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 Patients with C1-C3 injuries are likely to require long-term mechanical ventilatory support because of
the loss of innervation to the diaphragm. These individuals may be candidates for FES of the phrenic
nerve (or diaphragm) to reduce their need for mechanical ventilation, if their lower motor innervation to
the diaphragm remains intact.9 Swallowing and phonation functions are preserved.--- ndividuals with
injuries at the C1-C4 level will likely depend on others for help with almost all of their mobility and self-
care needs, although they may be able to use a power wheelchair with chin or pneumatic (sip and puff)
controls. If their elbow flexion and shoulder movement are suboptimal (muscle grade 2 or 3), a balanced
forearm orthosis (BFO) or mobile arm support (MAS) may assist them with feeding and grooming
activities. The use of a long bottle or straw can allow these individuals to drink independently. With a
spinal cord injury of C4 and higher, all the muscles which control breathing will be paralysed. these are
the intracostal muscles, the diaphragm and the abdominal muscles. In order to breath, the person will
need a machine called a ventilator to breath for them, this machine forces air in and out of the lungs to
re-oxygenate the blood. In order to cough, the person will need help by way of a carer performing an
assisted cough procedure.---

3. a. juvenile

For some children pain relievers may be the only medication needed. Others may need help from
medications designed to limit the progression of the disease. Typical medications used include:

Y ÿ
 ÿ  These medications, such as
ibuprofen (Advil, Motrin, others) and naproxen (Aleve), reduce pain and swelling.
Because children can develop side effects such as bleeding and liver and stomach
problems, be sure to use these medications under a doctor's supervision.
 ã Doctors use these medications
when NSAIDs alone fail to relieve symptoms of joint pain and swelling. They may be
taken in combination with NSAIDs and are used to slow the progress of juvenile
rheumatoid arthritis. Commonly used DMARDs for children include methotrexate
(Rheumatrex) and sulfasalazine (Azulfidine). Side effects may include nausea and liver
Y ï
 TNF blockers ² such as etanercept (Enbrel)
and infliximab (Remicade) ² can help reduce pain, morning stiffness and swollen joints.
But these types of drugs increase the risk of infections, particularly in the lungs ² and
even cancers, such as lymphoma.
Y á

 These prescription medications are for children with more severe
juvenile rheumatoid arthritis. They're used to control symptoms until a DMARD takes
effect or to prevent complications, such as inflammation of the sac around the heart
(pericarditis). Corticosteroids, such as prednisone, may be administered by mouth or by
injection. But they can interfere with normal growth and increase susceptibility to
infection, and generally should be used for the shortest possible duration. Stopping long-
term use of corticosteroids suddenly can be dangerous, so it's important to follow a
doctor's instructions on usage.



Y    Acetaminophen (Tylenol, others) can relieve pain, but doesn't reduce
inflammation. It has been shown to be effective for people with osteoarthritis who have
mild to moderate pain. Taking more than the recommended dosage of acetaminophen can
cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask
your doctor for guidance on limiting or abstaining from alcohol if you take
acetaminophen regularly. Acetaminophen can also affect other medications you may be
taking, so be sure to inform your doctor if you're taking it.
Y ÿ  Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce
inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and
naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by
prescription. Oral NSAIDs can cause stomach upset, so some prescription NSAIDs come
in a patch that you affix to your skin or in a gel form that you can rub on the painful joint.
Other NSAID side effects include ringing in your ears, cardiovascular problems, and liver
and kidney damage. The risk of major side effects is greatest if you use NSAIDs at high
dosages for long-term treatment.
Y ï
  Tramadol (Ultram) is a centrally acting analgesic that's available by
prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain
relief with fewer side effects ² such as stomach ulcers and bleeding ² than those of
NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for
short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in
combination with acetaminophen to increase pain relief.

 Prescription pain pills, such as codeine and propoxyphene
(Darvon), may provide relief from more severe osteoarthritis pain. These stronger
medications carry a risk of dependence, though that risk is thought to be small in people
who have severe pain. Side effects may include nausea, constipation and sleepiness.
Y á
  Injections of corticosteroid medications may relieve pain in your joint.
During this procedure your doctor numbs the area around your joint and then inserts a
needle into the space within your joint and injects medication. It isn't clear how or why
corticosteroid injections work in people with osteoarthritis. Your doctor may limit the
number of injections you can have each year, since too many corticosteroid injections
may cause joint damage.

Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors
typically prescribe medications with the fewest side effects first. You may need stronger drugs or
a combination of drugs as your disease progresses.

Y ÿ  Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce
inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and
naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by
prescription. Side effects may include ringing in your ears, increased bruising, gastric
ulcers, heart problems, stomach bleeding, and liver and kidney damage.
 Corticosteroid medications, such as prednisone and methylprednisolone
(Medrol), reduce inflammation and pain and slow joint damage. Side effects may include
easy bruising, thinning of bones, cataracts, weight gain, a round face and diabetes.
Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of
gradually tapering off the medication.
 ã These drugs can slow the
progression of rheumatoid arthritis and save the joints and other tissues from permanent
damage. Common DMARDs include methotrexate (Rheumatrex, Trexall), leflunomide
(Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and minocycline
(Dynacin, Minocin). Side effects vary but may include liver damage, bone marrow
suppression and severe lung infections.
 These medications act to tame your immune system, which is out
of control in rheumatoid arthritis. Examples include azathioprine (Imuran, Azasan),
cyclosporine (Neoral, Sandimmune, Gengraf) and cyclophosphamide (Cytoxan). These
medications can increase your susceptibility to infection.
Y ïÿ   
 Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory
substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning
stiffness, and tender or swollen joints ² usually within one or two weeks after treatment
begins. Examples include etanercept (Enbrel), infliximab (Remicade) and adalimumab
(Humira). Potential side effects include injection site irritation, congestive heart failure,
blood disorders, lymphoma, demyelinating diseases and increased risk of infection.


Medicines used to treat acute gout and/or prevent further attacks are as follows:

Y nonsteroidal antiinflammatory drugs (NSAIDs)

m Examples include indomethacin (Indocin), ibuprofen (Advil), and naproxen

(Aleve). Newer drugs such as celecoxib (Celebrex) can also be used. Aspirin
should not be used for this condition.

m High doses are needed to control the inflammation and can be tapered off within a
couple of weeks.
m Tell your doctor about your other health-care problems, particularly if you have a
history of peptic ulcer disease or intestinal bleeding, if you are taking warfarin
(Coumadin), or if you have problems with your kidney function.

m The primary complications of these medications include upset stomach, bleeding

ulcers, and decreased kidney function.

Y colchicine

m This medication is given in two different ways, either to treat the acute attack of
arthritis or to prevent recurring attacks.

m To treat the hot, swollen joint, colchicine is given rapidly (up to once an hour
until symptoms improve, side effects develop, or a maximum of 10 doses is
reached). While this approach is often effective, most people develop nausea,
vomiting, or diarrhea and so it is seldom used for this purpose.

m To help prevent an attack from coming back, colchicine can be given once or
twice a day. At this frequency, diarrhea is much less likely to occur. While the
chronic use of colchicine can reduce the attacks of gout, it does not prevent the
accumulation of uric acid that can lead to joint damage even without attacks of
hot, swollen joints.

m Tell your doctor if you have any problems with your kidney or liver function.

Y corticosteroids

m Corticosteroids such as prednisone are generally given when your doctor feels this
is a safer approach than using NSAIDs.

m When given as pills, a high dose is used initially and is tapered off within a couple
of weeks. It is important to take these medications as prescribed to avoid

m Some complications with the short-term use of corticosteroids include altered

mood, elevated blood pressure, and problems with control of glucose in patients
with diabetes.

m Corticosteroids can also be injected into the swollen joint. Resting the joint
temporarily, after it is injected with steroids, can be helpful.

m Occasionally, corticosteroids or a related compound, corticotropin (ACTH), can

also be injected into the muscle.