Prognosis Flashcards
Things to consider for motor incomplete SCI
- more variable, restoration
Consider:
Degree of motor return below level of injury
Insurance coverage
Access to ongoing PT/rehab
Housing options & accessibility
Body habitus
Age
Things to consider for motor complete SCI
- more predictable, compensation
Body habitus
Age
Flexibility
Adaptive equipment (AE)/Durable Medical Equipment (DME)
Insurance coverage
Housing options & accessibility
C1-C3 Motor Complete Expected Functional Outcomes
- Dependent (TotalA) mobility & self care
- Possibly independent with PWC
- Ventilator/phrenic nerve stimulator
- Directs care
C4 Motor Complete SCI Expected Functional Outcomes
- Dependent (TotalA) mobility & self care
- Assistance for ADLs w/ use of mobile arm support & other AE
C5 Motor Complete SCI Expected Functional Outcomes
- Mobile arm support for UE ADLs
- Min-modA LE dressing
- Min-modA rolling
- Dependent (TotalA) transfers
- Independent PWC mobility in community
- Manual cough assist
C6 Motor Complete SCI Expected Functional Outcomes
- Independent slideboard transfers (possible)
- Independent rolling
- Independent unsupported sitting
- ModI w/ AE for self care * Dress with some assistance for efficiency
- MWC independence possible (likely household) w/ adapted rims
- Independent manual cough
C7 Motor Complete SCI Expected Functional Outcomes
- Independent seated self care (likely with AE)
- Independent transfers w/o slideboard including floor & unlevel
- Independent stowing MWC into car
C8 Motor Complete SCI Expected Functional Outcomes
- Independent transfers including floor & unlevel
- Independent toilet/tub transfers (possibly need grab bars)
T1-T5 Motor Complete SCI Expected Functional Outcomes
- Curb negotiation with wheelies
- WC sports participation * Independent car transfers
T6-T8 Motor Complete SCI Expected Functional Outcomes
- Supervision with walker & KAFOs at home
- MWC for community mobility
T9-T12 Motor Complete SCI Expected Functional Outcomes
- Independent floor & tub transfers
- Independent household ambulation w/ KAFOs
- MWC for community mobility
T12-L3 Motor Complete SCI Expected Functional Outcomes
- Independent gait w/ forearm crutches & KAFOs
- May be community ambulator or use MWC for energy conservation
L4-L5 Motor Complete SCI Expected Functional Outcomes
- Likely community ambulators w/ bracing (AFOs) and possibly assistive devices
What is the gait training approach for incomplete injuries?
Restorative
Prognosis for recovery of gait
AIS A: poor
AIS B: 33%, variable, more likely with PP preservation
AIS C: 75%
AIS D: 100%
What is the gait training approach for complete injuries?
Complete
Positive Prognostic Indicators:
- Age <65
- Lower extremity motor function (any) –> L3 and S1 key myotomes
- Pinprick sensation sparing –> L3 & S1 key dermatomes
- AIS C or D classification
What is the Clinical Prediction Rule for Locomotor Recovery Post SCI
- AIS Testing administered within 15 days and 1 year post-injury independent walking (SCIM) used as primary outcome
1. Lower extremity motor scores for quads and PFs
2. Sensory scoring (light touch) for L3 and S1 dermatomes
3. Age (> or <65)
What can dictate the type of gait interventions in your POC?
Spinal Cord Level of injury
regardless of severity
Injury above L1
= upper motor neuron (UMN) injury → follows
recovery pattern for CNS damage – similar to CVA or TBI
Experience-dependent principles of neuroplasticity
PT should include task-specific, repetitive, high intensity stepping training
Injury below L1
= lower motor neuron (LMN) injury → follows
recovery pattern for PNS damage
Time for regrowth of peripheral nerves approx. 1-2 mm/day
PT should accommodate for deficits to maximize functional
independence – bracing, etc (KAFOs)
What is restoration gait training
application of experience-dependent principles of neuroplasticity
- focus on neurologic recovery of walking function
- Implementation: using various modalities, CPG to improve locomotor function following chronic stroke/incomplete SCI and brain injury
Manual Wheelchair - Rigid
- For full time independent MWC users
- Usually lower-level complete injuries
- can be challenging to get into car bc it doesnt fold
Manual Wheelchair - Folding manual
For part-time independent MWC users (some level of ambulation)
For MWC users who may require assistance
