Postop
- Hospital Care
3-5
days
Feeding,
Analgesics,IV Antibiotics x 48 hours,
Bed Rest ~ 2 - 3 days, ? Abdominal binder.
Watch for low pressure headache when upright (intracranial hypotension).
Check Abdominal and Back sutures and wound for signs of leakage
or infection. Increase the ITB dose after 36 hours, increase by
10 - 20% maximum, increase daily until perceptibly looser and
satisfied.
Determine time of first refill - DOUBLE CHECK RESERVOIR, CONCENTRATION
AND RATE (per hour & per day).
Mobilize,
Physical Therapy assessments, Home Care evaluation & discharge
planning, assess need for post implant therapy and other needs,
Social Service input.
PT
evaluation post implant: Acute stay approximately 5 days
- Tone
assessment
- Spasm
assessment
- ROM
- Strength,
Coordination , Reflexes, Sensation
- Bed
Mobility
- Transfers
- Balance
- Gait
- Safety
- Orthosis
- Seating
System
- Skin
Integrity
- Adaptive
Equipment Required - or modification of equipment already utilized
Rehabilitation
Post Implant
- Continue
to dialogue with physician as per orders & clinical findings.
- Patient
lies flat for 2-3 days to minimize nausea, vomiting & spinal
headaches.
- Avoid
trunk movement beyond 45 degrees for the first 4 weeks in all
planes of motion to avoid catheter dislodgment and flipping pump.
- Avoid
heat producing modalities (hot packs & diathermy) in the
immediate are of the pump.
- Advise
patient & caregiver of the patients percieved change in “center
of gravity”.
- Alter
strategies for transfers, gait, etc.
- Recognize
symptoms of baclofen overdose - contact physician immediately;
ongoing educate the patient and family-caregiver to this as well.
Dose
adjustments are an ongoing process, with more frequent adjustments
in the first few months post implant to reduce spasms without
making the patient flaccid. Communication is important between
the physician & the physical therapist. The patient must be
able to adapt to each change in prescription.
Post
Acute Rehabilitation Concerns:
- Treatment
plan depends on individual goals.
- Inpatient
Rehabilitation - potential to achieve goals in 4-6 weeks.
- Home
Care / Outpatient Rehabilitation - long term goals may require
several months to achieve.
- Seating
system - maintain posture, maintain skin integrity, reassess
need for support & balance.
- Orthosis
- splints & braces need to be re-evaluated.
- Adaptive
Equipment - may require more or less support; reassess.
- Monitor
dosage and maintain open line of communication with physician.
Setting
Goals Post Implant:
- Improve
ease of care & comfort
- Improve
function
- Prevent
deformity
- Clarify
expectations
- Realistic
for patient
- Commitment
- Document
Change
