Functional Expectations for Patients With Spinal Cord Injury Flashcards
key muscles available in a C1, C2, C3, C4 injury
- Face and neck muscles
- cranial nerve innervation
- diaphragm (partial innervation at C3 and C4)
available movements in a C1, C2, C3, C4 injury
- Talking
- Mastication
- Sipping
- Blowing
- Scapular elevation
key muscles available in a C5 injury
- Biceps
- Brachialis
- Brachioradialis
- Deltoid
- Infraspinatus
- Rhomboid (major and minor)
- Supinator
available movements in a C5 injury
- Elbow flexion and supination
- Shoulder external rotation
- Shoulder abduction and flexion to ~90°
Equipment and Assistance Required
C5 injury, bowel and bladder
Dependent, directs care provided by attendants
Equipment and Assistance Required
C5, transfers
- Dependent, attendants use mechanical lift
- Directs care provided by attendants
- May be able to perform with assistance and transfer board
available key muscles in C6 injury
- Extensor carpi radialis (tenodesis grasp)
- Infraspinatus (shoulder ER)
- Latissimus dorsi (shoulder IR, EXT, ADD)
- Pectoralis major (clavicular portion) (shoulder FLX, IR)
- Pronator teres
- Serratus anterior (protraction and superior rotation of the scapula)
- Teres minor (shoulder ER)
available movements in a C6 injury
- Shoulder flexion, extension, internal rotation, and adduction
- Scapular abduction, protraction, and upward rotation
- Forearm pronation
- Wrist extension (tenodesis grasp)
Equipment and Assistance Required
C6 injury, bowel and bladder care
May be able to be independent with adaptive equipment, likely to require assistance/dependent
Equipment and Assistance Required
C6 injury, transfers
- Independent to some assistance with transfer board
- Assistance with uneven transfers
C5 injury, driving
Independent with van with adaptive controls
available key muscles in C7 injury
- Extensor pollicus longus and brevis
- Extrinsic finger extensors
- Flexor carpi radialis Triceps
available movements in a C7 injury
- Elbow extension
- Wrist flexion
- Finger extension
Equipment and Assistance Required
C7 injury, ADL
Independent with most ADL with adaptive equipment
avalaible key muscles in a C8 injury
- Extrinsic finger flexors
- Flexor carpi ulnaris
- Flexor pollicis longus and brevis
- Intrinsic finger flexor
avalaible movements in a C8 injury
finger flexion
avalaible key muscles in a T1 to T12 injury
- Intercostals
- Long muscles of back (sacrospinalis and semispinalis)
- Abdominal musculature (~T7 and below)
avalaible movements in T1 to T12 injury
- Improved trunk control with more caudal SCI
- Increased respiratory reserve
- Pectoral girdle stabilized for lifting objects
Equipment and Assistance Required
T1 to T12 injury, ambulation
- Independent with physiological standing and ambulation for exercise over short distance in the home Assistive devices (e.g., forearm crutches)
- Orthoses: hip-knee-ankle-foot-ortho- sis (HKAFO), knee-ankle-foot orthosis (KAFO)
key avalable muscles in a L1, L2, L3 injury
- Gracilis (hip ADD and knee FLX)
- Iliopsoas (hip FLX)
- Quadratus lumborum
- Rectus femoris (hip FLX, knee EXT)
- Sartorius (hip FLX, ABD, ER, little knee FLX)
available movements in a L1, L2, L3 injury
- Hip flexion
- Hip adduction
- Knee extension
Equipment and Assistance Required
L1, L2, L3 injury, ambulation
- Independent short distances in home and possibly community
- Many choose to use wheelchair in the community due to high energy demands of community ambulation Assistive devices (e.g., forearm crutches)
- Orthoses: HKAFO, KAFO, AFO (depending on which muscles are innervated)
key avalable muscles in a L4, L5, SI injury
- Quadriceps (L4)
- Anterior tibialis (L5)
- Hamstrings (L5–S1)
- Gastrocnemius (S1)
- Gluteus medius and maximus (L5–S1)
- Extensor digitorum, posterior tibialis, peroneals, flexor digitorum (L5, S1)
avalaible movements in a L4, L5, SI injury
- Strong hip flexion
- Strong knee extension
- Knee flexion
- Ankle dorsiflexion
- Ankle plantarflexion
- Ankle eversion
- Toe extension
Equipment and Assistance Required
L4, L5, S1 injury, ambulation
- Independent ambulation in home and community (L4-level injury may elect to use wheelchairfor long distances)
- Assistive devices (e.g., forearm crutches, canes)
- Orthoses: AFO
- Less supportive assistive device and orthoses the more caudal the SCI
Individuals with complete (ASIA A) UMN injuries are not likely to regain the functional LE strength required to become independent ______ .
ambulators
For individuals with ASIA B (sensory incomplete) the preservation of pinprick sensation is an important prognostic indicator of the recovery of ________
ambulation
Lower extremity ASIA motor score, quadriceps strength in particular, can be a useful predictor of functional ____________ in people with motor incomplete injuries
walking ability
In a cohort of almost 500 patients, findings indicated that age, motor scores of quadriceps and gastrocnemius, and light touch sensory scores at L3 and S1 were able to accurately distinguish between_____________ and those who require assistance or cannot ambulate.
independent home ambulators (as scored on the SCIM)