Organ System Disorders and Medical Complications: Anticipate and Prevent
Anticipate the complication before it happens
Rehabilitation of organ system disorders is largely prevention and early recognition. Venous thromboembolism: risk-stratify, use mechanical plus pharmacologic prophylaxis when safe, and treat unilateral leg swelling in an immobilized patient as DVT until proven otherwise. Heterotopic ossification presents later with reduced range of motion, warmth, and elevated alkaline phosphatase; a triple-phase bone scan turns positive before plain films, but DVT must be excluded first. Pressure injuries are staged by depth: stage 1 nonblanchable erythema, stage 2 partial-thickness loss, stage 3 full-thickness loss without exposed fascia, stage 4 exposed bone, tendon, or muscle; unstageable means eschar obscures depth, and deep tissue injury is intact skin with purple discoloration.
Neurogenic bladder: upper motor neuron lesions cause detrusor overactivity with risk of high storage pressures and renal damage, so urodynamics guides management; lower motor neuron lesions cause an areflexic bladder best managed with intermittent catheterization. Bowel programs rely on scheduled evacuation, fluid, and fiber. Autonomic dysreflexia occurs with lesions at T6 or above - hypertension, pounding headache, flushing, bradycardia - and the first steps are sitting the patient upright and removing the noxious stimulus (bladder, bowel, skin). Dysphagia after stroke warrants a swallow evaluation before oral intake to prevent aspiration pneumonia. Cardiac rehabilitation questions turn on MET levels, exercise prescription, and monitoring.
Worked example
A C5 tetraplegic patient develops a pounding headache with BP 190/110. Sit him up, loosen clothing, and check catheter and bowel first; treat pharmacologically only if the stimulus does not resolve it.
Rule of thumb
In spinal cord injury at T6 or above, headache plus hypertension equals autonomic dysreflexia until proven otherwise.