refer him to a therapist for intensive counseling on sexual techniques. |
(b) Individuals with spinal cord injury are at an increased risk for carbohydrate intolerance, cardiovascular disease, and dyslipidemia. There does not appear to be an added risk for prostate cancer in men with chronic SCI.
Ref: Schmitt JK, James J, Midha M, Armstrong B, McGurl J. Primary care for persons with spinal cord injury. In: Lin VW, editor. Spinal cord medicine principles and practice. New York: Demos; 2003. p237-45.
Compared to individuals without spinal cord injury, individuals with spinal cord injuries have a
(a) lower risk of osteoporosis. (b) higher risk of diabetes. (c) lower rate of dyslipidemia. (d) higher rate of prostate cancer. |
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Answer: (b)
Commentary: Amitriptyline, a tricyclic antidepressant, can be effective in the treatment of neuropathic pain but has a significant side effect profile that includes an anticholinergic and sedative effect. These side effects would be desirable in this patient with leaking and difficulty sleeping. Prozac may be helpful with pain but may actually cause insomnia and has little anticholinergic effects. Trazodone is a mild sedative with slight anticholinergic properties. Alprazolam is primarily a sedative and is not commonly used for neuropathic pain. Reference: Bockenek WL, Stewart, JB. Pain in patients with spinal cord injury. In: Kirshblum S, Campagnola DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 389-408.
An individual with T3 ASIA A paraplegia complains of burning pain in his legs. Additional review of symptoms includes urinary leakage between catheterizations and difficulty sleeping. The best pharmacologic intervention at this time would be
(a) fluoxetine (Prozac). (b) amitriptyline (Elavil). (c) alprazolam (Xanax). (d) trazodone (Desyrel) |
Answer: (d)
Commentary: Falls comprise the leading cause of traumatic spinal cord injury in the 46- to 60-year-old age group, while motor vehicle crashes are the most common etiology for traumatic spinal cord injury among people younger than age 46. Incidence rates for acts of violence and sports-related injuries are lower in the 46-60 age group than in younger age groups. Ref: DeViVo MJ. Epidemiology of traumatic spinal cord injury. In: Kirshblum S, Campagnolo DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 71-3.
According to the most recent data from the National Spinal Cord Injury Statistical Center and Model Spinal Cord Injury Systems, which source of trauma is the leading cause of traumatic spinal cord injury among individuals between the ages of 46 and 60 years?
(a) Motor vehicle accidents (b) Acts of violence (c) Sports-related injuries (d) Falls |
(d) The functional position of the hand includes supporting the wrist in 20o to 30o of extension, supporting the palmar arch with the 4th and 5th metacarpals slightly anterior to the second and third digits. Metacarpophalangeal flexion of 30° to 40° would be excessive. The thumb web space should be preserved.
For an individual who has C5 tetraplegia, orthotic splinting attempts to maintain the functional position of the hand. This usually includes
(a) closing the thumb web space. (b) 30o to 40o of metacarpophalangeal flexion. (c) promoting flattening of the palmar arch. (d) supporting the wrist in 20o to 30o of extension. |
Answer: (c)
Commentary: This patient is presenting with autonomic dysreflexia (AD). Once diagnosed, the first step in the management of AD is to sit the patient up, if supine, and loosen any restrictive clothing. If the blood pressure remains elevated, the urinary system should be evaluated. In this case, therefore, the second step would be to flush the suprapubic catheter. If the blood pressure continues to be elevated after bladder distention has been ruled out, the lower bowels should be evaluated for fecal impaction, but only after the systolic blood pressure is reduced to less than150 mmHg, using medications if necessary. Medications, such as nitroglycerin paste (nitropaste), should be used only after these first 3 steps are taken. In the acute setting the need is unlikely, but to avoid life threatening hypotension in chronic SCI and AD avoid using nitrates with sildenafil (Viagra) and other phosphodiesterase type 5 inhibitors. Reference: Consortium for Spinal Cord Injury Medicine. Acute management of autonomic dysfunction: adults with spinal cord injury presenting to health-care facilities. J Spinal Cord Med. 2002;25:S67-S88.
A 22-year-old male with C6 ASIA B tetraplegia secondary to a motor vehicle accident 2 months ago is undergoing inpatient rehabilitation. His bladder is managed with a suprapubic catheter and he is on a daily bowel program using digital stimulation and a bisacodyl (Dulcolax) suppository. While resting supine in bed one evening, he suddenly develops a pounding headache. His blood pressure is found to be 180/100 and his heart rate is 56. His face is flushed. What is the first step
in the initial management of this patient? (a) Flush his suprapubic catheter. (b) Using a well lubricated finger, check his lower rectum for fecal impaction. (c) Sit him up and loosen any restrictive clothing. (d) Apply 1⁄2 inch of nitropaste to his anterior chest wall. |
(c) Posttraumatic syrinx results in neurologic decline in 3% to 8% of patients with spinal cord injuries and can develop 2 months to 30 years after spinal cord injury. Prompt diagnosis is essential and magnetic resonance imaging is usually definitive for diagnosing posttraumatic syrinx. Surgical treatment is usually indicated when there is clear neurological decline.
A 46-year-old man with a 1-year history of C8 ASIA A spinal cord injury presents to your clinic with a 1-month history of increasing bilateral upper extremity weakness and pain. There is no history of trauma. You would
(a) observe for 2 to 4 weeks and repeat ASIA exam. (b) perform electrodiagnostic testing to rule out peripheral nerve compression. (c) order a magnetic resonance imaging study to look for posttraumatic syringomyelia. (d) initiate a workup for pernicious anemia. |
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Answer: (b)
Detrusor sphincter dyssynergia is a common bladder condition seen in spinal cord injury patients. The detrusor is overactive and spastic, and the internal sphincter is also hyperactive. It results in a small bladder that is unable to empty. This increases the risk of high-voiding pressures and vesicoureteral reflux. Alpha receptors are found in the proximal urethra and bladder neck, and therefore alpha blockers can lower urethral resistance. One of the complications of using this medication is orhtostatic hypotension. The medication should be taken at night while in the supine position. Patients taking alpha lockers should be cautioned to avoid phosphodiesterase inhibitors to prevent an abrupt drop in blood pressure.
Which statement is true regarding the use of alpha blockers in the treatment of detrusor sphincter dyssynergia?
(a) urethral resistance is increased with the use of alpha blockers (b) phosphodiesterase inhibitors should be used with caution in patients on alpha blockers (c) alpha blockers should be taken in the morning in the upright position (d) all of the above |
Answer: (b)
Commentary: Prior history of depression is a general risk factor for depression after a spinal cord injury. Etiology, level of injury and ventilator use are not risk factors. Reference: (a) Consortium for Spinal Cord Injury Medicine. Depression following spinal cord injury: a clinical practice guideline for primary care physicians. Washington (DC): Paralyzed Veterans of America; 1998. (b) Kirshblum S. Rehabilitation of spinal cord injury. In: Delisa JA, Gans BM, Walsh NE, editors. Physical medicine and rehabilitation: principles and practice. 4th ed. Philadelphia: Lippincott-Raven; 2005. p 136-7.
An 18-year-old female with a history of depression and C2 ASIA A spinal cord injury acquired in a diving accident requires continuous ventilation. She is diagnosed with a major depressive disorder 8 weeks after her injury. Which factor has increased her risk for developing depression after her spinal cord injury?
(a) Ventilator use (b) Prior history of depression (c) Level of injury (d) Traumatic nature of injury |
Answer: (b)
Commentary: Although each person is different, individuals with C5 tetraplegia are in general able to feed themselves with adaptive equipment after set-up and are able to assist with some upper body dressing. Some are able to independently use a manual wheelchair, but most require some assistance, especially on carpets, non-level surfaces and outdoors. Many prefer to use a power wheelchair. People with complete C4 levels of injury are not able to feed themselves, assist with activities of daily living (ADLs), or propel a manual wheelchair, especially if they have no zone of partial preservation. People with C6 and C7 levels of injury are often capable of transferring (independently or with assistance) and of attaining more independence with ADLs. Reference: (a) Consortium for Spinal Cord Injury Medicine. Outcomes following traumatic spinal cord injury: Clinical practice guidelines. Washington (DC): Paralyzed Veterans of America; 1999. (b) Bryce TN, Ragnarsson KT, Stein AB, Biering-Sorensen F. Spinal cord Injury.
After completing inpatient rehabilitation, an 18-year-old male with complete tetraplegia is able to feed himself with adaptive equipment and requires some assistance with upper body dressing and grooming. He is able to assist with bed mobility, but is dependent for transfers. He is also able to
use a manual wheelchair with rim projections indoors on flat surfaces, but when outdoors he prefers to use a power wheelchair with a joystick. His physical therapist reports that he has achieved his maximal expected outcome. What is his level of injury? (a) C4 (b) C5 (c) C6 (d) C7 |
(b) Damage to the sacral roots usually results in a flaccid bladder. Incontinence often occurs due to a weak sphincter mechanism, particularly if the patient has increased bladder volume or an increase in intra-abdominal pressure. However, the external sphincter may not always be affected to the same degree as the detrusor. This imbalance results in bladder overdistension and the possibility of upper tract
deterioration. Ref: Linsenmeyer TA. Neurogenic bladder following spinal cord injury. In: Kirshblum S, Campanula D, DeLisa J, editors. Spinal cord medicine. Philadelphia: Williams & Wilkins; 2002. p198-200.
Trauma to the sacral roots would most likely result in
(a) vesicoureteral reflux. (b) incontinence. (c) detrusor hyperreflexia. (d) small bladder capacity. |
(d) Renal ultrasound should be included in the annual assessment of renal function and is more sensitive for detecting early hydronephrosis than are plain films. An IVP is not required on a regular basis unless a specific indication exists, such as localizing a renal stone. Patients with indwelling catheters should have a cystoscopy after the first 10 years postinjury. Ref: Schmitt JK, James J, Midha M, Armstrong B, McGurl J. Primary care for persons with spinal cord injury. In: Lin VW, editor. Spinal cord medicine principles and practice. New York: Demos; 2003. p237-45.
A 23-year-old man with C8 tetraplegia requests your opinion regarding routine urologic evaluations after spinal cord injury. You advise that
(a) an intravenous pyelogram (IVP) should be performed every 1 to 2 years. (b) annual abdominal plain films are sufficient to detect early hydronephrosis. (c) renal ultrasound should be performed every 5 years. (d) it is reasonable to wait 10 years before getting his first cystoscopy. |
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Answer: B
Commentary: Hydrocolloid dressings maintain a moist wound environment. Subsequently, proteases and collagenase digest eschar that is in contact with the wound fluid. This process is called autolysis. In enzymatic debridement, chemical agents such as papain-urea break down necrotic tissue. Sharp debridement is performed using an instrument such as a scalpel. An example of mechanical debridement would be wet-to-dry dressing or whirlpool treatment. Ref: Priebe MM. Pressure ulcers. In: O'Young BJ, Young MA, Stiens SA, editors. Physical medicine and rehabilitation secrets. 2nd ed. Philadelphia: Hanley & Belfus; 2002. p 462. (b) Goldman R, Popescu A, Hess CT, Salcido R. Prevention and management of chronic wounds. In: Braddom RL, editor. Physical medicine and rehabilitation. 3rd ed. Philadelphia: Elsevier; 2007 p 690-1.
Hydrocolloid dressings facilitate debridement through which mechanism?
(a) Enzymatic (b) Autolytic (c) Sharp (d) Mechanical |
Answer: (d)
Commentary: In paraplegia, the overall leading cause of death is heart disease, followed by septicemia and then suicide. In tetraplegia, pneumonia is the leading cause of death.Reference: DeVivo MJ. Epidemiology of traumatic spinal cord injury. In: Kirshblum S, Campagnola DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 78-9.
What is the overall leading cause of death for individuals with paraplegia?
(a) Pulmonary embolism (b) Suicide (c) Septicemia (d) Heart disease |
(b) The proper minimum width of a doorway for a wheelchair without a turn is 32 inches. If a turn is involved, then the doorway width should be at least 36 inches.
Ref: Hsiao I, Hodne T. Architectural considerations for improving access. In: Lin VW, editor. Spinal cord medicine principles and practice. New York: Demos; 2003. p 975-86.
Your adult patient with a spinal cord injury needs to access his bathroom in his standard-width wheelchair. If no turn is required following entry into the bathroom, the minimal width of the doorway should be
(a) 26 inches. (b) 32 inches. (c) 36 inches. (d) 40 inches. |
(a) If anticoagulation is delayed for more than 72 hours after injury, a test to exclude the presence of clots in the legs should be performed. In complete injuries, low molecular weight heparin should be used when starting chemical prophylaxis. Pulmonary embolisms may occur as a result of upper extremity DVT and are not prevented by the IVC filter. In general, the longer you wait to remove the IVC filter, the more problems you may experience in the filter retrieval process.
Ref: Campagnolo DI, Merli GJ. Autonomic and cardiovascular complications of spinal cord injury. In:Kirshblum S, Campagnola D, DeLisa J, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 123-34.
A 37-year-old woman with C5 ASIA A tetraplegia from trauma 1 month ago is admitted to your acute rehabilitation unit. She has a retrievable inferior vena cava (IVC) filter and no history of chemical prophylaxis for deep vein thrombosis (DVT). Her surgical team reports to you that they are no longer concerned with an acute bleeding potential related to her trauma and her hematocrit is stable. What should you do first?
(a) Order a lower extremity doppler study to look for DVT (b) Start mechanical prophylaxis with sequential compression devices (c) Tell the patient she is completely protected from pulmonary emboli (d) Leave the IVC filter in place for a minimum of 4 months |
Answer: (d)
Commentary: Superior mesenteric artery (SMA) syndrome is a condition in which the third segment of the duodenum is compressed between the SMA and the aorta. Although it occurs rarely, it is more common in people with tetraplegia, especially if the person lost weight and is immobilized in the supine position. An upper GI series confirms the diagnosis with an abrupt cessation of barium in the third part of the duodenum. In addition to lying on the left side, some individuals get relief with metoclopramide (Reglan). A serum calcium level could be used to diagnose immobilization hypercalcemia, which is a common cause of nausea and vomiting in patients with tetraplegia. Hypercalcemia is not, however, alleviated with positioning and it usually occurs within the first few months after injury. Abdominal x-ray could identify chronic constipation, but since her bowel program is going well, constipation is not likely to be the cause of her symptoms. Although hydrocephalus would be identified by means of a head CT scan, it is the least likely diagnosis in this case. Reference: Kirshblum S. Rehabilitation of spinal cord injury. In: DeLisa JA, Gans BM, Walsh NE, editors. Physical medicine and rehabilitation: principles and practice. 4th ed. Philadelphia: Lippincott-Raven; 2005. p 1729.
A 23-year-old woman with C7 ASIA B tetraplegia resulting from an accident 8 months ago is complaining of nausea for several days and has vomited non-bloody, non-bilious food particles the last 3 evenings when placed back to bed after dinner. She also reports some abdominal tightness and bloating. Her symptoms are relieved when lying on the left side. Her bowel training program is going well, resulting in regular, effective bowel movements. She recently lost 25 pounds and appears quite thin on exam. Which study will confirm this patient’s most likely diagnosis?
(a) Abdominal x-ray (b) Head computed tomography (CT) scan (c) Serum calcium level (d) Upper gastrointestinal (GI) series |
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(b) The patient is likely developing spontaneous detrusor contractions. You would consider using an anticholinergic agent to decrease detrusor (and hence bladder) pressures. Ideally, you would obtain urodynamic studies to ascertain bladder pressures and detrusor-sphincter coordination and would use these findings to guide treatment.
Five weeks after sustaining a T6 complete spinal cord injury, your patient is noted to have new urinary incontinence with intermittent catheterization volumes of less than 150cc. Work-up is negative for a urinary tract infection. You consider starting
(a) tamsulosin (Flomax). (b) tolterodine (Detrol). (c) terazosin (Hytrin). (d) bethanechol (Urecholine). |
Answer: A
Commentary: The majority of patients with complete tetraplegia regain 1 level below their original injury. Up to 87% of motor incomplete subjects (ASIA C) identified at 72 hours post injury were ambulating at 1 year. The ratio of complete to incomplete SCI is close to 50:50. Recovery after incomplete SCI is often most rapid up to 6 months postinjury but can still occur at a slower rate after 2 years. Ref: Ditunno JF, Flanders AE, et al. Predicting outcome in traumatic spinal cord injury. In: Kirshblum S, Campagnola DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002. p 108-22.
Which statement is TRUE concerning traumatic spinal cord injury (SCI)?
(a) More than 80% of individuals identified as having motor incomplete SCI at 72 hours after their injury will walk. (b) There is a plateau of functional recovery after incomplete SCI that occurs after the first 3 months. (c) More than 80% of individuals with complete tetraplegia will regain 2 motor levels below their initial injury level. (d) Approximately one-third of individuals with SCI have complete injuries and two-thirds have incomplete injuries. |
Answer: (a)
Commentary: Quick release axles allow persons with spinal cord injury who drive to load their wheelchairs into the car more easily. Projection rims assist with wheelchair propulsion in patients who have insufficient hand function. The tilt-in-space recline system offers independent pressure relief in patients with tetraparesis. Arm troughs support the arms and forearms of persons with limited upper limb strength. A patient with T10 spinal cord injury has sufficient upper limb and trunk control so that projection rims, arm trough, and tilt-in-space features are not necessary. Reference: Furumasu J, Gilinsky G, Krapfl BJ. Positioning and wheeled moblity for children and adults with disabilities. In: Goldberg B, Hsu JD, editors. Atlas of orthoses and assistive devices. 3rd ed. St. Louis: Mosby; 1997. p 588, 595, 597, 600.
Which wheelchair component is appropriate for a patient with T10 spinal cord injury?
(a) Quick release axle (b) Projection rims (c) Arm trough (d) Tilt-in-space system |
Answer: (c)
Commentary: With the exception of vital capacity (VC), the direction of change in total lung capacity and functional residual capacity decrease in the supine position and increase in the seated position, similar to an individual without a spinal cord injury. In contrast, patients with tetraplegia or high paraplegia have a decrease in the VC in the seated position, which is the result of an increase in the residual volume (RV) caused by the effect of gravity on the abdominal contents, causing the diaphragm to move down into a less efficient position and increasing the RV. Reference: Baydur A, Sassoon CSH. Respiratory dysfunction in spinal cord disorders. In: Lin VW, editor. Spinal cord medicine principles and practice. New York: Demos; 2010. p 216.
Which respiratory measure declines when a patient with tetraplegia moves from a supine to seated position?
a) Total lung capacity b) Functional residual capacity c) Vital capacity d) Residual volume |
Answer: (d)
Commentary: Micturition by electrical stimulation requires intact parasympathetic neurons to the detrusor muscle. This stimulation is often combined with posterior sacral rhizotomy to increase bladder capacity and decrease reflex incontinence and sphincter contraction. Detrusor sphincter dyssynergia is avoided with rhizotomy, protecting the upper tracts and reducing autonomic dysreflexia. The pudendal nerve controls the external sphincter via the somatic nervous system, which is not affected by rhizotomy. Reference: (1) Sheffler LR, Chae J. Neuromuscular stimulation in neurorehabilitation. Muscle Nerve. 2007;35:571-3. (2) Consortium for Spinal Cord Medicine.Clinical practice guidelines. Bladder management for adults with spinal cord injury. J Spinal Cord Med. 2006;29:541, 550-1, 560-1.
A bladder neuroprosthesis applies electrical stimulation to intact sacral parasympathetic nerves (S2-S4) to produce effective micturition and improve bowel function. A posterior rhizotomy from S2-S4 is typically also performed at the same time in order to
(a) decrease pain and increase patient acceptance of the neuroprosthesis. (b) improve bladder emptying and lower the postvoid residual. (c) improve external urethral sphincter relaxation. (d) decrease autonomic dysreflexia when the bladder is emptying. |
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