Outcomes Flashcards
Thoracic Level
innervation of neck, upper limb, shoulder girdle, and trunk mm, but no volitional LE movement are present
ortho goals: maintain straight spine, level pelvis, and symmetric lower limbs
Neck, upper limb, and shoulder girdle are innervated byb C1-T4, back extensors C2-L4, intercostals by thoracic nerves, and abdominals T5-L1
Individuals with motor fxn at or above T10 have strong upper limbs and upper thoracic/neck motions, weak lower trunk musculature
Difficulty with unsupported sitting balance and may have decreased respiratory fxn
May require sliding board for transfers d/t poor trunk control and ue dyscoordination
T12 have trong trunk muscualture and good sitting balance and may have weak hip hiking (QL- T12-L3)
Amb may be attempted for exercise, but generally not an effective means for mobility, w/c required for functional household and community mobility
Children with thoracic lesions also tend to have greater involvement of CNS with corresponding cognitive deficits
even though many achieve indep in basic self care and mobility by late childhood, they often require supervised living situations throughout live, rarely competitively employed but often participate in sheltered workshop settings or perform volunteer work
High Lumbar L1-2
weak hip mvmts
Iliopsoas suppled by L1-4 with primary innervation of L2-3
Sartorious L2-3
Adductors L2-4
L1 motor function- weak hip flexion may be present
L2- hip flexors, adductors, and rotators are grade 3 or better
Often have unopposed hip flexion and adduction contractures often present at L2 level and result in dislocated hips
Short distance household amb possible
–When small body proportions using KAFO or RGO and ue support
Prognosis for function and indep living as adults simular to thoracic group
– more in this group achieve indep living but rarely maintain employment
L3 Level
have strong hip flexion and adduction, weak hip rotation, and at least antigravity knee extension
Quads innervated by L2-4
Children with grade 3 quads = need KADO’s and forearm crutches to amb household and short community distances and w/c for long community distances
Adulthood- most are primarily w/c mobile
60% achieve indep living
small % actively participate in full time employment
L4 Level
antigravity knee flexion and grade 4 ankle DF with inversion may be present
Medial hams innervated by L4-S2 and ant tib innervated primarily by L4 with some innervation from S1
Considered L4 lesion if the emdial hams or anterior tib is at least a grade 3
Calcaneal foot deformities are common as a result of the unopposed action of tib ant
Knee extension is strong– usually functional ambulators with AFO’s and crutches
- when first learning to walk may need KAFO’s a walker or both
- w/c needed for long distances
Adult follow up– only 20% continued to amb as adults
independent living and employment similar to L3
L5 Level
Based on presence of lateral hams with at least grade of 3, either grade 2 glute min and med (L4-S1), grade 3 post tib (L5-S1) , or grade 4 peroneus tertius (L4-S1)
Has at least antigravity knee flexion and weak hip extension using the hamstrings and may have weak hip abduction, may have weak PF with inversion, strong DF or eversion, or both
weak toe mvmts may also be present
Hindfoot valgus or or calcaneal foot deformities are common as a result of mm imbalance
can amb without orthoses, but they require them to correct foot alignment for adequate push off
gluteal lurch is typical unless use ue support
bilateral ue support recommended when amb community distance to decrease energy expenditure, decrease gluteal lurch and trunk sway, maintain symmetric alignment, protect lower limb joints, safety
need for ue support becomes more apparent after growth spurt
w/c may be required when there is a rapid change in body proportions or for long distances on rough terrain, can also use bike for long community distances
80% of individuals with lesions L5 and below achieve independent living as adults, 30% employed full time 20% part time
S1 level
mm function present through S1 with at least two of the following additional mm actions present: gastroc/soleus grade 2, glute med grade 3, glute max grade 2
have improved hip stability and can walker without orthotics or ue support
weak push off noted when running or on stairs
mild to mod gluteal lurch often present
gait and activity limitations are more pronounced after adolescent growth spurt
Generally have strong toe musculature
Foot deformities less common
May require orthotics to improve lower limb alignment and optimal mm length
ML stability at ankle is required for adequate fxn of PF mm during push off
S2, S203, and no loss levels
Motor function at S2 level = PF muscles are at least grade 3 and glutes grade 4
– Gait abnormality: decreased push off and strid length when walking rapidly or running d/t decreased PF strength
Motor level S2-3 = if all lower limb mm groups have grade 5 strength except for one or two groups with grade 4 strength
No loss = use if BB fxn normally and lower limb strength is judged to be normal through MMT
– fxn deficits may be present but still classified as no loss
Orthotics often beneficial in maintaining ankle in neutral and to optimize ankle mm fxn
