boses (DVTs) are blood clots that form deep within the veins, usually in the legs and thighs, and result from slowed or halted blood flow (venous stasis) in immobilized individuals with spinal cord injuries. The most feared complication of DVT is pulmonary embolism, which can bring sudden death. Pulmonary embolism occurs when a blood clot within a deep vein dislodges and travels to the pulmonary artery, where it obstructs the passage of oxygenated blood to the rest of the body. Widespread adoption of preventive regimens in the early 1990s decreased the incidence of DVT in individuals with spinal cord injuries in acute care or rehabilitation from 14 to 9.8 percent and the incidence of pulmonary embolism from nearly 4 to 2.6 percent (Chen et al., 1999).

Today, the incidences of both DVTs and pulmonary embolism have declined because of greater awareness of the conditions and several controlled clinical trials that found that combination strategies are effective in preventing DVT and pulmonary embolism. A panel rating the quality of evidence found several treatment modalities that warranted designation as a standard of care because they had been found to be effective in controlled clinical trials (AANS/CNS, 2002b). The standards for preventing DVT call for prophylactic treatment with low-molecular-weight heparins (an anticoagulant) or adjusted-dose heparin, the use of rotating beds, or a combination of these modalities. Low-dose heparin, in combination with compression stockings or electrical stimulation, is also recommended as a standard of care. High doses of heparin have been found to lead to higher incidence of bleeding. Several other preventive treatments were also listed as options for care (AANS/CNS, 2002c).

Bladder Dysfunction

Bladder dysfunction affects virtually all individuals with spinal cord injuries (see Chapter 2). Its treatment depends on the site and the type of injury, including the extent of sacral injury. Three types of bladder problems are common after a spinal cord injury. The first, flaccid bladder, results from injury to the sacral cord, which controls reflexive contraction of the bladder. The injury leaves the bladder’s detrusor muscle incapable of being contracted and thus causes urine to back up in the kidneys. The treatment is intermittent catheterization, in which a tube is inserted into the bladder to permit passive drainage at regularly scheduled intervals to prevent urine from overfilling the bladder. Bladder overfill causes damage to the bladder wall and heightens the risk of infection (Burns et al., 2001). In order to reduce the incidence of urinary tract infections, intermittent catheterization should be performed by the patient (Cardenas and Mayo, 1987).

The other two types of dysfunction are detrusor hyperreflexia and detrusor-sphincter dyssynergia. The goal of treating detrusor hyperreflexia

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