Functional Capacity by Nerve Level Flashcards
C1-4
Nerve spared, muscles still functioning
Nerve spared: C4
Still functioning: Trap, diaphragm, cervical paraspinal muscles
C1-C4
Movement possible; patterns of weakness
mvmt possible: neck F, E, & rotation, scapular elevation, inspiration
patterns of weakness: paralysis of trunk, UE, LE; inability to cough, endurance and vital capacity low, may or may not wean from ventilator
C1-C4
Functional expectations; self-care and independent living skills training appropriate for intervention
Functional expectations: breathing, possibly capable of weak shoulder shrug, facial muscles innervated by cranial nerves (so those still functional after SCI)
self-care and idp living skills:
- mouth stick training
- learning how to self-inspect skin and shift pressure distribution through position changes with technology
- learn how to instruct personal care assistants
C4-C5
Nerve spared; muscles still functioning
nerve spared: C5
muscles still functioning: biceps, deltoids, brachioradialis, brachialis, rhomboids, supinator, partial serratus anterior
C4-C5
mvmt possible; patterns of weakness
mvmt possible: shoulder flexion, extension, abduction, elbow flexion, forearm supination, scapular protraction and retraction
patterns of weakness: absent elbow extension, pronation, all wrist and hand movements, total paralysis of trunk and lower extremities
C5-C6
Nerve spared; muscles still functioning
Nerve spared: C6
muscles still functioning: full serratus anterior, partial lats, clavicular pecs, extensor carpi radialis L&B
C4-C5
functional expectations; self-care and independent living skills training appropriate for intervention
functional expectations: Can bring hand to mouth (feeding, brushing, grooming), maybe W/C manual operation
self-care and idp living skills training:
- use of dorsal long opponens splint
- learning how to self-inspect skin and shift pressure distribution through position changes using teachnology
- learn how to instruct personal care assistants, good environmental setup can increase activities and burden of care
- can write with universal cuff or type on keyboard using a pencil and universal cuff
- OT would want to prevent elbow contractures
- person can maybe operate own ceiling lift
- can maybe drive
- can maybe take a bath at this level, but probably will need a lot of help and good setup
C5-C6
movement possible; patterns of weakness
mvmt possible:
- scapular protraction
- forearm supination and pronation
- radial wrist extension
- some horizontal adduction at shoulder
patterns of weakness: absent wrist flexion, elbow extension, hand movement, total paralysis of trunk and LEs
C5-C6
functional expectations; self-care and independent living skills training appropriate for intervention
functional expectations:
- can possibly use propping mechanism to help with transfer, tenodesis splinting and ranging helpful to maximize wrist and hand function
- ability to reach overhead is helpful with dressing
- can reach past midline
self-care and idp living skills training:
- learning how to utilize a tenodesis grasp
- learning to use a universal cuff
- learning to write
- learning to groom and dress (can use buttons, zippers, and ties)
- use of built of utensils
- self-catheterization
- working on good trunk balance, bed mobility
- education on use of AE
- can use tools and apply pressure (using tenodesis)
- learning how to self-inspect skin and shift pressure distribution through position changes using technology (in WC: lateral shifts, propping with external rotation and locking elbows)
- learn how to instruct personal care assistants
- can wash hair/shower independently
- independent sliding board transfer
- driving, holding, baby in sling, public transportation all possibilities
C5-C6
functional expectations; self-care and independent living skills training appropriate for intervention
functional expectations:
- can possibly use propping mechanism to help with transfer, tenodesis splinting and ranging helpful to maximize wrist and hand function
- ability to reach overhead is helpful with dressing
- can reach past midline
self-care and idp living skills training:
- learning how to utilize a tenodesis grasp
- learning to use a universal cuff
- maybe use of short opponens splint
- learning to write
- learning to groom and dress (can use buttons, zippers, and ties)
- use of built of utensils
- self-catheterization
- working on good trunk balance, bed mobility
- education on use of AE
- can use tools and apply pressure (using tenodesis)
- learning how to self-inspect skin and shift pressure distribution through position changes using technology (in WC: lateral shifts, propping with external rotation and locking elbows)
- learn how to instruct personal care assistants
- can wash hair/shower independently
- independent sliding board transfer
- driving, holding, baby in sling, public transportation all possibilities
C6-C7
movement possible; patterns of weakness
movement possible:
- elbow extension
- ulnar wrist extension
- wrist flexion
- some finger movement (weak): mostly finger extension*, and start of thumb movement
patterns of weakness: paralysis of trunk and LE, limited grasp release and dexterity secondary to partial intrinsic muscles of the hand
C6-C7
functional expectations; self-care and independent living skills training appropriate for intervention
functional expectations: due to use of triceps, person can really help with transfers, skin care, and W/C propulsion
self-care and idp living skills training:
- grooming
- UE and LE dressing
- bed mobility and trunk balance
- independent in sliding board transfer
- adaptive device (digital stimulator) for independent bowel management
- driving
C7-T1
Nerve spared; muscles still functioning
nerve spared: C8
muscles still functioning: flexor carpi ulnaris, flexor dig superficialis, flexor dig profundus, ETC, partial lumbricales, opponens pollicis, flex/ext/abd pollicis
C7-T1
movement possible; patterns of weakness
movement possible:
- finger flexors
- more hand strength
- more thumb function
patterns of weakness: paralysis of trunk and LE, limited grasp and release and dexterity secondary to partial intrinsic muscles of the hand (same as C6-C7/C7 spared)
C7-T1
functional expectations; self-care and independent living skills training appropriate for intervention
functional expectations: stronger grasp
self-care and independent living skills training appropriate for intervention: same as C7 spared -grooming -UE and LE dressing -bed mobility and trunk balance -independent in sliding board transfer -adaptive device (digital stimulator) for independent bowel management -driving
