Psychophysiological dysfunctions of temporary loss of working capacity in victims with spine injuries

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Psychophysiological dysfunctions of temporary loss of working capacity in victims with spine injuries

Lukashenko Yuriy Ihorovych Graduate student (postgraduate student) of the Mykhailo Kotsyubynskyi State Pedagogical University, intern physician of physical rehabilitation medicine, Zhmerinka Rehabilitation Hospital, Vinnytsia Regional Council, Zhmerinka

Abstract

The article reveals the psychophysiological dysfunctions of temporary disability of victims with spinal cord injury. Fractures of the spine with damage to the spinal cord and (or) its roots occur with direct application of mechanical force (direct injuries), falling from a height onto the legs or head (catatrauma), excessive bending or extension of the spine (indirect injuries), diving down into the water head, namely their clinical course, and determines the relevance of the researched topic. Most often, this kind of spinal injury occurs in the transitional area from the lumbar to the thoracic vertebrae, where their biochemical characteristics undergo significant changes, which makes them more vulnerable compared to the vertebral elements of the chest or lower back. The diagnosis of spine and spinal cord injury is established based on the anamnesis and the results of clinical and paraclinical examinations. psychophysiological dysfunctions fractures spine

Neurological manifestations give an idea only about the level of damage to the spinal cord, and it is difficult to talk about the degree and nature of damage to the nervous tissue. Neurological disorders are manifested by: motor, sensory, trophic and pelvic disorders, as well as root pain (in the trunk area, the pain is of a girdling nature, and in the limbs - in the affected root along the limb), which are especially strong in partial damage, and not in anatomical interruption.

Sensitivity disorders can be segmental, conductive, root, and sometimes dissociated in the form of anesthesia, hypoesthesia, less often hyperesthesia. In the first hours and days after the injury, sensitivity disorders are usually symmetrical, conduction disorders prevail over all others, which is caused by spinal shock. The presence of radicular pain in the acute period of injury can be caused by compression of the roots by an acute herniation of the intervertebral disc, subarachnoid hemorrhage. The appearance of radicular pain in the late period of injury indicates the development of late complications (arachnoiditis, epiduritis, abscess, osteomyelitis).

Keywords: spinal injuries, psychophysiological dysfunctions, premedical assistance, psychoemotional and social consequences, prevention of complications and rehabilitation.

Лукашенко Юрій Ігорович здобувач вищої освіти (аспірант) Вінницький державний педагогічний університет імені Михайла Коцюбинського, лікар- інтерн фізичної реабілітаційної медицини, КНП «Жмеринська лікарня відновного лікування Вінницької обласної ради», м. Жмеринка

ПСИХОФІЗІОЛОГІЧНІ ДИСФУНКЦІЇ ТИМЧАСОВОЇ ВТРАТИ ПРАЦЕЗДАТНОСТІ ПОТЕРПІЛИХ ІЗ УШКОДЖЕННЯМ ХРЕБТА

Анотація

У статті розкрито психофізіологічні дисфункції тимчасової втрати працездатності потерпілих із ушкодженням хребта. Переломи хребта з ушкодженням спинного мозку та (або) його корінців виникають при безпосередньому застосуванні механічної сили (прямі ушкодження), падінні з висоти на ноги чи голову (кататравма), при надмірному згинанні чи розгинанні хребта (непрямі ушкодження), при пірнанні у воду вниз головою, а саме їх клінічний перебіг й визначає актуальність досліджуваної теми. Найчастіше подібного роду травма хребта зустрічаються на перехідній ділянці від поперекових до грудних хребців, де їх біохімічні характеристики зазнають значних змін, що робить їх уразливішими порівняно з хребетними елементами конкретно грудей чи попереку. Діагноз травми хребта та спинного мозку встановлюється за даними анамнезу та результатами клінічного і параклінічного обстежень.

Неврологічні прояви дають уявлення тільки про рівень пошкодження спинного мозку, а говорити про ступінь і характер пошкодження нервової тканини тяжко. Неврологічні розлади проявляються: руховими, чутливими, трофічними та тазовими розладами, а також корінцевим болем (в ділянці тулуба біль має оперізуючий характер, а на кінцівках - в ураженому корінці вздовж кінцівки), які особливо сильні при частковому пошкодженні, а не при анатомічному перериванні.

Розлади чутливості можуть бути сегментарні, провідникові, корінцеві та деколи десоційовані у вигляді анестезії, гіпестезії, рідше гіперестезії. В перші години та дні після травми розлади чутливості зазвичай симетричні, провідникові розлади переважають над усіма іншими, що зумовлено спінальним шоком. Наявність корінцевого болю в гострому періоді травми може бути зумовлене стисненням корінців гострим випинанням грижі міжхребцевого диска, підпавутинним крововиливом. Поява корінцевого болю в пізній період травми вказує на розвиток пізніх ускладнень (арахноїдит, епідурит, абсцес, остеомієліт).

Ключові слова: травми хребта, психофізіологічні дисфункції, домедична допомога, психоемоційні та соціальні наслідки, профілактика ускладнень та реабілітація.

Formulation of the problem. The risk of injury to the spine and spinal cord as a result of injuries is about 3%, but more than half of patients with this type of injury are <35 years old. Men predominate in the group of victims with spinal injuries (4:1). In 40-50% of cases, this type of injury occurs as a result of traffic accidents (traffic accidents), in second place (approximately 20%) - as a result of falling from a height [2, 3].

Analysis of recent research and publications. Recently, combat spine injury is not a problem of exclusively military surgery. The aggravation of the criminogenic situation in many countries of the world, participation in the political struggle of extremist groups equipped with firearms, terrorist acts using powerful explosive devices force us to consider such trauma one of the important problems of extreme medicine. Spinal injuries can lead to various complications. As a result, the victim will be unable to work for a long period of time [2, 4, 5].

Fractures of the spine with damage to the spinal cord and (or) its roots occur with direct application of mechanical force (direct injuries), falling from a height onto the legs or head (catatrauma), excessive bending or extension of the spine (indirect injuries), diving down into the water head, namely their clinical course, and determines the relevance of the researched topic.

The purpose of the article is to substantiate the psychophysiological dysfunctions of temporary incapacity for work in victims with spinal cord injury.

Presenting main material. In the Law of Ukraine "Basics of the Legislation of Ukraine on Health Care" and other normative legal acts in the field of health care, the term "spinal injury" is used in such a sense as the presence of signs of a spinal cord injury, including signs of spinal cord damage, regardless of the mechanism of injury. Signs of a spinal cord injury include: severe pain or a feeling of pressure in the head, neck, or back; tingling or loss of sensation in the fingers and toes; loss of motor functions of limbs; loss of sensitivity in certain parts of the body; deformation in the spine; bruises, wounds in the region of the spine [5].

Table 1

Classification of causes and symptoms according to the mechanism

of spinal cord injury

Victims with a spinal cord injury are characterized by significant psychoemotional and social consequences. A spinal injury can completely change the entire life of the affected person for the worse. In addition to the fact that adequate social adaptation is especially important, which can often be provided only by a specialized rehabilitation center such as 4].

It should be noted that the cervical spine, due to the most mobile joints, is most often prone to dislocations due to its structure. Massive lumbar and thoracic vertebrae often break or combine a fracture with a dislocation. Most often, this kind of spinal injury occurs in the transitional area from the lumbar to the thoracic vertebrae, where their biochemical characteristics undergo significant changes, which makes them more vulnerable compared to the vertebral elements of the chest or lower back. The mechanism of injury to the spine in the thoracic and lumbar regions significantly affects their classification [4, 5]:

With vertical compression and disruption of the vertebral bodies, a type A spinal injury occurs, which is possible with a strong compression effect.

Damage to ligaments, joints, vertebral processes, arches, and legs under the action of strong extension, bending, and stretching form the category of spine injuries of type B.

Spinal rotation injuries of type C are the most severe injuries that occur with stretching, twisting, and pressure at the same time. In such a situation, the segment

consisting of two vertebrae and the intervertebral disc located between them is mainly disrupted.

The diagnosis of spine and spinal cord injury is established based on the anamnesis and the results of clinical and paraclinical examinations. During the examination of the injured person, information about the circumstances of the injury should be obtained, which allows to assess the nature of the damage. The rate of development of neurological disorders is important. With a rapid loss of muscle strength and sensitivity, the prospects for recovery are less favorable than with their slow increase, which reflects progressive compression of the spinal cord with the need for urgent surgical intervention [1, 2, 5].

Before the clinical examination, the patient should be undressed with great care to avoid any movement of the spine. At the same time, clothes cannot be removed over the head, but must be cut. A quick and methodical examination of all organs and systems aims to reveal not only the level and degree of damage to the spinal cord, but also accompanying damage. Immediately after the injury, severe pain, difficulty breathing (in case of a fracture of the thoracic vertebrae), pain in the abdomen (in case of damage to the lumbar vertebrae), local pain intensifies during palpation of spinous processes is noticed. With fractures in the lumbar region of the spine, the symptom of "sticky heel" may be observed. With fractures of the cervical vertebrae, there is a forced position of the head, tension of the neck muscles, sharp pain during head movements [1, 4].

The neurological examination should determine the level of disorder (loss) of sensitivity and active movements, as well as the presence and nature of pelvic disorders. Preservation of at least minimal ability to make voluntary movements may indicate a favorable prognosis. All types of sensitivity (tactile, pain, temperature, proprioceptive) are consistently checked, and a scrupulous search is made for "islands" of residual sensitivity, which has a favorable prognostic value. The level of damage to the spinal cord is more reliably indicated by motor disorders than by sensory disorders. In the acute period, flaccid paralysis is registered, in later periods - spasticity. The presence of pathological Babinski reflexes indicates damage to the pyramidal tract or simultaneous injury to the spinal cord and brain [2, 3].

Neurological manifestations give an idea only about the level of damage to the spinal cord, and it is difficult to talk about the degree and nature of damage to the nervous tissue. Neurological disorders are manifested by: motor, sensory, trophic and pelvic disorders, as well as root pain (in the trunk area, the pain is of a girdling nature, and in the limbs - in the affected root along the limb), which are especially strong with partial damage, and not with anatomical interruption [ 4, 5].

Sensitivity disorders can be segmental, conductive, root, and sometimes dissociated in the form of anesthesia, hypoesthesia, less often hyperesthesia. In the first hours and days after the injury, sensitivity disorders are usually symmetrical, conduction disorders prevail over all others, which is caused by spinal shock. The presence of radicular pain in the acute period of injury can be caused by compression

of the roots by an acute herniation of the intervertebral disc, subarachnoid hemorrhage. The appearance of radicular pain in the late period of injury indicates the development of late complications (arachnoiditis, epiduritis, abscess, osteomyelitis).

The mechanism of providing pre-medical care to victims of suspected spinal cord injury by persons who do not have a medical education, but according to their official duties must provide pre-medical care, determines the following sequence of actions [5] (Table 2).

Table 2

The sequence of actions in the provision of first aid to victims of suspected spinal cord injury

№П/П SEQUENCE OF ACTIONS

Transfer all received information to the specialists of the emergency (ambulance) medical assistance team or the dispatcher of the emergency medical assistance service.

The degree of damage to the spinal cord can be accompanied by a short-term disturbance of conduction up to persistent permanent paralysis based on a complete anatomical rupture of the spinal cord. Here, the phenomena of spinal shock come to the fore, the basis of which are the phenomena of mild inhibition or the parabiotic state. Only from these positions, the main mechanisms of reversible traumatic changes in the spinal cord, which are the main factors of "recovery", should be considered.

Recovery after spinal trauma can last quite a long period of time, when the nerves of the patient, as well as those around him, are on edge. Cognitive-behavioral therapy and counseling by a qualified psychologist, neurologist, and the help that a chiropractor can provide are important. Physiotherapy and exercise therapy (physical therapy) can play a crucial role in the recovery process. Depression, apathy, and frustration can develop into dementia if the injured person is a person with special needs who has reached a respectable age. It is impossible to neglect any method that modern rehabilitation practice has, which successfully combines drug treatment with psychological programs for recovery after a spinal cord injury.

Restoration of neurological functions will be in the case of incomplete damage to the spinal cord, when decompression is carried out early and is combined with local hypothermia and intravenous administration of corticosteroids. With a complete anatomical rupture of the brain, the operation does not bring improvement. However, stabilization of the spine is justified because it improves the prevention of complications and improves rehabilitation.

Conclusion

Thus, spinal cord injury is characterized by the instability of the injury, which is caused by a violation of the anatomical integrity of the vertebrae, discs, joints, and ligaments, in which repeated displacement of the vertebrae with additional compression of the spinal cord and roots is possible. Unstable injuries of the spine include multifragmentary (explosive) fractures, rotational injuries, vertebral dislocations, fractures and dislocations of articular processes, ruptures of intervertebral discs and their combination with damage to the vertebral bodies. All victims with spinal instability need medical stabilization (with the help of corsets, splints, ties, using surgical methods).

The main list of psychophysiological dysfunctions includes: temporary loss of physiological function (nerve conduction after minor injury); anatomical changes (mainly from the side of myelin sheaths); clinically, mainly movement disorders are observed, from the sensitivity side, paresthesias are first of all noted; vegetative disorders are absent or not expressed. The instability of the spinal cord injury is characterized by recovery that occurs within a few days. This form corresponds to a concussion of a nerve.

Complete disruption of the nerve or severe damage due to the severity of the condition, characterized by the rupture of individual trunks, as a result of which regeneration of the spine is impossible without surgical intervention.

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Наказ Міністерства охорони здоров'я України 09 березня 2022 року № 441 «Порядок надання домедичної допомоги постраждалим при підозрі на пошкодження хребта». URL: http://surl.li/pjkko

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