Sunshine Neuro and Ortho Care

Seizures:-What is a seizure?A seizure (pronounced “see-zhr”) is a surge of abnormal electrical activity in your brain. The most recognizable symptoms of a seizure are a temporary loss of consciousness and uncontrollable movements (convulsions).Not all seizures look the same. You might stop what you’re doing and stare off into space for a few seconds. You might jerk your arm or feel your muscles twitch. You might only have one seizure in your life or have multiple seizures per day. Your experience with seizures can be very different from someone else’s.There are many possible causes of seizures because a lot of things can interfere with your brain’s typical electrical patterns. These range from changes to your blood sugar levels to an illness, injury or underlying condition.SymptomsSymptoms vary based on the type of seizure. They also can range from mild to serious. Seizure symptoms may include:Short-lived confusion.A staring spell.Jerking movements of the arms and legs that can't be stopped.Loss of consciousness or awareness.Changes in thinking or emotions. These may include fear, anxiety or a feeling of already having lived the moment, called deja vu.Most seizures fall into one of two classes called focal or generalized. The classes are based on how and where the brain activity causing the seizure began. If health professionals don't know how the seizures began, they may say the seizures are of unknown onset.What are the types of seizures?There are two main types of seizures:Generalized seizures (generalized onset seizures): Electrical activity starts on both sides of your brain at the same time. You may shake both sides of your body, shake one side or only stare and stop what you’re doing. Usually, it affects kids or young adults, but it can occur at any age.Focal seizures (focal onset seizures): Electrical activity begins on one side or “focus” of your brain. Symptoms usually affect one side of your body and may or may not affect your awareness. This means that you may or may not remember the seizure. Focal seizures may stay focal or may spread to both sides.Generalized seizure typesThe types of generalized seizure disorders include:Absence seizures: You stop what you’re doing and have a blank stare.Atonic seizures (drop seizures): You lose muscle control and drop to the ground suddenly.Clonic seizures: You’ll shake both sides of your body and pass out or shake one side and not pass out.Myoclonic seizures: These involve a quick jerk or twitch that affects one muscle or a group of connected muscles.Secondary generalized seizures: You have a focal seizure (electrical activity starts in one part of your brain) followed by a generalized seizure (electrical activity spreads to both sides of your brain).Tonic-clonic seizures: Your muscles stiffen, you lose consciousness and have convulsions.Tonic seizures: You pass out and your muscles tighten up but you don’t have convulsions.Focal seizuresFocal seizures result from electrical activity in one area of the brain. This type of seizure can happen with or without passing out, called losing consciousness.Focal seizures with impaired awareness. These seizures involve a change or loss of consciousness or awareness that feels like being in a dream. During these types of seizures, people may seem awake. But they stare into space and don't respond to anything around them.They may repeat movements such as hand rubbing and mouth movements, repeat certain words, or walk in circles. They may not remember the seizure or even know that it happened.Focal seizures without impaired awareness. These seizures may change emotions. They also may change how things look, smell, feel, taste or sound. But people having a focal seizure don't pass out.During these types of seizures, people may feel angry, joyful or sad. Some people have nausea or odd feelings that are hard to describe. These seizures may cause trouble speaking and jerking of a body part such as an arm or a leg. They also may cause sudden symptoms such as tingling, dizziness and seeing flashing lights.Symptoms of focal seizures may seem like those of other conditions of the brain or nervous system. These other conditions include migraine, mental illness or a condition that affects how the brain manages sleep-wake cycles, called narcolepsy.Generalized seizuresSeizures that appear to involve all areas of the brain from the time they start are called generalized seizures. Types of generalized seizures include:Absence seizures. Absence seizures often happen in children. These seizures once were called petit mal seizures. People who have absence seizures most often stare into space or make slight body movements such as eye blinking or lip smacking. The seizures most often last for 5 to 10 seconds.Absence seizures can happen up to hundreds of times a day. They can come in clusters. And they can cause a brief loss of awareness.Tonic seizures. Tonic seizures cause muscles to get stiff. These seizures most often affect muscles in the back, arms and legs. People who have these seizures may pass out and fall to the ground.Atonic seizures. Atonic seizures cause a sudden loss of muscle use, most often in the legs. They're also called drop seizures. People having this type of seizure may collapse.Clonic seizures. Clonic seizures are linked with jerking muscle movements. These seizures usually affect the neck, face and arms on both sides of the body.Myoclonic seizures. Myoclonic seizures most often cause sudden brief jerks or twitches of the arms and legs. People who have these seizures don't often pass out.Tonic-clonic seizures. Tonic-clonic seizures are the most common type of generalized seizure. They once were called grand mal seizures. They can cause passing out, body stiffness and shaking. They sometimes cause people to urinate or to bite their tongues.Tonic-clonic seizures last for several minutes. Tonic-clonic seizures may start as focal seizures that spread to involve most or all of the brain.Seizure stagesSeizures can have a beginning phase, a middle phase and an end phase. These phases also are called prodrome, ictal and postictal.Prodrome. This is the earliest warning that a seizure may happen. During the prodrome, people may have a hard-to-describe sense that a seizure may happen. They also may have changes in behavior. This can happen in the hours or even days before a seizure.The prodrome stage may include an aura. The aura is the first symptom of a seizure. Symptoms during the aura may include the feeling that a person or place is familiar, called deja vu, or a feeling that a person or place is not familiar.Or people may simply feel strange, feel fear or panic, or even have good feelings. Symptoms also may include smells, sounds, tastes, blurred vision or racing thoughts. Most often, auras are feelings that are hard to describe. The prodrome may include headache, numbness, tingling, nausea or dizziness.Many people with seizures have a prodrome or aura. But some people do not.Ictal phase. The ictal phase lasts from the first symptom, including the aura, to the end of the seizure. Symptoms of the ictal phase depend on the type of seizure.Postictal phase. This is the period after a seizure during recovery. The postictal stage can last minutes or hours. Some people recover quickly, while others take hours. The length of the postictal phase depends on the type of seizure and what part of the brain was affected.During this phase, people may be slow to respond, have trouble with memory, and have trouble talking or writing. They may feel sleepy, confused, dizzy, sad, scared, anxious or frustrated. They also may have nausea, a headache or weakness. They may feel thirsty or urinate.What are the symptoms of a seizure?Seizure symptoms vary based on the type and severity, but may include:Loss of consciousness.Uncontrollable movements (convulsions, muscle spasms, jerking).Staring.Other symptoms may include:Sudden emotional changes (confusion, fear, joy, anxiety).Teeth clenching.Drooling.Abnormal eye movements.Loss of bladder or bowel control.Noise making (grunting or snorting).These symptoms are temporary and only last for a few seconds to minutes.What are the warning signs of a seizure?Warning signs of a seizure may include:Sensory symptoms: Seeing bright lights or distortions in how objects appear, hearing unexpected sounds, sudden unexpected tastes (metallic or bitter) or smells and strange feelings on your skin (numbness or tingling).Emotional changes: Strong emotions like fear or joy, déjá vu (when a new experience somehow feels familiar) or jamais vu (when a familiar experience somehow feels new).Autonomic symptoms: These affect body systems that your brain runs automatically, like sweating, making too much saliva (drooling), an upset stomach and pale skin.Not everyone experiences warning signs before a seizure.What causes a seizure?A surge of electrical activity in your brain causes a seizure.Neurons (nerve cells) communicate by sending electrical signals to different parts of your brain. When a seizure happens, the affected brain cells fire signals uncontrollably to others around them. This kind of electrical activity overloads the affected areas of your brain and causes seizure symptoms.Seizure causes fall into two main categories depending on why they happen:Provoked seizures (nonepileptic): A trigger, which could be a temporary condition or certain circumstances, causes seizure symptoms to happen.Unprovoked seizures (epileptic): Seizures happen spontaneously (randomly). They may happen often. These seizures are the primary symptom of epilepsy.Seizures without a known cause are called idiopathic seizures.Seizure triggersThe following may trigger a seizure:Abnormal blood sugar levels (low or very high blood sugar).Certain medications, such as Wellbutrin® or bupropion.Flashing or flickering lights.Heat illness.High fever.Sleep deprivation.Stress.Substance use (including alcohol withdrawal).Triggers are different for each person. If you have seizures regularly, you may want to keep track of what you were doing before a seizure took place. A healthcare provider can review this information with you to determine your triggers.Conditions that cause seizuresSeizures can happen for many different reasons. These include but aren’t limited to the following:Aneurysms.Brain tumors.Cerebral hypoxia.Cerebrovascular disease.Diabetes.Severe concussion and traumatic brain injury, especially ones with loss of consciousness.Degenerative brain diseases like Alzheimer’s disease or frontotemporal dementia.Eclampsia.Electrolyte problems, especially low sodium (hyponatremia), calcium or magnesium.Epilepsy (seizures that happen frequently without any clear, underlying cause).Genetic conditions.Other conditions that can cause seizures may include:Hormone-related changes.Infections (especially encephalitis, meningitis or sepsis).Inflammation from autoimmune conditions.Mental health issues (known as psychogenic seizures) like conversion disorder.Problems with how your brain developed (congenital brain abnormalities meaning occurring with birth).Strokes.Toxins and poisons (such as carbon monoxide poisoning or heavy metal poisoning).Venomous bites or stings.What are the risk factors for a seizure?Anyone at any age can have a seizure. You may be more at risk if you:Have an underlying medical condition.Have a biological family history of seizures.Are a child (under 18 years).Are over age 50.What are the complications of a seizure?Seizures often involve losing consciousness and passing out. When this happens, there’s a risk of injuries from falling or suddenly stopping what you’re doing at the time (like driving, operating machinery or climbing heights). Convulsions may cause you to smack your arms or legs on hard objects, causing cuts, bruises or broken bones.Status epilepticus happens when a seizure lasts for more than five minutes or you have more than one seizure without enough time between them to recover. Status epilepticus is a life-threatening medical emergency because it can cause brain damage or even death.Seizures and mental healthSeizures can significantly impact your mental health. It’s also common to have symptoms of anxiety and depression with seizures.This may happen because seizures are distracting and can pull you away from the activities you enjoy. You may feel anxious or fearful of having another seizure. You may keep yourself up at night worrying about when the next one might happen. You might avoid going out in public or spending time with loved ones if you’re embarrassed about having a seizure in front of others.Seizures happen outside of your control, so it’s normal to have these feelings. A mental health professional can help you manage how seizures affect your emotional well-being.Diagnosis and TestsHow is a seizure diagnosed?A healthcare provider, usually a neurologist, will diagnose a seizure after a physical exam, neurological exam and testing. During the exams, your provider will learn more about your symptoms and review your medical history and family health history.It often helps to have someone with you during your appointment who witnessed the seizure to explain what they noticed, as you might not remember what happened.What tests diagnose a seizure?Tests may help confirm whether you had a seizure and — if you did — what might have caused it.A key part of diagnosing seizures is finding if there’s a focal point — a specific area in your brain where your seizures start. Locating a focal point can help your provider plan for treatment.Tests to diagnose seizures include:Blood tests.Computed tomography (CT) scan.Electroencephalogram (EEG).Genetic tests.Magnetic resonance imaging (MRI).Positron emission tomography (PET) scan.Spinal tap (lumbar puncture).Providers might also recommend tests if they suspect injuries or complications from a seizure. Your provider will tell you (or someone you choose to make medical decisions for you) what tests they recommend and why.How is a seizure treated?Seizure treatment varies based on the type, severity and cause. Your healthcare provider may recommend the following:Managing any underlying causes or conditions: Your provider will first treat any underlying conditions — like a stroke or low blood sugar. This may prevent future seizures.Taking antiseizure medications: Medications may help prevent seizures or decrease how often they happen.Surgery: Surgery may reduce seizure frequency and severity by addressing the area of your brain where seizures start (focal point).Brain stimulation: A surgeon will implant a device into your brain to deliver a mild electrical current. The current interferes with and tries to stop abnormal electrical activity. There are different types of brain stimulation available, like vagus nerve stimulation.When to see a doctorSeek medical help right away if you have a seizure or if you see someone have a seizure and any of the following happens:The seizure lasts more than five minutes.The person isn't breathing after the seizure stops.A second seizure follows right away.The person has a high fever.The person's body overheats, called heat exhaustion.The person is pregnant.The person has diabetes.The seizure causes an injury.The seizure happens in water.Can a seizure be prevented?Seizures are unpredictable, so it’s not possible to completely prevent them. The best thing you can do is avoid possible causes or triggers, like managing blood glucose levels or protecting yourself from illness and injury.What can I expect if I have a seizure?Fewer than half of people who have a single, unprovoked seizure will have another. If a second seizure happens, healthcare providers may recommend starting antiseizure medications. For provoked seizures, the risk of having another depends on what caused the first seizure. If it’s treatable, your risk of having another seizure is low (unless you have a repeat of the circumstances that caused the first seizure).Medications may prevent seizures or reduce how often they happen. However, it sometimes takes trying multiple medications (or combinations of them) to find one that works best.In some cases, seizures may be more difficult to treat with medications alone. A provider may recommend surgery, following a specific meal plan or other treatment options.If seizures happen often, your provider can help you take precautions to stay safe. You may choose to wear a medical ID bracelet or carry a medical ID card with you so others will know what to do in the event of a seizure.How long does a seizure last?Seizure symptoms usually last for a few seconds to minutes, up to 15 minutes. Symptoms can last longer if you have several seizures, one after the other (this is a medical emergency).

Spinal cord injury:-What is a spinal cord injury?A spinal cord injury (SCI) is damage to the spinal cord—the bundle of nerves and nerve fibers that sends and receives signals from the brain. The spinal cord extends from the lower part of the brain down through the lower back.Direct injury to the spinal cord itself or damage to the tissue and bones (vertebrae) that surround the spinal cord can cause an SCI. This damage can cause temporary or permanent changes in feeling, movement, strength, and body functions below the point where the injury happens.Spinal cord injury symptomsThe symptoms of spinal cord injuries depend on the part of the spinal cord that is damaged and how much damage there is. SCIs to upper parts of the spinal cord affect more of the body than injuries lower down. An injury to the upper part of the spinal cord can cause paralysis in most of the body and affect all limbs (tetraplegia or quadriplegia).An injury that happens lower down the spinal cord may only affect a person’s lower body and legs (paraplegia). Paralysis can happen immediately upon injury (primary damage) or develop over time from bleeding and swelling in the spinal cord and cell death (secondary damage).An SCI can damage a few, many, or almost all of the nerve fibers that cross the site of injury. If the injury causes little or no nerve cell death, a person can make an almost complete recovery.An SCI can cause one or more symptoms, including:Numbness, tingling, or a loss of (or changes in) sensation in hands and feetParalysis (loss of movement)Pain or pressure in the head, neck, or backWeakness in any part of the bodyUnnatural or uncomfortable positions of the spine or headLoss of bladder and bowel controlProblems with walkingDifficulty breathingChanges in sexual functionWhat causes an acute SCI?Many things can cause SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:FallsMotor vehicle accidents, such as cars, motorcycles, and being struck when walkingSports injuriesDiving accidentsTrampoline accidentsViolence, such as gunshot or stab woundsInfections that form a collection of pus (abscess) on the spinal cordBirth injuries. These typically affect the spinal cord in the neck area.Who is at risk for acute SCI?Some people are at higher risk for SCI than others. Those at higher risk are people ages 16 to 30 or older than age 65. tThe majority of people who suffer SCIs are male. Non-Hispanic whites are at higher risk for SCI than any other ethnic group.Types of spinal cord injuryAn SCI can be either complete or incomplete:An incomplete injury means the spinal cord is still able to send some messages to or from the brain. People still have some feeling, function, and muscle control below the site of their injury.A complete injury means that there is no nerve communication below the injury site. People lose muscle control, feeling, or function below the injury.Anatomy of the spinal cordThe spinal cord is a soft, cylindrical column of tightly bundled cells (nerve cells and glia), nerve fibers that transmit nerve signals (called axons), and blood vessels. It sends and receives information between the brain and the rest of the body. Millions of nerve cells in the spinal cord coordinate complex patterns of movements, such as rhythmic breathing and walking.The spinal cord extends from the brain to the lower back through a canal in the center of the vertebrae. Like the brain, the spinal cord has three layers of tissue for protection—and cerebrospinal fluid (CSF) surrounds it to act as a cushion against shock or injury.Other types of nerve cells sit just outside the spinal cord and send information to and from the brain. Doctors refer to these nerve cells based on their location:Cervical spinal nerves (known as C1 to C7) in the neck control signals to the back of the head, the neck and shoulders, the arms and hands, and the diaphragm.Thoracic spinal nerves (known as T1 to T12) in the upper mid-back control signals to the chest muscles, some muscles of the back, and many organ systems.Lumbar spinal nerves (known as L1 to L5) in the lower mid-back control signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the legs.Sacral spinal nerves (known as S1 to S5) in the lower back control signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus.Who is more likely to get a spinal cord injury?Motor vehicle accidents and serious falls are the most common causes of SCI in the U.S. Other causes include:Acts of violence (mostly gunshot wounds and assaults)Sports injuriesMedical or surgical injuriesIndustrial or workplace accidentsDiseasesConditions that can damage the spinal cordRisk factors for an SCI include age (either being between ages 16 and 30, or after age 65 for dangerous falls), alcohol use, or not wearing proper gear—such as a seat belt or protective sports equipment.What are the symptoms of an acute SCI?Symptoms of an acute SCI can vary widely. The location of the injury on the spinal cord determines what part of the body is affected. And how bad the symptoms are.Your spine may be in shock right after a spinal cord injury. This causes loss or decrease in feeling, muscle movement, and reflexes. It will be easier for your healthcare provider to find out the extent of injuries as swelling eases.Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, the first and second vertebrae in the spinal column (C1, C2), or the midcervical vertebrae (C3, C4, and C5) affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs, and sexual function.Quadriplegia is loss of function in both arms and both legs.Paraplegia is loss of function in the legs and lower body.The extent of the damage to the spinal cord determines whether the injury is complete or incomplete.A complete injury means that there is no movement or feeling below the level of the injury.An incomplete injury means that there is still some degree of feeling or movement below the level of the injury.These are the most common symptoms of acute spinal cord injuries:Muscle weaknessLoss of voluntary muscle movement in the chest, arms, or legsBreathing problemsLoss of feeling in the chest, arms, or legsLoss of bowel and bladder functionThe symptoms of SCI may look like other health conditions or problems. How are acute SCIs diagnosed?Acute SCI is a medical emergency. Emergency evaluation is needed anytime there is a suspected injury to the spinal cord. The effects of an SCI may not be clear at first. A full health evaluation and tests are needed. During the exam, the healthcare provider will ask about your health history and how the injury occurred. A spinal cord injury can cause ongoing nerve problems. These will need more medical follow-up. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI.Diagnostic tests may include:Blood testsX-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.CT scan. An imaging test that uses X-rays and computer technology to make detailed images of the body. A CT scan shows images of any part of the body. This includes the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.MRI scan. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. This is done without using X-rays.Treating spinal cord injuriesAt an accident scene, if SCI is suspected, emergency personnel will place a rigid collar around the neck and carefully place the person on a backboard to prevent further damage to the spinal cord. They may use sedatives to relax the person and prevent movement. Emergency responders may also insert a breathing tube if there are problems breathing and the body isn't receiving enough oxygen from the lungs.Doctors are now able to predict with reasonable accuracy the likely long-term outcome of an SCI. This helps people experiencing spinal cord injuries to set achievable goals for themselves and gives families and loved ones a realistic set of expectations for the future.Immediate treatment at the trauma center or emergency room may include:Realigning the spine using a rigid brace or mechanical force, which is usually done as soon as possible to stabilize the spine and prevent additional damage.Surgery to remove any fractured bones or other objects that are pressing on the spinal column. Spinal decompression surgery to relieve pressure within the spinal column may also be necessary in the days after injury. Results of neurosurgical studies show that, in some cases, earlier surgery is connected to better functional recovery.An SCI may result in the following problems, which require treatment:Breathing problems. About one-third of people with an SCI will need temporary or permanent help with breathing and may require a breathing tube. Any injury to the spinal cord between the C1-C4 segments can stop breathing as the nerves in this region cause the diaphragm to move and the lungs to expand. People with an SCI may need special training with breathing and swallowing. Their caregivers may need training as well.Pneumonia. Breathing complications are the leading cause of death in people with an SCI, commonly as a result of pneumonia. People using a ventilator to help with breathing, are at increased risk of developing pneumonia. The person will need careful monitoring and antibiotic treatment if symptoms of pneumonia appear. Ways to prevent pneumonia include clearing the throat and taking precautions to avoid food and liquids being sucked into the lungs (aspiration).Circulatory (blood flow) problems. Changes in circulation can lead to unstable blood pressure, abnormal heart rhythms (arrhythmias), and blood clots that may appear days after injury. The injured person will need careful monitoring for each of these common issues after an SCI. People with spinal cord injuries are at increased risk for blood clots because blood flow can slow or stop in the large veins in the legs. Anticoagulant drugs and compression stockings to increase blood flow in the lower legs and feet can reduce the risk for blood clots.Stiffness and changes in muscle tone. Reflexes may become exaggerated over time, causing muscle stiffness and an increase in muscle tone (spasticity) that may require special treatment. Muscles below the injury site may weaken when people don’t use them.Autonomic dysreflexia. Autonomic dysreflexia is a life-threatening reflex action that primarily affects those with injuries to the neck or upper back. Symptoms may include flushing or sweating, a pounding headache, anxiety, sudden increase in blood pressure, vision changes, or goose bumps on the arms and legs. If possible, the person needs to stay in a sitting position to keep blood flowing to the legs and feet, which helps reduce blood pressure.Pressure sores (also known as pressure ulcers). Pressure sores are areas of skin that have broken down because of continuous pressure on the skin and reduced blood flow to the area. People with paraplegia and tetraplegia are at risk for pressure sores. To prevent pressure sores, they change their position regularly, either on their own or with the help of assistive devices or a caregiver.Pain. Some people with an SCI develop neurogenic pain—an intense burning or stinging sensation. This pain may be constant or may come and go. Many things can trigger it—and some people may even feel pain in parts of the body that have otherwise lost sensation. Treatments for chronic pain include medicines, spinal or brain electrical stimulation, and surgery. But none of these treatments are completely effective at relieving neurogenic pain long term.Bladder and bowel problems. People may need to use a catheter to empty their bladder and learn new ways to empty their bowels. The person may need to change their diet.Sexual function. Depending on the severity and location of the injury, and the person’s recovery after the injury, their sexual function and fertility may be affected. A urologist and other specialists can suggest different options to support sexual functioning and health.Depression. Many people living with an SCI may develop depression due to lifestyle changes after the injury. Therapy and medicine can help treat depression and other mental health conditions.Spinal cord injury rehabilitationRehabilitation programs for people with an SCI combine physical therapies with skill-building activities. They also have counseling designed to provide social and emotional support and increase the person’s independence and quality of life.A doctor specializing in physical medicine and rehabilitation usually leads the rehabilitation team. The team may include social workers, physical and occupational therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists, a case worker, and other specialists.The first phase of rehabilitation after injury usually focuses on regaining communication skills and leg and arm strength. Adaptive or assistive devices may help people with an SCI to regain independence and improve mobility and quality of life. They can also help with communication skills, such as writing, typing, and using the telephone.Depending on how serious the injury is, the person may need:BracesA wheelchairElectronic stimulatorsAssisted training with walkingNeural prosthetics (assistive devices that may stimulate the nerves to restore lost functions)Computer adaptations and other computer-assisted technologyRehabilitation for an SCI can include:Physical therapy, which are exercise programs that strengthen muscles.Occupational therapy, which helps redevelop fine motor skills. People with an SCI may need help regaining skills to perform activities for daily living—such as getting in and out of a bed, personal hygiene, eating, and using the toilet. The person may learn how to cope with spasticity, autonomic dysreflexia, and neurogenic pain as part of their occupational therapy.Vocational rehabilitation, which is identifying basic work skills and physical and cognitive capabilities that can support paid work. Through this process, the person and their team can identify potential, accessible workplaces and any assistive equipment they will need..Educational training, which can help the person develop skills for a new line of work that may be less dependent upon a person’s physical abilities. People with an SCI are encouraged to participate in activities that provide a sense of satisfaction and self-esteem, such as educational classes, hobbies, special interest groups, and family and community events.Recreation therapy, which encourages people with an SCI to participate in sports, arts, or other leisure activities that they can do with their new level of mobility. This can help people achieve a balanced lifestyle that provides opportunities for socialization and self-expression.Living with an acute SCIsPhysical therapy will likely be a very important part of your rehabilitation. In this treatment, specialists will work with you to prevent muscle wasting and shortening (contractures), and to help you retrain other muscles to aid in mobility and movement. Another type of therapy is occupational therapy. It helps you learn new ways of doing everyday tasks in spite of your new physical limitations.A traumatic event that results in a SCI is devastating to both you and your family. The healthcare team will help educate your family after your hospital stay and rehabilitation on how to help care for you at home. They will also help you understand the specific problems that need medical attention right away.You will need frequent medical evaluations and testing after your hospital stay and rehabilitation to keep track of your progress.It’s important to focus on maximizing your capabilities at home and in the community.You may feel sad or depressed after your injury. If this happens to you or a loved one, your healthcare provider may recommend that you see a mental health professional. Antidepressants and talk therapy (psychotherapy) can help treat depression.When should I call my healthcare provider?Depending on the severity of the injury, some people might recover some of their lost function, but others might continue to have long-term problems. Be sure to talk with your healthcare provider about when you would need to call them.Your healthcare provider will likely advise you to call them if any problems you are having become worse, including weakness, numbness or other changes in sensation, or changes in bladder or bowel control.People who have serious long-term effects from a spinal cord injury can also develop a number of other complications. Your healthcare provider might advise you to call them if you have problems, such as:Skin sores or infectionsTrouble breathingFever, cough, or other signs of infectionSevere headacheNot urinating regularly or having severe diarrhea or constipationSevere muscle cramps or spasmsIncreasing painSudden blood pressure changesKey points about acute SCIsAn acute spinal cord injury is caused by trauma to the spinal cord. It's a medical emergency that needs to be treated right away.The severity of symptoms (such as weakness, paralysis, and loss of feeling) depends on how badly the spinal cord is damaged and where on the cord the injury occurs. Damage to the cord in the middle of the back might affect only the legs, whereas damage to the spinal cord in the neck might also affect the arms and even the breathing muscles.Treatment might include surgery, medicine, and other treatments as needed. Some people might recover some function over time, but others might continue to have long-term problems. Physical and occupational therapy can help you adapt to new ways of doing things.What are the latest updates on spinal cord injury?Current research on spinal cord injuries focuses on advancing our understanding of the four key principles of spinal cord repair:Neuroprotection. Preventing cell death and protecting surviving nerve cells from further damage improves functional outcome. This includes using medicines to reduce nerve cell death and lower the body's core temperature.Repair and regeneration. Encouraging the spinal cord to self-repair and stimulating the regrowth of nerve fibers can help people regain function. These efforts include exploring cell transplants, growth-promoting substances, and bioengineered growth scaffolds.Cell-based therapies. Replacing damaged nerve or support cells with other cell types, including stem cells, jumpstarts nerve cell growth and creates new cell connections.Neuroplasticity. Retraining central nervous system circuits to restore body functions and form new nerve connections and pathways may help with voluntary muscle movement and coordination. These techniques happen after injury or cell death. They include rehabilitation, electrical stimulation, robot-assisted training, and brain-computer interface technology..

Amputation:-What is amputation?Amputation is surgery to remove all or part of a body appendage, usually a limb or extremity (an arm, leg, hand or foot). You might need surgery to amputate a body part if it’s too sick or injured to save and it endangers other parts. You might also need surgery if you lose a body part in a traumatic accident. When limb loss is unavoidable, amputation surgeons ensure that it’s clean and safe for the rest of you.Common types include:Arm amputation.Hand amputation.Finger amputation.Leg amputation.Foot amputation.Toe amputation.Less commonly, amputation can also mean removing a part of your face, like an ear, nose or tongue. A mastectomy is amputation of a breast. You can also have your testicles or penis removed (amputated).What are the different types of amputations?Doctors typically divide amputation types first into upper amputations and lower amputations. Upper amputations involve the fingers, wrist, or arm. Lower amputations involve the toes, ankle, or leg.Ideally, if you need an amputation, a doctor will speak with you about the need for a certain location and prosthetic options.The following are medical terms for certain amputation types.Upper extremityTranscarpal. An amputation of a finger or a portion of the hand.Wrist disarticulation. An amputation through the wrist.Transradial. An amputation below the elbow.Elbow disarticulation. Amputation through the elbow or at elbow level.Transhumeral. Amputation above the elbow.Shoulder disarticulation. Amputation at the shoulder.Lower extremityToe amputation. Removal of one or more toes.Midfoot amputation. Removal of the toes and half of the foot, with the heel and ankle joint remaining. Also called a transmetatarsal amputation (TMA).Transtibial amputation. Also known as a below-knee amputation.Knee disarticulation. Also known as a through-knee amputation.Transfemoral amputation. An amputation above the knee.Hip disarticulation. An amputation in the area of the hip joint.Hemipelvectomy. An amputation of the entire leg and portion of the pelvis to the sacrum.Why is amputation sometimes necessary?According to 2020 researchTrusted Source, the largest percentage of amputations are related to chronic disease that impairs blood flow and affects bone tissue. However, there are additional amputation causes.Why is amputation done?Devastating injuries and diseases are the usual causes of surgical amputation. In many cases, the body part has lost its ability to function as it should. Nerves no longer return sensation from the part or allow you to move it at will. Or blood vessels no longer nourish the tissues. Loss of sensation can cause injuries that you don’t notice, leading to infections. Loss of blood flow will eventually cause the tissues to die.The surgery is usually a preventive measure. It helps preserve the health of the rest of your body. Tissue death, infections and cancer can easily spread from the sick part to the rest. A part that’s wounded beyond repair becomes a hazard if you can’t control it or protect it well enough. Removing the part also gives you the option to replace it with a more functional and aesthetic-looking prosthetic part.What are the most common causes of amputation?Common conditions that may lead to surgical amputation include:Complications of peripheral artery disease (PAD), which causes a loss of blood flow.Complications of diabetes, which causes nerve damage and loss of sensation.Nonhealing and/or infected foot and toe ulcers (often related to diabetes or PAD).Gangrene, tissue death from loss of blood flow, which can spread.Stage three frostbite that leads to irreversible tissue death.Life-threatening infections in your bones, joints or other tissues.Cancerous tumors that surgeons are unable to safely remove from your body part.Severe injuries, including severing, crushing and burn injuries.Procedure DetailsWhat happens before amputation surgery?If it’s not an emergency, you’ll go through a few steps of preparation before surgery:AssessmentYour healthcare team will carefully assess the extent of your disease or injury. In some cases, they might be able to attempt to save your limb using advanced surgical techniques. This is called limb salvage surgery. If this is an option for you, your provider will discuss the risks and benefits with you. If not, they’ll use your assessment to plan your surgery.CounselingAmputation is more than the surgery itself. It’s a psychological and physical journey that will have lifelong repercussions. Likewise, your healthcare team will include more than surgeons. You may meet with a variety of therapists to prepare you for surgery and plan for your recovery. If you’re interested in a prosthetic limb, you’ll meet with a prosthetist to discuss your options.What happens during the procedure?During surgery, your surgeon will remove all diseased and damaged tissues. They’ll work to preserve as much healthy tissue as possible. They may need to repair individual nerves or blood vessels through microsurgery. They may also need to file or smooth the end of your bone, and they’ll often stitch your muscle to your bone to reinforce it. They’ll leave enough soft tissue at the end of the stump to close it.You may have discussed plans for a certain type of prosthesis with your surgeon. In some cases, they might perform extra steps in your surgery to prepare you for that prosthesis. Examples include:Target muscle reinnervationThis option for upper limb amputees can make it easier to control a myoelectric arm or hand. After amputating, your surgeon redirects the severed nerves that controlled your amputated limb to a new “target muscle” somewhere else on your body — often in your shoulder or chest. This allows you to operate your prosthesis more intuitively by activating this other muscle.OsseointegrationOsseointegration means integrating your prosthesis with your bone (osseo-). Your surgeon implants a metal anchor into your bone that extends from the end of your limb. Your prosthesis can attach directly to it. This makes the prosthesis easier to attach and remove. It also helps to prevent some of the skin complications that a traditional prosthesis socket can sometimes cause.RotationplastyRotationplasty is rare a procedure that involves amputating part or all of your upper leg and reattaching your healthy lower leg as your upper leg. Your surgeon rotates your lower leg so that your ankle bends the right way to replace your knee. This allows you to use a below-the-knee prosthesis with your shortened leg, instead of needing an above-the-knee prosthesis.What happens after surgery?You’ll spend a few days to weeks recovering in the hospital after surgery. You’ll have oxygen through a mask, fluids through an IV and pain control as needed. You may have a urinary catheter and bedpan, so you don’t have to get up to go to the bathroom. Your healthcare team will carefully monitor your wound healing. Within a few days, a physical therapist will begin guiding you in small daily exercises to prevent stiffness.You’ll continue your rehabilitation either at home or in a rehabilitation facility for people with limb loss. During this time, you’ll work with a variety of specialists to learn how to live with your changed body.Your rehabilitation will likely include:Physical therapy. You’ll need to move regularly to prevent your tissues from stiffening. You’ll also need to learn to use your body in new ways, relying on different muscles than you used to.Occupational therapy. An occupational therapist helps you learn to adapt your practical life to your new body. They’ll teach you new ways to accomplish routine tasks at home and at work.Psychotherapy. Amputation is a profound psychological event. It will take time to adjust and to process through the full range of feelings it can evoke. It’s a good idea to have a mental health professional to talk to during this time. Your mental health is important to your overall recovery.Prosthesis fitting and training. If you plan to use a prosthetic limb, you’ll begin the fitting process after you’ve recovered. You’ll then spend several months learning how to use it.Risks / BenefitsWhat are the advantages of amputation?Surgical amputation is almost always a life-saving or life-preserving procedure. Occasionally, it’s a choice between removing a damaged and dysfunctional limb or salvaging it and living with it as-is. This might mean living with chronic pain, a constant safety hazard or a limb that you can’t use. Alternatively, removing and replacing it with a more functional prosthesis might improve your quality of life.What are the possible risks of amputation surgery?Any major surgery carries some risk of complications. These can occur during or after surgery. Those who need amputation surgery may be more at risk of complications than others. This is because they’re often already in poor health. Preexisting conditions like cardiovascular disease, trauma, cancer and infections can contribute to the risk of sudden respiratory failure, heart failure or kidney failure.Preexisting conditions can also make it difficult for your body to recover well. With reduced resources for healing, wounds may be slow to close or may reopen, and you may have excessive swelling or bleeding. Your stressed immune system may be too weak to fight infections like pneumonia, which can happen with extended bed rest. Bed rest and cardiovascular disease also make blood clots more likely.Amputations related to blood flow conditionsChronic disease and infection can lead to interrupted blood flow that jeopardizes a limb. When this is the case, a doctor may recommend amputation to preserve as much of the limb as possible.Chronic conditions are a leading cause of lower extremity amputations. The American Academy of Physical Medicine and Rehabilitation (AAPMR) estimates that 93.4 percent of all lower extremity amputations are related to vascular disease. This includes conditions such as diabetes and peripheral artery disease.The most common lower extremity amputations related to blood flow conditions are:toe (33.2 percent)transtibial (28.2 percent)transfemoral (26.1 percent)foot amputations (10.6 percent)Amputations due to chronic disease are associated with 5-year mortality ratesTrusted Source that are higher than some cancer types. This is because the need for amputation in many instances can indicate a person’s medical condition or overall health is worsening. Enhancing a person’s healthcare and overall health are excellent goals after amputation.Cancer-related amputationsCancer-related amputation accounts for 0.8 percent of total amputations. This is often due to bone cancer or cancer that has metastasized to the bone. However, cancer is the most common amputation cause for those between the ages of 10 and 20.Traumatic amputationsInjuries and trauma can lead to amputations. An estimated 5.8 percent of lower limb amputations are related to trauma. This can include injuries from car accidents and workplace-related accidents.The Bureau of Labor Statistics estimates that 6,200 work-related amputations happened in the United States in 2018. More than 58 percent of these involved using some type of machinery, particularly metal and woodworking machinery.How amputations affect the bodyBecause amputation removes a portion of the body that was naturally present, it’s easy to wonder how this affects your overall health. There are undeniably effects that can occur due to amputation. It’s important to work with your doctor and physical therapist to minimize these effects whenever possible.Examples include:changes in your center of gravity and balanceincreased risk of arthritis in your remaining limb (if applicable) because it often has to increase its workloadback pain due to changes in the body’s positioning for lower limb amputeesOften, the effects of an amputation are related to where it is and your overall health.Amputation complicationsAmputations are surgical procedures that have risks involved. Also, if the amputation was the result of trauma or infection, you may have other medical conditions to recover from as well. This can complicate recovery after amputation.According to the AAPMR, some of the most common amputation complications include:infectionpinched nervephantom limb sensation and pain (feeling as if the limb is still there, even if it isn’t)residual limb painAnother complication is joint contracture. This is when the remaining muscles, tendons, and other tissues tighten so much that you can’t move the remaining joint.How long does it take to recover from surgery?Recovery times can vary. In general, it takes two to three months for your surgical wounds to heal and your swelling to go down. Once your residual limb has settled into its final size and shape, you can begin fitting for a prosthesis. You’ll begin physical therapy as soon as possible after surgery. You’ll likely continue with it for at least six months. Training to use a prosthetic limb can take even longer.Amputation healing time and recovery tipsAmputation healing times can vary by the event that caused the amputation and the amputation site.For example, amputations due to chronic conditions such as diabetes or peripheral artery disease may take longer to heal. Blood flow and wound healing are already impaired by these conditions, which may extend recovery times.A small 2018 study suggests it likely takes less time to recover from a toe amputation than a leg amputation. A surgeon should help you determine your expected recovery period.Some tips to help the recovery process:Follow wound care instructions carefully. Most surgical incision sites should be kept clean and dry. Notify your doctor if you experience significant drainage or infection signs.Take medications such as antibiotics as prescribed. This can help prevent surgical site infections.Participate in physical therapy as you are able to keep muscles strong and tendons and other tissues mobile.It can take time to regain function after an amputation. Some individuals undergoing leg amputations reported it took as many as 6 months to regain their functional independence.How painful is amputation?If you experience it consciously, limb amputation is one of the most painful assaults your body can endure. Fortunately, you won’t feel it during surgery, and you’ll have strong pain control after surgery. While you’ll probably experience some postoperative pain, your healthcare team will do their best to help you manage it. However, limb loss can lead to other, longer-lasting pain syndromes, including:Residual limb pain. Pain in your residual limb or “stump” can have a variety of causes. Nerve damage from surgery can cause recurring nerve pain. Using a prosthesis can irritate the skin on your stump in various ways. You should address these issues with your prosthetist.Phantom limb pain. Many amputees experience periodic sensations, such as pain, that seem to come from their amputated limb. This happens because the severed nerves continue to transmit signals to your brain. Address phantom limb pain with your provider.Psychological pain. Understandably, limb loss can cause significant psychological distress, especially when it’s unexpected. It can feel overwhelming and can raise your risk of clinical depression and PTSD. You’ll need professional support to process the psychological pain.Where do amputated limbs go?If you are wondering where amputated limbs go, you aren’t alone. Especially if you’re about to undergo an amputation, it’s fairly common to ask questions about how and where these limbs are disposed of.A 2019 study described four potential destinationsTrusted Source for your limb after the procedure. The limb could be:sent to a biohazard crematoria where it is destroyeddonated to a medical college for use in dissectionsent to a pathologist for testing, such as for cancer cells or infectionreturned to you if you have a proven religious need to retain the limb