Functional Level Flashcards
SCI Prognosis
Impairments
Cognition (Dual Diagnosis) Respiratory GIT incl Swallowing Bladder Bowel Nutrition DVT HO Spasticity Contractures Skin Orthostatic Hypotension Hypercalcaemia AD Spine
High Tetraplegia
Persons with motor levels at or above C3 will usually require long-term ventilator assistance, whereas most individuals with lesions at C4 will be able to wean off the ventilator.
Respiratory equipment including a ventilator, a method for secretion management (i.e., suction machine, mechanical insufflator/exsufflator), backup ventilator batteries, and a generator in case of power failure, should be obtained.
One should be in touch with the local power company and emergency services to alert them of the patient’s status and condition prior to discharge.
C4
weight shifts, ROM, positioning in bed, donning orthoses, transfers, and in setting up their ECU.
- hese individuals should be independent in power wheelchair mobility, using breath control, mouth stick, head array, and tongue or chin control mechanisms.
- the patient can control a power chair, then both a power chair (power recline or tilt wheelchair) and a manual positional wheelchair should be prescribed . The manual wheelchair is used when accessibility for a power wheelchair is not available, or in case the power wheelchair fails. Once properly set up, persons at these levels of injury should be independent in their ECU control.
C4
Persons with an NLI at C4 who have some elbow flexion and deltoid strength may be able to use a mobile arm support (MAS) or balanced forearm orthosis (BFO) to assist with feeding, grooming, and hygiene. Once the elbow flexors have antigravity strength with adequate endurance, the MAS is no longer needed. A long straw or a bottle that the person can easily access to drink fluids should be obtained as early as possible.
C5
The C5 motor level adds the key muscle group of the elbow flexors (biceps), as well as the deltoids, rhomboids and partial innervation of the brachialis, brachioradialis, supraspinatus, infraspinatus, and serratus anterior. It is important during the acute period after SCI to prevent elbow flexion and forearm supination contractures caused by unopposed biceps activity. Continued stretching should be performed acutely and in the
P.1734
chronic phase after rehabilitation.
C5
The addition of the elbow flexors should allow for use of a joystick for a power wheelchair and can allow manual wheelchair propulsion on level surfaces with either rim projections (lugs) or plastic coated hand rims with a protective glove. A power wheelchair, with a power recline or tilt mechanism, is usually still required in addition to the manual wheelchair. A power or manual-assist wheelchair may also be advantageous to improve the distance one can propel the wheelchair.
C5
A long opponens splint, with a pocket for inserting different utensils, is important to assist with many tasks including feeding, hygiene, grooming, and writing. Most functional activities will require the use of assistive devices, and therefore tendon transfers may be considered after neurological recovery is complete. Implanted electrical stimulation units may also be beneficial.
C6
The C6 level adds the key muscle group that performs wrist extension (extensor carpi radialis), as well as partially innervating the supinator, pronator teres, and latissimus dorsi.
Active wrist extension can allow for tenodesis, the opposition of the thumb and index finger with flexion as the tendons are stretched with wrist extension.
One should avoid overly stretching the finger flexors initially after injury in C5 and C6 motor level patients to avoid potentially losing the tenodesis action.
C6
Feeding, grooming, and UE hygiene are usually independent after assistance with setting up the appropriate utensils, however, clothing modifications such as Velcro closures on shoes, loops on zippers, and pullover garments are recommended.
Assistance for meal preparation is still required as well as for other homemaking tasks.
Transfers may be possible using a transfer board and with loops for LE management, but most often requires assistance. Although persons with a C6 motor level can propel a manual wheelchair with plastic-coated rims, a power wheelchair is often required for long distances, especially if the individual will be returning to the workplace. A power-assist wheelchair may be of benefit as well.
C7, C8
The C7 motor level adds the elbow extensors (triceps) as the key muscle group; C8 the long finger flexors. The C7 level is considered the key level for becoming independent in most activities at the wheelchair level, including weight shifts, transfers between level surfaces, feeding, grooming, upper body dressing, and light meal preparation.
Uneven surface transfers, lower body dressing, and house cleaning may require some assistance.
The independent use of a car is possible if the individual can transfer and load /unload the wheelchair.
IC in males can be performed although it is more difficult for females, especially if LE spasticity is present.
Bowel care on a padded commode seat, especially suppository insertion, may still require assistance or the use of adaptive devices (i.e., suppository inserter).
Respiratory
Ventilator dependent (some C3, many C4 may be able to be weaned off ventilator) C5-7-8 Low endurance and vital capacity; may require assistance to clear secretions
Pressure relief
Total assist; may be independent with equipment
Wheelchair propulsion
C5: Power: independent
Manual: independent to some assist indoors on non-carpet surface; some to total assist outdoors
C6: Power: independent with standard arm drive on all surfaces
Manual: independent indoors; some assist outdoors
C7: Manual: independent on all indoor surfaces and level outdoor terrain; may need some assist or power for uneven terrain or long distances
Bed
Electric hospital bed or full to king size standard bed, pressure relief mattress or overlay
Transfers
Power or mechanical lift, transfer board
