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Care Professionals Newsletter - Autumn 2009

Welcome to the Autumn 2009 Edition of our Care Professionals Newsletter

In this newsletter we have information and articles on the following:

• Autonomic Dysreflexia: The Key Facts
• In Control! Are you serious?
• The Shada Conference on Disability
• Meet Two More of our Care Service Managers

Autonomic Dysreflexia: The Key Facts

What is it?

Autonomic Dysreflexia basically means over-activity of the autonomic nervous system. It occurs in some people with a high spinal injury and is an abnormal response to a physical problem below the spinal cord injury (SCI). It usually occurs in those who have been spinal cord injured above T6, but it has been reported in those injured lower down the spinal cord as far as T10 or in other non-SCI neurological conditions, however this is extremely rare. If Autonomic Dysreflexia does not receive immediate and decisive intervention, it can lead to unconsciousness, a stroke, abnormal heart rhythms, heart attack and even death.

Understanding Autonomic Dysreflexia is a key part of any SCI rehabilitation programme, but if the individual has never experienced it, it is easy for spinal cord injured people to forget what was taught in the Spinal Centre. Equally, within the protective environment of the Spinal Centre, many of the causes of Autonomic Dysreflexia would be prevented from escalating e.g pressure sore, constipation.

The first episode of Autonomic Dysreflexia generally occurs within four to six months after a spinal injury, however it may occur as early as two months or as late as 12 years after the initial injury.

What are the symptoms?

Symptoms vary from person to person, but the significant rise in blood pressure (e.g 200/100 mmHG) produces a severe pounding headache in most people. Other common symptoms are:

• Profuse sweating or flushed, reddened skin, usually above the level of SCI.
• Pallor below the level of SCI.
• Goose bumps.
• Blurry vision or seeing spots.
• A feeling of tightness in your chest.
• Sense of apprehension or anxiety.
• Slow heart beat.

Why does it occur?

Autonomic Dysreflexia generally occurs as a result of a 'noxious' (harmful) stimuli, bladder and catheter problems are the most common cause. Constipation, skin abrasions, cuts and bruises, pressure sores and ingrown toenails, sexual activity, abdominal conditions (such as colitis and gastric ulcer), pregnancy and labour as well as many other events and conditions can lead to Autonomic Dysreflexia.

What happens is that the spinal cord tries to send the pain message to the brain, but the SCI blocks the messages from getting through. These messages to the spinal cord result in the autonomic nerves making the blood vessels in the legs and abdomen constrict. Blood is thus squeezed out into the veins, arteries and capillaries in the rest of the body making the blood pressure rise rapidly. The brain sensing the high blood pressure, slows the head down, enlarging the blood vessels in the face, neck and chest making the affected person look red and blotchy. The signals from the brain which should make the blood vessels in the legs stop constricting are blocked by the SCI and do not get through.

Action to take

Autonomic Dysreflexia is a medical emergency and should be treated as such. Those who have previously experienced an episode will probably recognise the onset of symptoms and know what the likely causes are. However, if one of your spinal injured patients starts developing the symptoms described earlier in this article, especially a severe pounding headache, it is worth considering whether it could be the onset of Autonomic Dysreflexia. They should check whether their catheter is draining, make sure no trauma has occurred to the skin below the SCI and that pressure sores are intact. Constipation is another common cause.

These are the steps that the individual should take when they encounter the onset of Autonomic Dysreflexia symptoms.

• Try and identify what the cause of the Autonomic Dysreflexia might be. Alleviating the root of the problem may be enough to cause it to subside.
• Sit up (unless your abdomen or bladder are distended (swollen) e.g. blocked catheter, or abdominal pressure would increase).
• Loosen any restrictive clothing, splintage or straps.
• Decide whether to take Autonomic Dysreflexia medication, if it has been prescribed.
• If the symptoms persist, seek emergency medical advice by calling 999.

Prevention of Autonomic Dyreflexia

As the saying goes, prevention is better than cure. Good bowel, bladder and pressure area management will go a long way to preventing Autonomic Dysreflexia from occurring in the first place. A well balanced diet and good fluid intake are key. Wearing comfortable clothes and footwear and avoiding long periods of exposure to the sun are also important.

Remember that the average blood pressure in someone who is spinal injured is 90/60mmHg. Medical and nursing staff may not realise that a blood pressure of 120/80 mmHg is actually high for this patient group.

Most spinal cord injured people who have experienced Autonomic Dysreflexia are discharged home with Nifedpine or GTN, and they should always have a supply to hand when away from home. The bottle or box should be checked regularly to be sure it has not expired.

As so many doctors and nurses have little or no experience of spinal injury and especially Autonomicc Dysreflexia, it is essential that the spinal injured individual can explain what Autonomic Dysreflexia is and how dangerous it can be if left untreated. SIA issue a free medical emergency card which can be completed with relevant contact details and stored in a wallet. The card outlines the most important points of SCI care such as bladder and bowel management and pressure area care as well as explaining what Autonomic Dysreflexia is.

Zoe Jones, Care Service Manager

The Shada Conference on Disability: Sex, Relationships and Pleasure

This conference will be held at the Royal Society of Medicine in London on Friday 13th November 2009. The conference has been designed to recognise how very difficult it is for many health professionals to handle sexual issues with disabled people and it offers ways to overcome these difficulties.

What will you gain from the conference?

• A new model to enable professionals to engage comfortably with disabled peopled on sexual issues.
• Legal advice on the use of sex workers with disabled clients and residents, as well as on many other sticky issues.
• Guidance on policy making.
• Disabled people speaking openly about their experiences, what they are doing to help themselves and what could be improved.
• Sex workers discussing their work with disabled clients.

The conference is aimed at practitioners in primary and secondary care: medical practitioners and nurses, targeting those who treat the most needy groups, e.g orthopaedic surgeons, those who deal with deaf, blind and deaf-blind adults, those caring for people with acute profound injuries and the young chronic sick, occupational therapists, physiotherapists, sex educators and sex therapists, social care workers, council disability officers, GUM clinic staff and charities such as the Brook Advisory Service, YouthNet and the fpa.

To register for the conference please go to http://www.shada.org.uk/?q=node/14 and a link from here will take you directly to the registration page.

Claire Lewis, Care Service Manager

Meet Two More of our Care Service Managers

Sandy joined Active Assistance on 20 July 2009 as our Care Service Manager for the London & Home Counties Region.

Originally from Germany, Sandy has worked in a variety of settings since qualifiying as a Physiotherapist in 2000. Over the last 9 years Sandy has gained a lot of experience in neurological rehabilitation and complex neuro-disability and has a special interest and expertise in Spinal Cord injury. Sandy has experience in general neurological rehabilitation, stroke rehabilitation and out-reach services, traumatic brain injuries rehabilitation, as well as musculo-skeletal, respiratory and trauma management. From 2006 until 2009 Sandy worked as a Senior Physiotherapist at the Royal National Orthopaedic Hospital in Stanmore, in Pain Management and the Spinal Cord Injuries Centre. During her time in the SCIC, Sandy had played a pivotal role in organising the team for the Inter Spinal Unit Games for 2007 and 2008 and set up a regular Archery programme at the SCIC. Sandy has been a pro-active member of the MDT in the SCIC and through this she has gained experience in discharge planning and facilitation of the transition of clients back into the community.

When not at work, Sandy has been a 'buddy' for the Back-Up trust and helps to organise skiing trips for people with Spinal Cord injury.