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Autonomic Dysreflexia cards can save a life

Posted by Karen Koehler on April 30, 2012

DSCN2652.JPGOne of the side effects of an SCI is Autonomic Dysreflexia.  AD is an over-activity of the autonomic nervous system. 

 The reflex resuts in spasms and a narrowing of the blood vessels.  This causes a rise in blood pressure.  A message is then sent to the brain which sends messages to the heart.  This caues the heartbeat to slow down and the blood vessels above the level of injury to dilate.  But the brain cannot send messages below the level of injury and therefore the blood pressure cannot be regulated.

The condition can be life threatening.  It can impair heart rate, breathing, digestion, etc.  It  usually occcurs when an injury is above the T6 level. 

The Reeve Foundation has developed wallet size informational cards.  These give a quick summary of what it means, what happens during an episode, and what to do when it does.  The info can also be downloaded.

Information from Christopherreeve.org

Photo:  the laminated card

Number One cause of death for those with SCI

Posted by Karen Koehler on March 05, 2012

DSCN2590.JPGSurprise!  It's cardiovascular disease.

Those with SCI develop the disease at younger ages and at a greater frequency that the able bodied population.

The disease includes autonomic dysreflexia - the drastic increase in blood pressure of those with cervical and upper thoracic injuries.  If untreated it can lead to bleeding in the brain and/or death.

This unstable blood pressure control not only impacts the greater SCI population, but specifically is a worry for athletes with SCI.  Dr. Andrei Krassioukov, a lead researcher in the field led a major study during the 2010 Vancouver Paralympic games.  He says:

"With Paralympic athletes, we have two problems in this area.  One is those who don't this is a risk and need crucial practical information.  The other is athletes who are aware of autonomic blood presure spikes and will actually attempt to use it as a competitive advantage, which is extremely risky."

Different research organizations are increasing their study of cardiovascular disease in those with SCI.  Dr. Krassioukov is leading one such team of 20 scientists in Canada and the US.    He says:

"Twenty-years ago I applied for my first grant to study the effect of spinal cord injury on the cardiovascular system, but it was widely believed that people with SCI didn't need to worry about cardiovascular disease, and the research community should focus on curing paralysis.  While that is still the end goal, we now know how severe and life threatening cardiovascular issues can be.  With this [new] grant we will study different types of exercise interventions as well as translating findings in such a way that we can educate health care providers on the specific cardiovascular problems that are associated with SCI."

This article is excerpted from:  http://icord.org/news/cardiovascular-health-and-spinal-cord-injury-the-surprising-truth/

Photo:  Rock climbing wall at the Arizona Disability Empowerment Center - physical fitness center

Neurogenic bladder, bowel and nutrition

Posted by Karen Koehler on February 23, 2012

 

Diet can play a role in managing a neurogenic bladder and bowel. 

Neurogenic bowel:  Regular meals should be spaced throughout the day.  Adequate fluid intake is 40 ml per kg body weight plus 500 ml, or at least 1.5 liters per day.  Fiber requirements are less than the recdommended amount for the general population - 15 to 20 grams per day.

Neurogenic bladder:  Drink adequate fluids.  While there is some evidence 3 cups of cranberry juice a day may help prvent urinary tract infections, regular juice has too many sugar calories.  Drink sugar-free cranberry juice instead.  Studies have not yet found cranberry tablets to be effective, but some people report success.

 

Source: Vickeri Barton, RD, CD, Associate Director of Nutrition and SErvices, Harborview Medical Center. Presentation April 2011.

Work out & eat right for SCI bone health

Posted by Karen Koehler on February 17, 2012

DSCN2600.JPGPeople with SCI are at higher risk for osteoporosis due to lack of weight bearing on lower limbs.  Decreased bone density increases the risk of fractures and related health problems

Here are some tips to maximize bone health:

  • Be active!
  • DEXA scan is an imaging machine recommended to measure bone density
  • Consume adequate calcium.  Adults 19-50 years 1000 mg/day.  Those over 51 - 1200 mg/day.  Eat dairy products, dark leafy grean veggies, tofu, canned salmon, calicium fortified orange juice
  • Use supplements if unable to get enough through diet.  Tums antacids are a good, cheap source of calcium.  Note - supplements may cause constipation
  • Get 600 IU/day of Vitamin D
  • Limit caffeine
  • Stop smoking
  • Medication such as Fosamax may be prescribed by your doctor
  • Practice good fall prevention during transfers and other activities

See, Effects of resistance training on adiposity and metablism after SCI, Gorgey AS, Mather KJ, Cupp HR, Gater DR, Med Sci Sports Exerc. 2011 June 8.

See, the development of evidence-informed physical activity guidelines for adults with SCI, Ginis KA, Hicks AL, Latimer AE, et al, Spinal Cord. 2011 June 7.

Source: Vickeri Barton, RD, CD, Associate Director of Nutrition and SErvices, Harborview Medical Center. Presentation April 2011.

Photo:  Director of the Arizona Disability Employerment Center Physical Fitness Center.

 

Nutrition, pressure sores, and a new treatment breakthrough

Posted by Karen Koehler on February 16, 2012

Those with SCI have the same protein nutrition needs as the general population.  This changes if a pressure sore develops.  Wound healing requires a big increase in protein. 

A person with or without SCI needs 0.8 to 1.0 grams of protein per kg of body weight per day.

Those with stage II pressure ulcers need 1.2 to 1.5 grams

Those with state II and IV pressure ulcers need 1.5 to 2.0 grams

Extra protein servings can occur through snacks or larger meals.  Examples of good sources of protein include almonds, meat, dairy, tofu, and certain grains like quinoa.

Source:  Vickeri Barton, RD, CD, Associate Director of Nutrition and SErvices, Harborview Medical Center.  Presentation April 2011.

New research is being performed on how to best treat chronic pressure ulcers. In a recent study, three veterans with SCI and chronic stage IV pressure ulcers were treated with a sustained-release "platelet-rich plasma" (PRP). The goal is to stimulate wound healing. The PRP treatment consistently resulted in formation of granulation tissue and improved vascularity for each of the patients treated. At the same time it reduced the overall ulcer area and volume. Sell SA, Ericksen JJ, Reis TW, et al., J Spinal Cord Med. 2011 Jan; 34(1): 122-7.

Factors associated with heart disease risk in SCI

Posted by Karen Koehler on February 09, 2012

DSCN2505.JPGHeart disease risk can be reduced by keeping cholesterol, waist circumference and other risk factors in check.

Blood fats (lipids) target goals:  Keep total cholesterol less than 200 mg/dl.  Triglycerides less than 150 mg/dl. LDL the "bad cholesterol" needs to stay under 130 mg/dl.  HDL the "good cholesterol" needs to stay above 40 mg/dl.  However HDL is often lower in persons with SCI due to decreased physical activity. 

C Reactive Protein:  CRP is associated with risk for heart disease and created when there is stress or inflammation going on in the body.    CRP can be elevated if there is an infection or pressure sore so it doesn't always correlate to heart disease issues. 1.0 mg/L and below means there is low risk.  Between 1.0 mg/L and 3.0 there is average risk.  ABove 3.0 is high risk.  CRP isn't controllable by diet and needs physician care.

Ways to decrease cholesterol (without drugs):

  1. limit fat intake especially of saturated/trans fats
  2. eat more fish
  3. maintain a healthy weight
  4. stop smoking
  5. be as active as circumstances allow

It is hard to find scales than take wheelchairs.  But it is important to track weight.  Monthly weighing is recommended at a clinic or doctor's office.

See article on general nutrition and weight issues.

Source: Vickeri Barton, RD, CD, Associate Director of Nutrition and Services, Harborview Medical Center. Presentation April 2011.

Please don't Supersize Me - SCI nutrition and weight issues

Posted by Karen Koehler on February 08, 2012

DSCN2504.JPGThose with SCI need fewer calories than the non-paralyzed.  This is because metabolic activity decreases after SCI due to denervated muscle.

Generally, those with paraplegia should weigh  5-10% and those with tetraplegia, 10-15%  less than normative weight tables.  Just as important is the measure of body fat (Body Mass Index).  Because persons with SCI have lower muscle mass, normative BMI charts also do not apply.  New research suggests a BMI of 22 should be used to defined obesity in those with SCI.  This is compared to BMI of over 30 in the general population.

A recent study of weight gain following SCI found a significant increase in BMI after a new SCI.  In particular within the first year after acute rehabilitation.  Age, level of injury and impairment category did not significantly predict BMI change.  Crane DA, Little JW, Burns SP,  J Spinal Cord Med. 2011;34(2):227-32.

Medical complications can result after SCI when weight and BMI becomes too high:

  1. The risk increases for diabetes, elevated cholesterol and obesity
  2. There is a tendency to gain weight.  This affects mobility and independence. 
  3. The risk increases for developing pressure sores
  4. The risk increases for osteoporosis

 See the companion articles on general guidelines for weight control.

Source: Vickeri Barton, RD, CD, Associate Director of Nutrition and Services, Harborview Medical Center. Presentation April 2011.

The story of Toby Forrest

Posted by Karen Koehler on November 06, 2011

toby.png

A young musician named Toby had a diving accident.  He became a C5 quadriplegic.  This movie tells Toby's inspirational story. 

This movie was published by the Foundation for Biomedical Research.  www.fbresearch.org

 

Being paralyzed doesn't mean being pain free

Posted by Karen Koehler on October 04, 2011

pain.jpg

22 years ago, Kurt Gengenbach became a C4 quadriplegic during a senior high school hockey game.  He went in for a hit, lost the edge of his skate and slammed headfirst into the boards.

Many people assume that if you are paralyzed, you can't feel anything.  But this is not the case.

Kurt says: "My pain dictates my life much more than my disability ever has."

What a chilling statement. How terrible his pain must be.

Kurt says "You don't get used to it, you just learn to deal with it."  .A big frustration is that people do not realize how bad the situation is. "I sometimes beg for the ability to make someone feel my pain for five or 10 seconds," he says. "I feel bad for saying that.  It's very hard for people to understand.

Now, researchers are taking the first steps toward developing a tool to detect pain based on patterns of human brain activity. The most recent experiments involve functional MRIs of the brain that show what activity is going on.

In a study reported last month, Stanford University School of Medicine researchers put people inside MRI machines, applied a heat probe to their arms, then looked at the brain patterns with and without heat.

The brain patterns were recorded and interpreted by computer algorithms to create a model of what pain - in this case, mild pain in a carefully controlled lab setting - looks like.

The next step is to see whether the same method can be used to measure chronic pain.

"The issue of validation of pain is a critical one," said senior author Dr. Sean Mackey, chief of the division of pain management at Stanford.

"They don't feel like they've been believed, they feel as if their physicians and friends and families think the pain is not real. They're desperately looking for a way to prove to people that they do have pain."

Read more: http://www.ottawacitizen.com/health/burden+proof/5490697/story.html#ixzz1ZqEkZr8x

Photo of Kurt Gengenbach by:  Sarah Dea, Postmedia News

Sponataneous recovery after SCI

Posted by Karen Koehler on September 25, 2011

Almost all people who sustain a SCI show some recovery of motor function below the initial spinal injury level. The spontaneous recovery of motor function in those with motor-complete SCI is fairly limited.  But recovery in incomplete SCI patients is both more substantial and highly variable. With motor complete lesions  the majority of functional return is within the zone of partial preservation.

Most recovery occurs in the first 3 months.  But a small amount can occur for up to18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. 

Spinal Cord 45, 190-205 (March 2007).

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