Presentations
- Acquired spinal cord dysfunction
Conditions
- Non-traumatic acquired spinal cord dysfunction with causes, such as:
- autoimmune
- infectious
- inflammatory
- neoplastic
- vascular
- Traumatic spinal cord injury (SCI)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Ventilator-dependent tetraplegia
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomy of the spinal cord and column, including:
- blood supply and topography of motor
- motor and sensory levels, with corresponding myotomes and dermatomes
- sensory and autonomic pathways within the spinal cord
- Autonomic dysfunction, including autonomic dysreflexia:
- management
- pathophysiology
- symptoms and signs
- Factors influencing outcomes after SCI
- Level and severity of injury:
- expected functional independence
- International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) classification
- Pathophysiology of SCI, including:
- incomplete spinal cord injury syndromes
- mechanisms of SCI, including spinal cord injury without radiological signs (SCIWORA)
- Spinal shock
- Physiology of the spinal cord, including effects on:
- bladder function
- bowel function
- cardiac function
- respiratory function
- sexual function
- Skin integrity and pressure injuries
Clinical assessment tools
- ISNCSCI
- Musculoskeletal assessment
- Neurologic exam
Investigations
- Diagnostic medical imaging, such as:
- Investigation for sequelae, such as:
- bone densitometry
- polysomnography
- urodynamics
- Investigation for surveillance following spinal cord injury, such as kidney ultrasound
Procedures
- Bladder management strategies, such as:
- clean intermittent catheters
- indwelling catheter
- Mitrofanoff procedure
- suprapubic catheter
- vesicostomy
- Bowel management strategies, such as:
- Spasticity management
- Surgical management for stabilisation after spinal cord injury
- Prevention strategies for traumatic spinal cord injury
Acute management
- Acute pressure care
- Bladder management
- Deep vein thrombosis (DVT) / Pulmonary embolism (PE) prophylaxis
- Gastrointestinal dysfunction
- Haemodynamics, including blood pressure
- Neuroprotection strategies
- Respiratory insufficiency, including:
- indications for mechanical ventilation and basic principles of noninvasive positive pressure ventilation and respiratory function in tetraplegia
- indications for mechanical ventilation
- Spinal shock
- Thermoregulation
Bladder and bowel management
- Neurogenic bladder:
- assessment of bladder function
- monitoring for kidney complications of bladder dysfunction
- types of bladder dysfunction
- Neurogenic bladder interventions, such as:
- bladder emptying, including clean intermittent catheterisation
- pharmacological management of neurogenic bladder
- surgical interventions, such as:
- electrical nerve stimulators
- external sphincterotomy
- suprapubic catheter
- vesicostomy
- Neurogenic bowel:
- bowel management programs
- dietary management
- pharmacological management
Community reintegration
- Adaptive techniques and assistive devices for activities for daily living (ADLs)
- Available funding supports
- Carer training
- Community support services
- Disability support options
- Driving:
- assessment
- modification
- training
- Housing, including:
- environmental controls
- equipment
- home modifications
- Leisure and sports activities
- Mobility
- Peer support organisations
- Return to education
- Technology for:
- environmental control
- recreation
- vocation
- Vocational rehabilitation
Long-term monitoring
- ADLs and equipment
- Bladder management and kidney surveillance
- Bone health and fracture prevention
- Growth and nutrition
- Musculoskeletal surveillance of contracture, hips, and spine
- Psychosocial support
- Puberty and menarche management
- Recreation and leisure
- Respiratory and sleep health
- School and vocation
- Sexuality and reproductive health
- Skin integrity
Management of common complications
- Autonomic dysfunction, such as:
- autonomic dysreflexia
- impaired temperature control
- orthostatic hypotension
- Heterotopic ossification
- Pain
- Respiratory insufficiency
- Skin integrity and pressure issues
- Spasticity and contractures
- Spinal deformity
- Syrinx
- Venous thromboembolism
