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Vision Impairment In Older Adults Essay

1530 words - 7 pages

“B.L. age 17, has a compression fracture at C5 to C6, a result of diving from a bridge into a river and hitting a submerged rock. Fortunately a companion who had first aid training as a lifeguard rescued her and tried to minimize any secondary damage. In the emergency department, B.L. could not move her limbs or sense touch and lacked reflexes in her limbs. […] Surgery was performed to relieve pressure and stabilize the fracture site. […] Several weeks later, routine examination indicated that some spinal cord reflexes were returning in the lower extremities. […] Gradually more reflexes returned. Some muscle tone and movement of the shoulder and upper arm become apparent, but o other ...view middle of the document...

Multiple vertebral pieces may pinch, tear or lacerate nerve fibers, or damage blood vessels. Bleeding is dangerous not only because of the extra pressure on already exposed spinal cord but also because it impairs the transport of nutrients to injured nerve fibers -- thus resulting in more damage (Gould, Dyer, 2010).
Appropriate handling (immobilization) of the injured person is crucial immediately after the trauma to limit the damage and prevent additional harm. Immediate medical intervention (controlling the bleeding, edema and blood flow, removing bone fragments, immobilizing the spine to prevent ischemia and necrosis) may also limit the extent of the trauma and save some functions (surgery performed on B.L. relieving pressure and stabilizing the fracture).
Immediately after the injury it is difficult to adequately assess the extent of the injury. This is because of the conduction of impulses ceases in the cerebral cortex and in the nerve fibers at the side of injury and slightly above it - a situation known in medical world as a “spinal shock”. At this time loss of sensation and movement may affect an area greater of the actual impairment. During the period of spinal shock no reflexes will be observed as all neurologic activity stops (B.L. had initially no sensation and motor control over the limbs and truck). Spinal shock may last a few days to several weeks, but once the inflammation is gone, damaged tissue is removed and the healing process is on its way can a new assessment reveal the limits of sensation in the upper body and limbs; this is the time when permanent damage will be reveled and evaluated (Gould, Dyer, 2010).
If the spinal cord is only partially torn some sensation and motor function may be regained below the side of the injury – this happens because undamaged nerve fibers can still transmit signals, while partially damaged neurons can slowly re-grow their axons, if the cell body is viable and adequate nutrients are available. It is possible that some functions below the site of injury can return, however regaining total control of all body parts is nearly impossible. Most likely some reflexes will return as the effects of the spinal shock cease (spinal cord reflexes and some muscle tone returned to B.L. after the spinal shock ceased several week later). Since voluntary control of urination is not present, many paralyzed patients can develop “neurogenic” (or automatic) bladder , which will contract in response to the pressure that urine puts on the walls of the bladder (micturition reflex). Assessment of the damage should be performed periodically so the patient can fully understand their condition and plan for therapy to regain some of the lost independence and build up self-esteem.
Depending on the location of the trauma, injured person looses sensation and control over certain parts of the body. Specially designed dermatomes – maps illustrating which pairs of spinal nerves control specific areas of the human body...

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