AD
Increased systolic BP by 40 mmHg or more above baseline (>150 mmHg)
Autonomic dysreflexia
Main s/s of autonomic dysreflexia
Severe headache
What will the patient look like once they have been relieved of AD
Patient will relax, stop sweating, HA will disappear and patient will be exhausted
Neural tube did not close entirely, meninges and nervous tissue protrude through defect
SB with myeloschisis
motor: strong trunk, no LE movement
bracing: HKAFO's, sometimes with thoracic corset
function: sliding board transfers, good sitting balance, therapeutic ambulation, independent wheelchair mobility
T12
In autonomic dysreflexia, ________ response occurs above the NLI
Parasympathetic (bradycardia and vasodilation)
Can begin anytime within the first year; always after spinal shock clears; triggers sympathetic reflex to the intermediolateral grey columns; lack of compensatory descending medullary parasympathetic response (vagal N); generalized vasoconstriction occurs
Autonomic dysreflexia
Critical motor function: No LE movement
bracing: standing brace or equipment
Function: supported sitting
< T10
Least severe; typically L5-S1; meninges do not protrude through the defect; tuft of hair or dimple in the back
SB occulta
Neural tube disorder; vitamin deficiency, genetics, teratogens; failure of the vertebral arches to fuse in midline
Spina bifida
In autonomic dysreflexia, ________ response continues below the NLI
Sympathetic
What to do first during autonomic dysreflexia
SIT THE PATIENT UP
motor: quadriceps, medial hamstrings, anterior tibialis
bracing: KAFOs, crutches, floor reaction, AFOs twister cables
function: household and short community ambulation, wheelchair long distances
L3-L4
Meninges and SC protrude through the defect
SB with myelomeningocele
motor: unopposed hip flexion, some adduction
bracing: standing brace or equipment; HKAFOs, KAFOs or RGOs; crutches once ambulating with walker
function: household ambulation; may community ambulate if motivated
L1-L2
Autonomic dysreflexia happens at which spinal level
T6 and above
After sitting the patient up during AD, what are the next steps
1. sit the patient up
2. remove restrictive clothing
3. find the trigger
4. if it doesn't clear, call 911
motor: lateral hamstring, peroneals
bracing: usually no AFOs or upper limb support
function: community ambulation
S1
Meninges protrude through the defect, typically lumbar (dont necessarily have neurological tissue coming out)
SB cystica/meningocele
motor: weak toe activity
bracing: KAFOs, crutches, floor reaction, AFOs
function: household and short community ambulation, wheelchair for long distances
L5
The two major players in autonomic dysreflexia
1. T6 and above
2. Noxious stimulus below the NLI
What can happen if autonomic dysreflexia does not clear
Can lead to stroke, death
motor: mild intrinsic foot weakness
bracing: possible crutch or cane with increased age
function: community ambulation
S2-3
Common comorbidity with spina bifida
Hip dislocation
Other systems involved with spina bifida
Respiratory, integumentary, musculoskeletal