The annual incidence of traumatic spinal cord injuries in our country is 21 per million. Injuries are most common in the 16-30 age group and are more common in men. The aim of rehabilitation in spinal cord injuries is to prevent complications, maximize physical independence, and turn the patient into a productive individual who assumes age-appropriate social roles. The most important thing in early rehabilitation is positioning. Joint range of motion exercises and strengthening training are started. Mat exercises begin when the patient is ready to get out of bed. Mat activities include rotation, prone elbow and hands positioning, sitting balance and transfer training. Knee-ankle-foot orthoses are needed to support the knee and ankle in patients with spinal cord injuries at the back level for walking. For walking, firstly, standing up on the parallel bar, balancing, turning, moving the lower extremity by lifting the hip up and stepping are practiced. After you start walking comfortably on the parallel bar, you can practice walking with a walker and then with crutches. For patients with higher-level spinal cord injuries and those who are not expected to walk, an appropriate wheelchair is selected and training is given for the effective and safe use of the wheelchair. One of the goals of the rehabilitation program is to prevent complications such as lung problems, clot formation in the deep veins of the leg, blood pressure problems, bone tissue development in soft tissues, osteoporosis, urinary problems, sexual problems, pressure sores, muscle contraction and pain encountered during the rehabilitation process. If complications develop, a rehabilitation program should be planned for these problems.
SPINA BIFIDA REHABILITATION
Neural tube defects are the most common, serious congenital disorders of the brain and spinal cord. It occurs as a result of the closure defect of the brain, spinal cord and spine in the first weeks of embryonic life. The disease that occurs when the back part of the neural tube does not close is called spina bifida. The defect is noticed at birth by the presence of an external sac in the back or waist area.
Spina bifida cystica (SBS):It is the cystic form of spina bifida. Meningocele, myelomeningocele and myeloschisis There are three types: is.
Meningocele:It is the cystic expansion of the spinal cord membrane. Since there is not much damage to the nerve fibers, there may be no neurological problem. The cyst is covered with skin. Since the nerve fibers are inside the spinal canal, it does not cause a significant paralysis.
Myelomeningocele: Nerve roots and spinal cord, as well as membranes, may be found in the herniated sac. It is the most common type of spina bifida. Paralysis, bladder and bowel problems may occur mainly in the legs.
Myeloschisis: It is the most severe form. Nerve tissue is completely exposed. There is no closure by the spinal cord membrane and skin.
Spina bifida occulta (SBO): There is a bone defect in the back of the spinal cord. The spinal cord and nerves are not affected. Dimples, increased hair growth, or dark discoloration may be observed in the waist area. It usually does not cause any complaints.
Rehabilitation
Early rehabilitation includes bladder and bowel care, prevention of joint limitations, hip dislocation and spinal deformities, orthotics, walking training and wheelchair It covers the use of the newborn.
The family is given training on positioning, holding and transferring the newborn. Joint range of motion exercises are taught. The rehabilitation plan varies depending on the lesion level, the child's developmental age, family support, and accompanying problems such as cognitive problems.
Neurological changes, kidney function disorders, joint diseases, and pressure sores should be checked regularly in adulthood in patients with myelomeningocele. Back, waist, neck and leg pain are common in wheelchair-dependent patients.
Indicators such as the level of lesion, the severity of deformity in the legs, and the age of starting to walk are used as walking indicators. Walking can be achieved with surgery, orthoses, physical therapy and occupational therapies.
Movement is achieved by walking without support or assistance, using a wheelchair or with orthoses and supports.
BRACIAL PLEXUS REHABILITATION
Four cervical nerve roots (C5-C8) and the first dorsal root (T1) originating from the spinal cord in the neck region combine and divide into three large main branches. This structure is the brachial plexus It is called sus. It is located in an area of approximately 15 cm between the lower side of the neck and the armpit. Brachial plexus injury occurs as a result of lesions of the nerve network in this region.
Unilateral nerve damage can usually occur as a result of damage that occurs during birth. Its incidence is 1 in 1000. The main risk factors for brachial plexus injury in newborns are large birth, breech presentation, and multiple pregnancy. It often occurs as a result of stretching, tearing or rupture of the nerve roots of the plexus body due to pulling during birth. If there is no root avulsion, healing is generally expected to be good. However, in 25-30% of patients, the damage may be permanent.
Nerve injury can be diagnosed with the patient's clinical findings and radiologically with high-resolution MRI imaging technique. EMG is a very valuable diagnostic method to understand nerve and muscle damage. It should be applied three weeks after the injuries. It provides information about the localization and degree of injury.
Rehabilitation should start from the first days. The family should be shown the positioning of the affected arm and joint range of motion exercises.
Involvement of the upper nerve roots is called Erb-Duchenne type paralysis and is the most common type. Babies with this type of injury cannot move their arms and have difficulty extending and rotating their arms.
Lower nerve root involvement is called Klumpke's palsy. Isolated injury is rare. In the classical painting, arm, shoulder and elbow movements are good. However, claw deformity is observed in the hand. As a result of this type of damage, weakness occurs in the hand and wrist, but shoulder and arm movements are generally preserved.
The baby should be positioned appropriately while sleeping. Joint range of motion exercises should not cause pain and should be done gently. Splints are used to prevent or correct joint restrictions. Electrical stimulation is not generally used in newborns. It should be used at older ages if it can be tolerated.
TRAUMATIC BRAIN INJURY REHABILITATION
Traumatic brain injury causes impairment in physical, cognitive and psychosocial functions. It is defined as a characterized injury. Traumatic brain injury motor vehicles It has increased considerably today due to its more widespread use, increased life expectancy and falls.
The primary damage in traumatic brain injury is injury to the nerves due to damage to the brain tissue. Secondary damage develops due to damage to the brain tissue due to reasons such as low blood pressure, insufficient oxygenation of the brain tissue, narrowing of the vessels and widespread edema. The goal of early treatment in traumatic brain injury should be to prevent secondary damage.
It has been proven that the human brain is capable of making changes in nerve cells, connections and functions. This situation is called plasticity. Healing of brain tissue after injury occurs in two main steps. It is the recovery of brain tissues by reorganizing and starting neural transmission. It usually happens in the first six months. The other form of recovery is the formation of new nerve connections thanks to the plastic properties of the brain, which are increased by rehabilitation, and the recovery of the silent areas of the brain, and the recovery is not limited to time.
In patients with traumatic brain injury, permanent cognitive impairments and the impact of inappropriate behaviors on independent living are often It prevents physical disabilities.
The main steps in rehabilitation studies include walking, daily living activities, regulation of behavior, cognitive rehabilitation, psychotherapeutic approaches, treatment of communication and swallowing difficulties, prevention and treatment of complications, integration into society and family education.
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PARKINSON'S DISEASE REHABILITATION
The main symptoms of the disease are tremors at rest, slowness in movements, muscle contraction, freezing, and forward-leaning posture. The disease usually begins after the age of 50. It is twice as common in men as in women. Parkinson's disease develops as a result of the damage to dopamine-producing nerve cells in some parts of the brain. Although the cause of this effect is unknown, genetic factors are held responsible.
One of the most prominent clinical symptoms of the disease is slowness in movements. Slowdown in arm movements accompanying walking, decrease in facial expressions, dullness in facial expression, salivation from the mouth due to inability to swallow saliva. Flowing words, shrinkage of writing, and monotonous speech are observed.
Apart from these, low blood pressure, sweating disorders, constipation and sexual dysfunction may occur. In advanced stages of the disease, dementia may develop. Even in the early stages of the disease, symptoms such as slowing down of thinking, concentration disorders, loss of self-confidence, loss of social motivation, depression and anxiety may occur.
Drug Treatments
Dopamine. Drugs that increase the level of dopamine, drugs that stimulate dopamine receptors and reduce the metabolism of dopamine are used.
Rehabilitation
The main goal of rehabilitation is to maximize functional skills, reduce the side effects of the disease and drug treatments. is to be minimized. In the early and middle stages of the disease, rehabilitation practices should be aimed at preventing immobility and falls, increasing physical capacity, improving body posture and walking, and ensuring balance. In the later stages, training should be aimed at educating caregivers, preventing bedsores, and preventing joint restrictions.
Rehabilitation practices traditionally include occupational therapy, walking and movement exercises, relaxation techniques, speech therapies, breathing and swallowing exercises.
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