HPG5016 Musculoskeletal

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HPG5016 Musculoskeletal Neurological
Physiology for Rehabilitation

• Catherine Carracher
• Exercise Physiologist
• Victorian Rehabilitation Centre
• 2nd June 2003

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Trauma Multi-trauma

• - Speaker Background
• - Trauma What is it?
• - What care is required?
• - Injuries
• - Slide presentation
• - Discussion

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Trauma What is it?

• 1 Physical Injury caused by a violent or
  disruptive action or by the introduction into the
  body of a toxic substance
• 2 Psychic injury resulting from a severe
  emotional shock
• a)A narrow escape or exposure to death (thinking
  you might die, surviving a fatal accident,
  witnessing the death of another)

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• b) Being severely injured (sustaining an injury,
  become disabled/disfigured from injury)
• c) Traumatic loss (death of a loved one)
• Recovery is influenced by
• i) Nature, degree and duration of trauma
• ii) Type of involvement
• iii) Individual characteristics
• iv) Pre trauma stresses
• v) Availability of support.

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Treatment Location Modality

• What care is available
• Hospital (acute or rehab) Public/private as
  in/outpatient depends on geographical area of
  accident, severity of injury, residential address
• Local Services usually 1 or 2 services only

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Victorian Rehabilitation Centre Eastern
Melbourne

• Geographics
• 55 Inpatient Beds (high dependancy nursing)
• 5 Independent Living Units
• ?? Outpatients

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• Areas of Specialty
• Orthopaedics
• Neurology
• Child Adolescent
• WorkCover Early Intervention
• Respiratory
• Pain
• Inpatient/Outpatient Services
• Treatment Areas
• Individual group treatment areas eg physio,
  gymnasium, hydrotherapy, trades areas

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Physical Trauma - Pathology

• Examples of incidents
• i) Transport
• - driver or passenger (car/ truck/ bus/
  motorbike/ tram) - pedestrian - cyclist
• ii) Work
• - vehicle - machinery operation
• - falls - impacts

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Compensible Vs Non Compensible

• Compensible
• TAC WorkCover (Insurance) all medical
  costs covered and may be entitled to loss of
  earnings assistance
• Non-Compensible
• Private or Public Hospitals/Private Practice
  costs are personal

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Types of Injuries

• Fractures
• Ruptured/torn vessels /or organs
• Brain Injury
• Severed limb/s
• Soft tissue injuries (muscle ligament
  tears/sprains/ruptures)
• Spinal Cord Injury
• Joint Dislocation/ subluxation
• Nerve/s damage (severed/crushed/trapped)

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Pathophysiology of traumatic injury

• Hypoxia - Paresis
• Amputation - Paralysis
• PTA (post traumatic amnesia)
• Ataxia - Loss of function
• Tonus eg spacticity - Tracheostomy
• Craniotomy - Haemorrhaging
• Muscle/skin Graft - ABI
• Etc

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Complications in trauma recovery

• Infection (eg MRSA) - Edema
• Non/slow fracture union - Ischemia
• PTA - Pressure Sores
• Increased/decreased tone - Blood loss
• Weight, strength fitness loss
• CSF leak - No. of injuries
• Necrosis - Compartment syndrome
• Ossification - Etc..

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Fractures

• Caused by a sudden excessive force (crushing,
  bending, twisting, or pulling)
• i) Direct - bone breaks at the point of impact
• ii) Indirect - bone breaks at a distance from
  where the force is applied

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Fracture Types

• Complete the bone is completely broke into two
  or more fragments
• Transverse remains in place
• Oblique or spiral
• Impacted fragments are jammed together
• Comminuted unstable often more than two
  pieces

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• Incomplete bone is incompletely divided and the
  periosteum remains in continuity
• Greenstick the bone is buckled or bent
• Compression cancellous bone is crumpled eg
  vertebrae

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Fracture Management

• POP plaster of Paris
• Traction
• Internal Fixation holds a fracture firmly in
  place so that movements can begin at once
• Bone fragments are fixed with screws/ pins/
  metal plate

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• iv) External fixation fracture is held by
  screws/wires which pass through the bone above
  and below fracture and are attached to an
  external frame.
• Useful for fractures assoc with nerve or
  vessel damage, unstable fractures, pelvic
  fractures with assoc wound/s or graft/s un-united
  fractures which can be excised, compressed or
  elongated

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• Slide Presentation

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• Questions