Gittler Michelle S, McKinley William O, Stiens Steven A, Groah Suzanne L, Kirshblum Steven C
Department of Physical Medicine and Rehabilitation, Schwab Rehabilitation Hospital, Chicago, IL 60608, USA.
Arch Phys Med Rehabil. 2002 Mar;83(3 Suppl 1):S65-71, S90-8. doi: 10.1053/apmr.2002.32160.
This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home.
To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.
这个自主学习模块重点介绍了脊髓损伤（SCI）的康复结果。它是针对物理医学与康复领域的从业者和学员的自主物理医学教育项目中SCI医学章节的一部分。本文聚焦于SCI后功能恢复的多个关注点，主要包括行走的潜力、上肢恢复、功能性神经肌肉刺激（FNS）的选择、性活动以及转移性病变后的最佳结果。运动不完全损伤的患者比感觉不完全损伤的患者在行走方面预后更好。文中讨论了行走的积极预测因素，包括针刺觉和下肢运动评分大于20分。上肢至少在1年内可出现有意义的恢复。已开发出FNS选项，以促进四肢瘫痪患者上肢的功能控制、膈神经起搏和膀胱节制。个人自我表达的一个关键组成部分是其性取向；详细描述了SCI后的性功能，包括勃起功能障碍的治疗选择和女性的各种避孕方法。转移性SCI患者与创伤性SCI患者对适当康复住院时间的期望有所不同。差异可能包括改变常规路径和时间表，以关注以患者为中心的生活质量，以便过渡到家庭。
确定SCI和转移性癌症后在行走、上肢功能、FNS和性功能方面的潜在结果。
