Secondary complications are a major health issue for people living with brain and spinal cord injury. Secondary conditions are negative health outcomes that occur as a direct result of a disability. The most common secondary conditions for these patients are pressure sores, respiratory complications, urinary tract infections, spasticity and neuropathic pain.
Today, Angela Beninga, D.O., a staff physiatrist in Shepherd Center’s Multispecialty Clinic and the director of Shepherd Center’s Spinal Cord Injury Day Program, joins us to discuss diagnosis and treatment for common complications post-discharge.
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Common Complications After Discharge from Rehabilitation for Brain and Spinal Cord Injury
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Learn more about Angela Beninga, D.O
Angela Beninga, DO
Angela Beninga, D.O., joined Shepherd Center’s medical staff in 2012. She came to Shepherd from the University of Cincinnati’s Drake Center, where she served as director of spinal cord injury medicine and as an assistant professor. Dr. Beninga earned her medical degree from the Kansas City University of Medicine and Biosciences. She completed her internship at Ingham Regional Medical Center in Lansing, Michigan, and then completed a residency in physical medicine and rehabilitation at Michigan State University and a spinal cord injury rehabilitation fellowship at the University of Michigan.Learn more about Angela Beninga, D.O
Transcription:
Common Complications After Discharge from Rehabilitation for Brain and Spinal Cord Injury
Melanie Cole (Host): Secondary complications are a major health issue for people living with brain and spinal cord injury. My guest today is Dr. Angela Beninga. She’s a Staff Physiatrist at Shepherd Center’s Multispecialty Clinic and the Director of Shepherd Center’s Spinal Cord Injury Day Program. Welcome to the show, Dr. Beninga. Tell us, what do you see as the most common secondary complications that happen with people post discharge?
Dr. Angela Beninga (Guest): It usually depends on what type of injury they’ve had but a lot of times pain is probably the most common issue or complication we see or at least the most common issue that a patient is coming to clinic and having complaints about.
Melanie: So, are these things that you would notice or are these things that a home caregiver would notice?
Dr. Beninga: Both, I guess, probably is the best way to answer that. A lot of times either the patient will come in with those complaints or their caregiver is having difficulty managing the patient at home because of spasticity or pain. There are things that they’re not able to do that they wish they could do more of or do better with because of some of these secondary complications and symptoms. Sometimes, it’s things that just me having a conversation with the patient in clinic, being able to see that they’re having pain or having difficulties with. Sometimes it’s something that I bring up and maybe they’ve just gotten used to it and didn’t know to ask that question. So, it can come or be brought up in clinic in a lot of different ways.
Melanie: How can you help them with these negative health outcomes that can occur as a direct result of a disability? Then, what can you tell them about dealing with some of these secondary complications?
Dr. Beninga: It really depends on what the complications are. If it’s a skin issue, a lot of times it’s going to take a while for that to heal. So, there are certain medications, positioning, equipment--things like that that can help that skin heal better. Neuropathic pain can be helped with medication, different positioning. With urinary tract infections, we talk about different techniques to use to help to minimize the risk of an infection and things to do if they start to notice maybe that they’re getting an infection, like increasing their fluid intake, taking some over the counter medication, different techniques they’re using maybe when they’re managing their bladder to help decrease those risks. Spasticity can be medications; it can be activity and stretching. It can also be position related. So, usually, we try to combat whatever complication they’re having with multiple interventions and some of those may be medication but some of those may not be medication. So, we try to facilitate an improvement or healing of whatever complication it is by a couple of different avenues to help moderate that.
Melanie: Are there any ways to prevent some of these?
Dr. Beninga: Absolutely. Most of them have some element of prevention. So, skin especially if they’re doing regular weight shifts and they’re not putting themselves at risk to develop skin breakdown whether that’s doing weight shifts on their wheelchair or being cognizant of bracing or positions they’re in for periods of time, watching their skin daily, making sure that they’re doing a thorough examination of their skin every day or their caregivers are doing an examination of their skin every day. If they notice a red spot, you know, being able to make sure they’re getting pressure off that spot before it actually turns into an area of skin breakdown because one the skin has broken down, it can take weeks to months and sometimes years for those to heal. So, we definitely push the prevention when it comes to skin. Respiratory is the same, you know, making sure that they’re doing what they need to do to be able to utilize the maximum ability of their lung function to prevent infections or other potential complications. And, I would say that spasticity, bladder infections, and neuropathic pain also have some element of prevention whether it be stretching; exercise; with the spasticity, using a good technique when they’re managing their bladder to help decrease the risk of bacteria exposure; and pain, if there’s things that they’re doing that’s triggering that pain, figuring out how to minimize those exposures or how to do things early on when they’re experiencing pain so that the pain doesn’t become unbearable or maybe get to a point where they need medication.
Melanie: One of the secondary complications could be depression. What do you tell family members of loved ones that might be suffering from depression post discharge?
Dr. Beninga: It’s very common for individuals who have had a catastrophic injury to have a period of what we call an “adjustment disorder”. So, it’s very normal for the first six months to have depressed mood, anger, all sorts of different components. Usually, in a normal grieving process, those people are grieving a previous function level that they may not have anymore and they may not be able to return to that function level as they did before their injury. So, part of that is normal and part of that is healthy. It’s normal and healthy to go through a grieving process. If that grief starts to limit a patient’s ability to sleep or participate in activities or make progress with their therapy or anything, any of the goals they’re trying to achieve, then we start to worry a little bit more about depression and depressed mood. And, at that point we’ll start talking about ways to mitigate that whether it be with medications or counseling. We have peer support groups also that help patients kind of deal with that transition. So, part of it is being aware and letting the patient know that it’s okay to be grieving what they’re going through, and that that’s a normal part of that. But, if it limits them in function and limits their ability to participate in their daily activities or their rehabilitation after their injury, then we tend to look a little bit more on what we need to do as far as interventions to help them deal with that.
Melanie: And, tell us about Shepherd Center’s Spinal Cord Injury Day Program.
Dr. Beninga: The Day Program is most commonly used for patients who are transitioning from in-patient back home. Length of stays in hospitals, not surprising to anyone, those are getting shorter and shorter. So, patients are having to learn a lot of information and sort of how to relearn their activities of daily living, their day to day activities while they’re in-patients. And, sometimes they haven’t gotten to quite where they want to be by the time they discharge from the hospital. What the day program allows is a place where they can go and continue an aggressive out-patient therapy program. So, it’s usually five to six hours of therapy every day five days a week for anywhere from two weeks to six weeks to really continue to work on the patient gaining independence for dressing, bathing, transfers, all of their self-care so that by the time they do go home, they’re more independent. They require less help from their caregivers. They’re a bit more self-sufficient before they transition home. So, it’s just an outpatient therapy aggressive program that helps transition from in-patient to home. Sometimes our patients will go through that program once and then go home and continue to gain strength or maybe have some improvement in their neurologic status and they’ll come back and they’ll continue to work on new goals that maybe they couldn’t be working on the last time that they were in day program.
Melanie: So, please just offer your best advice in these last few minutes for loved ones and people suffering spinal cord or brain injury and what you really want them to know about those secondary complications and dealing with them or possibly preventing them.
Dr. Beninga: I think at Shepherd, we do a really good job of making sure that patients feel like they can get back to their life. It may be a little bit different than how they did things before but our goal is really to transition patients back into work, going to school, having a great life again in maybe a different way than they’re used to, but really to maintain that quality of life as best as we can. So, prevention is a big part of that. Doing regular weight shifts to make sure they don’t get pressure sores, things that maintaining a healthy weight, getting exercise, maintaining their flexibility, and that helps with skin issues, that helps with spasticity. A lot of times, that can help with pain. So, really, doing a lot of the things that we all able-bodied people have to do and eating right and getting exercise and taking care of our bodies is very important to help prevent a lot of these complications. And, some of them are different than the able-bodied population and some of them are exactly the same. But, making sure that patients understand that preventing a lot of these complications is probably the most important thing they can do because once you’ve developed them, like I said before, some can take weeks or months or even years to be able to heal whatever is going on and that can sometimes be very limiting in what they’re able to accomplish every day.
Melanie: Thank you so much for being with us today. It’s great information. You're listening to Shepherd Center Radio. For more information, you can go to www.shepherd.org. That's www.shepherd.org. This is Melanie Cole. Thanks so much for listening.
Common Complications After Discharge from Rehabilitation for Brain and Spinal Cord Injury
Melanie Cole (Host): Secondary complications are a major health issue for people living with brain and spinal cord injury. My guest today is Dr. Angela Beninga. She’s a Staff Physiatrist at Shepherd Center’s Multispecialty Clinic and the Director of Shepherd Center’s Spinal Cord Injury Day Program. Welcome to the show, Dr. Beninga. Tell us, what do you see as the most common secondary complications that happen with people post discharge?
Dr. Angela Beninga (Guest): It usually depends on what type of injury they’ve had but a lot of times pain is probably the most common issue or complication we see or at least the most common issue that a patient is coming to clinic and having complaints about.
Melanie: So, are these things that you would notice or are these things that a home caregiver would notice?
Dr. Beninga: Both, I guess, probably is the best way to answer that. A lot of times either the patient will come in with those complaints or their caregiver is having difficulty managing the patient at home because of spasticity or pain. There are things that they’re not able to do that they wish they could do more of or do better with because of some of these secondary complications and symptoms. Sometimes, it’s things that just me having a conversation with the patient in clinic, being able to see that they’re having pain or having difficulties with. Sometimes it’s something that I bring up and maybe they’ve just gotten used to it and didn’t know to ask that question. So, it can come or be brought up in clinic in a lot of different ways.
Melanie: How can you help them with these negative health outcomes that can occur as a direct result of a disability? Then, what can you tell them about dealing with some of these secondary complications?
Dr. Beninga: It really depends on what the complications are. If it’s a skin issue, a lot of times it’s going to take a while for that to heal. So, there are certain medications, positioning, equipment--things like that that can help that skin heal better. Neuropathic pain can be helped with medication, different positioning. With urinary tract infections, we talk about different techniques to use to help to minimize the risk of an infection and things to do if they start to notice maybe that they’re getting an infection, like increasing their fluid intake, taking some over the counter medication, different techniques they’re using maybe when they’re managing their bladder to help decrease those risks. Spasticity can be medications; it can be activity and stretching. It can also be position related. So, usually, we try to combat whatever complication they’re having with multiple interventions and some of those may be medication but some of those may not be medication. So, we try to facilitate an improvement or healing of whatever complication it is by a couple of different avenues to help moderate that.
Melanie: Are there any ways to prevent some of these?
Dr. Beninga: Absolutely. Most of them have some element of prevention. So, skin especially if they’re doing regular weight shifts and they’re not putting themselves at risk to develop skin breakdown whether that’s doing weight shifts on their wheelchair or being cognizant of bracing or positions they’re in for periods of time, watching their skin daily, making sure that they’re doing a thorough examination of their skin every day or their caregivers are doing an examination of their skin every day. If they notice a red spot, you know, being able to make sure they’re getting pressure off that spot before it actually turns into an area of skin breakdown because one the skin has broken down, it can take weeks to months and sometimes years for those to heal. So, we definitely push the prevention when it comes to skin. Respiratory is the same, you know, making sure that they’re doing what they need to do to be able to utilize the maximum ability of their lung function to prevent infections or other potential complications. And, I would say that spasticity, bladder infections, and neuropathic pain also have some element of prevention whether it be stretching; exercise; with the spasticity, using a good technique when they’re managing their bladder to help decrease the risk of bacteria exposure; and pain, if there’s things that they’re doing that’s triggering that pain, figuring out how to minimize those exposures or how to do things early on when they’re experiencing pain so that the pain doesn’t become unbearable or maybe get to a point where they need medication.
Melanie: One of the secondary complications could be depression. What do you tell family members of loved ones that might be suffering from depression post discharge?
Dr. Beninga: It’s very common for individuals who have had a catastrophic injury to have a period of what we call an “adjustment disorder”. So, it’s very normal for the first six months to have depressed mood, anger, all sorts of different components. Usually, in a normal grieving process, those people are grieving a previous function level that they may not have anymore and they may not be able to return to that function level as they did before their injury. So, part of that is normal and part of that is healthy. It’s normal and healthy to go through a grieving process. If that grief starts to limit a patient’s ability to sleep or participate in activities or make progress with their therapy or anything, any of the goals they’re trying to achieve, then we start to worry a little bit more about depression and depressed mood. And, at that point we’ll start talking about ways to mitigate that whether it be with medications or counseling. We have peer support groups also that help patients kind of deal with that transition. So, part of it is being aware and letting the patient know that it’s okay to be grieving what they’re going through, and that that’s a normal part of that. But, if it limits them in function and limits their ability to participate in their daily activities or their rehabilitation after their injury, then we tend to look a little bit more on what we need to do as far as interventions to help them deal with that.
Melanie: And, tell us about Shepherd Center’s Spinal Cord Injury Day Program.
Dr. Beninga: The Day Program is most commonly used for patients who are transitioning from in-patient back home. Length of stays in hospitals, not surprising to anyone, those are getting shorter and shorter. So, patients are having to learn a lot of information and sort of how to relearn their activities of daily living, their day to day activities while they’re in-patients. And, sometimes they haven’t gotten to quite where they want to be by the time they discharge from the hospital. What the day program allows is a place where they can go and continue an aggressive out-patient therapy program. So, it’s usually five to six hours of therapy every day five days a week for anywhere from two weeks to six weeks to really continue to work on the patient gaining independence for dressing, bathing, transfers, all of their self-care so that by the time they do go home, they’re more independent. They require less help from their caregivers. They’re a bit more self-sufficient before they transition home. So, it’s just an outpatient therapy aggressive program that helps transition from in-patient to home. Sometimes our patients will go through that program once and then go home and continue to gain strength or maybe have some improvement in their neurologic status and they’ll come back and they’ll continue to work on new goals that maybe they couldn’t be working on the last time that they were in day program.
Melanie: So, please just offer your best advice in these last few minutes for loved ones and people suffering spinal cord or brain injury and what you really want them to know about those secondary complications and dealing with them or possibly preventing them.
Dr. Beninga: I think at Shepherd, we do a really good job of making sure that patients feel like they can get back to their life. It may be a little bit different than how they did things before but our goal is really to transition patients back into work, going to school, having a great life again in maybe a different way than they’re used to, but really to maintain that quality of life as best as we can. So, prevention is a big part of that. Doing regular weight shifts to make sure they don’t get pressure sores, things that maintaining a healthy weight, getting exercise, maintaining their flexibility, and that helps with skin issues, that helps with spasticity. A lot of times, that can help with pain. So, really, doing a lot of the things that we all able-bodied people have to do and eating right and getting exercise and taking care of our bodies is very important to help prevent a lot of these complications. And, some of them are different than the able-bodied population and some of them are exactly the same. But, making sure that patients understand that preventing a lot of these complications is probably the most important thing they can do because once you’ve developed them, like I said before, some can take weeks or months or even years to be able to heal whatever is going on and that can sometimes be very limiting in what they’re able to accomplish every day.
Melanie: Thank you so much for being with us today. It’s great information. You're listening to Shepherd Center Radio. For more information, you can go to www.shepherd.org. That's www.shepherd.org. This is Melanie Cole. Thanks so much for listening.