SCI 3 - Expected Outcomes Flashcards
what is the potential for recovery in people w a complete injury
often regain 1 or 2 levels below level of injury
- means you often regain control of 1 or 2 levels of ms mvmt
what is the potential for recovery in an incomplete injury
more likely than people w complete injury to regain control of more ms mvmt
- no way to know how much, if any
what are general rules for predicting chance of improvement
longer you go w/o seeing improvement, chances are lower
as long as seeing some improvement (like regaining ms mvmt), chances are better
C1-3: breathing
ventilator dependent
C1-3: ADL care
total assist
C1-3: pressure relief
total assist except w equipment
C1-3: bed mobility/transfers
total assist
C1-3: wc mobility
total assist w manual
(I) driving power chair and performing pressure relief (tilt/recline) w head, chin, mouth or breath control
C1-3: home health aide needs?
requires 24hr attendant care
C4: breathing
may be able to w/o ventilater
total assist to clear secretions
- depends on strength of diaphragm
C4: ADL care
total assist
C4: pressure relief
total assist except w equipment
C4: bed mobility / transfers
total assist
C4: wc mobility
total assist w manual
(I) driving power chair and performing pressure relief (tilt/recline) w head, chin, mouth or breath control
C4: home health aide needs?
requires 24 hr attendant care
C5: key muscles innervated
biceps
brachialis
brachioradialis
deltoid
infraspinatus
rhomboid
supinator
key ms: elbow flexors, shoulder and scap mvmt
C5: breathing
(I)
may need (A) to clear secretions
help w self- assist cough techniques
C5: ADL care
some to total assist
(esp w dressing)
C5: pressure relief
total assist except w equipment
- may be able to use bicep strength for lateral wt shifts
C5: transfers
assisted w transfer board
may be able to become (I) w SB depending on function, body habitus, etc.
C5: bed skills
assistance required, able to participate in positioning
use of UE on bedrail, use of momentum for rolling/repositioning
C5: wc mobility
(I) driving power chair and performing pressure relief w hand control
able to propel manual wc on uncarpeted indoor surfaces (I) or w (A), benefits from plastic coated hand rims or power assist
- using biceps, delt
what is a concern of use of manual wc in C5 functional level
worry about repetitive injury/trauma to shoulder
- RC and scap
C6: key ms
extensor carpi rad
infraspinatus
lat dorsi
pec major (clavicular)
pronator teres
serratus anterior*
teres minor
what specific ms innervated by C6 have important functional implications
serratus anterior
- use in bed mobility and other functional mvmts
teres minor can also kick in and be used w these mvmts
C6: breathing
(I)
may need (A) to clear secretions
C6: ADL care
some to total (A)
- esp bathing, dressing
C6: bed mobility
some assist to (I) w adaptive equipment
ex: rings on bed - use of biceps and wrist ext
C6: transfers
some assist to (I) w SB
C6: wc mobility
(I) driving power chair w hand control
- may require tilt/recline for pressure relief
(I) w indoor manual wc propulsion
- partial to total (A) outdoors w manual wc
- benefit from power assist wheels
C6: driving
(I) car/van w adaptive control
C6: home health aide needs?
most people require at least 10hrs/day of personal/home care
C7 key ms
extensor pollicus long & brev
extrinsic finger ext
flexor carpi rad
triceps**
what specific ms innervated by C7 have significant functional implications
triceps
- elbow ext
- WB using triceps w/o compensatory techniques
C8 key ms
extrinsic finger flexors
flexor carpi ulnaris
flexor pollicus long and brev
intrinsic finger flex
why are functional outcomes improved significantly at C7 and C8 levels
greater UE ms capabilities
- can more easily pressure relieve
C7-8: breathing
(I)
may need (A) to clear secretions
C7-8: ADL care
some assist to (I)
C7-8: pressure relief
(I)
C7-8: transfers
(I)
may require assist b/w uneven surfaces
- ex: “pop over transfer”
C7-8: bed skills
(I)
may require adaptive equipment
- bed rail, leg loops
C7-8: wc mobility
(I) in pressure relief
(I) manual wc propulsion indoors and level outdoors
partial (A) uneven terrain
benefit from plastic coated rims and/or power assis
assist need dictated by contextual factors
C7-8: standing/amb
some (A) to (I) standing
amb not indicated
- would need orthoses and hang on Y ligs
not necessarily functional
C7-8: driving
(I) w adaptive controls
C7-8: home health aide needs?
may need up to 8hrs /day of personal/ home care
T1-12 key ms
intercostals
long ms of back
- sacrospinalis
- semispinalis
abs (T7-12)
T1-12: breathing
clearing secretions (I)
compromised vital capacity and endurance
T1-12: ADL care
(I)
T1-12: bed mobility
(I)
T1-12: transfers
(I) level and non level
(I) floor to chair
T1-12: wc mobility
(I) w manual indoors and outdoors
T1-12: standing
(I)
T1-12: amb
physiological standing and amb for exercise in home w lofstrand and KAFO
- typically not functional
why would we do standing/amb in a pt T1-12 if it isn’t funcitonal
mental health and emotional
physio benefits
- WBing –> loading bone
- improved circulation
- stretch and dec tone
T1-12: driving
(I) w hand controls
T1-12: home health aide needs?
may need up to 3hrs / day of personal/home care
L1-3. key ms
gracilis
iliopsoas
quad lumborum
rectus fem
sartorius
(hip flexors)
what is a key funcitonal implicaiton of L3 innervation
knee ext (rectus fem)
L1-3: breathing
intact respiratory function
L1-3: transfers
(I)
L1-3: wc mobility
(I) manual indoors and outdoors
L1-3: standing
(I)
L1-3: amb
some (A) to (I) amb for home short distances w loftstrand crutches and KAFO or AFO depending on innervated ms
L1-3: driving
(I) w hand controls
L1-3: home health aide needs
may need up to 2hrs / day of personal/home care
what is a consideration of the AFO chosen for L1-3
depends on ms innervation
- AFO vs KAFO
if have rectus fem, can use an AFO set to ensure stability of knee by positioning ankle so that knee isn’t hyper-ext
when would someone w L1-3 opt for a manual wc over amb
to keep up
preserve energy
prevent injury to legs
community setting
have to weigh benefits vs energy expenditures
L5-S1 key ms & specific level of innervation
quad (L4)
hamstring (L5-S1)
gastroc (S1)
glut med and max (L5-S1)
extensor digitorum
post tib
peroneals
flexor digitorum (L5-S1)
what functional implications do the key ms innervated by L4-S5 have
hip ext & ankle ms –> more functional amb
could opt for cane bc more control of hip ext ms and don’t have to hang on Y ligs
L4-S5: transfers
(I)
L4-S5: wc mobility/usage
(I) L4 may elect to use wc for long distances
L4-S5: standing
(I)
L4-S5: amb
functional
inc ability for community distance
(A) to (I) w amb home and community w loft strand crutches, cane, and AFOs
L4-S5: driving
(I) w hand controls
some functional w foot controls
L4-S5: home health aide needs?
may not be in need of any personal / home care
