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An analysis on Long-term care after Spinal Fractures

Spinal Trauma and Fractures occur when blunt physical force damages the vertebrae, disks of the spinal column, crushing, causing bruising,  or tearing of spinal cord tissue.  These injuries can also cause vascular injury with resultant ischemia leading to further damage. All forms of injury can cause spinal cord edema, which decreases blood flow and oxygenation. Damage may be mediated by excessive release of neurotransmitters from damaged cells, an inflammatory immune response with release of cytokines and accumulation of free radicals.

Drugs can effectively control jerkiness in many patients. Baclofen 5 mg orally 3 times a day and tizanidine 4 mg orally 3 times a day are used widely when Spinal Trauma and Fracturesoccurs. Intrathecal baclofen 50 to 100 mcg once a day are considered in patients in whom oral drugs are ineffective.

Rehabilitation is required to help people recover as fully as possible. It combines physical therapies, skill-building activities, and guidance to meet social and emotional needs. The rehabilitation team is directed by a trained physician. It usually includes nurses, nutritionists, psychologists,  social workers, recreational therapists, and vocational counselors.

Physical therapy concentrates on exercises for muscle strengthening, passive stretch exercises to forbid contractures, and proper use of assistive devices such as a walker or a wheelchair that may be needed to improve mobility. Strategies for controlling spasticity and neurological pain are taught.

Occupational therapy concentrates on redeveloping fine motor skills. Bladder and bowel management programs teach toileting techniques

Vocational rehabilitation involves assessing cognitive capabilities to determine the likelihood for meaningful employment. The vocational specialist helps identify possible work sites and determines need for workplace modifications. Recreational therapists use a similar approach in identifying and facilitating participation in hobbies.

Emotional care aims to combat unavoidable depression that occur after losing control of the body. Emotional care is profound to the success of all other components of rehabilitation and must be accompanied by efforts to teach the patient and encourage active involvement of family and friends.

Treatments to boost nerve regeneration and minimize scar tissue formation in the injured cord are under study. Such treatments involve implantation of a polymer scaffold at the level of cord injury. Stem cell research is being done. Many animal studies have shown auspicious results and there have been several phase I and II human clinical trials.

Implantation of an epidural stimulator is an4other treatment modality under research to improve voluntary movement after Spinal Trauma and Fractures. During this process, electrical pulses are delivered to the surface of the cord below the injury.

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