SCI Flashcards
Central Cord Syndrome
- Motor weakness UE>LE
- Loss of movement and sensation (pain + temperature)
Anterior Cord Syndrome
- Loss of motor, pain, and temperature
Brown-Sequard Syndrome
- Ipsilateral loss of motor and propioception
- Contralateral loss of pain and temperature beginning a few dermatomes below the lesion
Orthostatic hypotension
- Symptoms: Lightheaded, dizzy, ringing in ears, double vision
- Signs: Pallor of the face or lips, sweating, LBP
- Check for TEDS, compression ace wraps or binder
- Check for order of Midodrine (brings up BP)
- Lay patient down
Autonomic Dysreflexia
- Symptoms: Sudden pounding headache, nasal congestion, chills, blurred vision
- Signs: High BP, low pulse, blotchy skin above level of injury, goosebumps, profuse sweating above level of injury
- What to do: Sit patient up, remove compression garment
DVT
- Signs & symptoms: Pain, warmth over involved area, redness, swelling
Pulmonary Embolus
- Symptoms: SOB, tachycardic, chest pain, blue tinge to fingers, toes, or lips
- IMMEDIATE medical attention needed
UTI
- Signs & Symptoms: Fever, chills, pain with urination, increased spasticity
Important Functional Tools for SCI Patients
- FIM
- Wheelchair Skills test
- Walking Index for SCI
- Spinal cord injury functional ambulation inventory (SCI-FAI)
C1-C3 Muscles and Available Moments
- Muscles: CN VII Facial Muscles; First 6 segments of cervical spine; SCM (voluntary); Trapezius
- Available moment: Talking, Mastication, Sipping, Blowing, Ventilator Dependent
C1-C3 Bed Mobility
Dependent 1-2 people; should be able to direct
C1-C3 Transfers
Dependent 1-2 people via hoyer or football transfer; may need cervical collar or individual to assist with lines, tubes, head control
C1-C3 Wheelchair Mobility
Household mobility via power wheelchair with power seat functions
C1-C3 Functional Goals
- Independent mobility of power wheelchair with head control or sip n’ puff
- Independent communication and use of environmental control unit and computer mouth stick, scanner, or eye gaze
C4 Key muscles & Available moment
- Muscles: Facial muscles, neck muscles, diaphragm, full trapezius
- Available moment: Respiration, scapular elevation, ventilator weaning but will need assisted cough
C4 Bed mobility
- Dependent 1-2 people; should be able to direct
C4 transfers
- Dependent 1-2 people via hoyer or football transfer; may need cervical collar or individual to assist with lines, tubes, head control
C4 wheelchair mobility
- Household mobility via power wheelchair with power seat functions
C5 Muscles and available moment
- Muscles: Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboids, supinator
- Available moment: Shoulder ER, Shoulder abduction to 90 degrees, limited shoulder flexion, elbow flexion, supination, cough assist
C5 bed mobility
Max assist (use momentum, hook elbow onto ladder/rail
C5 transfers
Max assist - dependent*1 via hoyer or slideboard transfer
C5 wheelchair mobility
- Household mobility in ultralight manual wheelchair with projection rims
- Community mobility in power wheelchair
Additional functions that C5 SCI can perform
- Computer use with typing stick in u-cuff, adapted keyboard, or voice activation
C5 Functional Goals
- Independence w/ eating, tooth brushing, and some ADLs with set up and equipment
- Bed mobility: mod A with hospital bed & equipment
- Assistance prone push transfers
- Independence with community mobility in power wheelchair
- Independence with short distance house hold mobility in manual wheelchair
- Independence with hook and lean for pressure relief
C6 Muscles & Available moment
- Can almost be totally independent
- Muscles: ECR, pronator teres, infraspinatus, lats, pec major, serratus anterior, teres minor
- Available moment: Shoulder flexion, extension, IR, adduction; scapular abduction & IR; forearm pronation; wrist extension w/ tenodesis grasp; cough assist
C6 bed mobility
Max assist (use momentum, hook elbow onto ladder/rail
C6 transfers
- Can vary from dependent to hoyer
- Max A to CTG via slideboard
C6 Wheelchair mobility
- Household mobility in ultralight manual wheelchair with projection rims
- Community mobility in power wheelchair
C6 functional goals
- Independent with ADLs, require assistance w/ dressing b/c energy expenditure
- Independence with bed mobility on firm surfaces
- Independence with transfers on level surfaces
- Independent manual wheelchair mobility level surfaces
C7 muscles & available moment
- Muscles: EPL, EPB, extrinsic finger extensors, FCR, triceps
- Available moment: Elbow extension, wrist flexion, finger extension
C7 bed mobility
Min A - Mod A - use momentum or bedrail
C7 transfers
- Can vary from dependent to hoyer
- Min A to supervision via slideboard
C7 wheelcahir mobility
- Household mobility in light weight manual wheelchair
- Depending on UE status, age, weight, and level of activity, certain patients may be in power wheelchairs
Functional goals for C7
- Independent bed mobility w/out equipment
- Independent transfers for all surfaces
- Independent pressure relief
- Independent manual wheelchair propulsion (may need some assistance with uneven terrain)
- Independent dressing and self ROM
Treatment considerations for C7
- Shoulder & elbow injuries
- Use of FES
- Shoulder taping
- Strengthening activities
- Modalities
- Swimming
C8-T1 Muscles & available moment
- Muscles: Extrinsic finger flexors; FCU; FPL; FPB; Intrinsic finger flexors
- Available Moment: Full innervation of UE muscles including fine motor skills and strong grasp
C8-T1 bed mobility
Can vary from min A to independent
C8-T1 transfers
Can vary from mod A to independent with slideboard
C8-T1 wheelchair mobility
- Household mobility in ultralight weight manual wheelchair
- Community mobility in power wheelchair
C8-T1 Functional Goals
- Independence with transferring wheelchair in and out of vehicle
- Independence with ADLs and bowel and bladder management
T2-T6 Muscles & anticipated outcome
- Muscles: Corresponding to level of injury - partial intercostals, back muscles
- Available moment: Full UE muscle strength (grip + fine motor); intercostal assistance for breathing; postural back muscles
T2-T6 bed mobility
Min A to independent
T2-T6 transfers
Mod A to independent with slideboard
T2-T6 wheelchair mobility
- Household mobility in ultralight manual wheelchair
- Community mobility in power wheelchair with power seat functions
T7-T12 muscles & anticipated outcome
- Muscles: Corresponding to level of injury - intercostals, abdominals, back muscles
- Available moment: Full UE strength (grip + fine motor), intercostal assistance for breathing; postural back and abdominal muscles
T7-T12 bed mobility
Independent without bedrail
T7-T12 transfers
Independent via slideboard or squat pivot
T7-T12 wheelchair mobility
Household and community in light weight manual wheelchair
T7-T12 Ambulation clinical criteria
- Musculoskeletal integrity
- Motivation/commitment
- ROM
- Spasticity
- Tolerance to upright
- Cognition
- Balance
L1-L3 muscles & available moment
- Muscles: Gracilis, iliopsoas, sartorius
- Available moment: Hip flexion, adduction
L1-L3 bed mobility
Independent without bedrail
L1-L3 transfers
Independent via squat pivot
L1-L3 wheelchair mobility
Household and community mobility in light weight manual wheelchair
L1-L3 ambulation
Can vary from independent to mod A for household ambulation with bracing and assistive device
L4-L5 muscles & available moment
- Muscles: QL, sartorius, ED, quads, medial hamstring, posterior tib, anterior tib, low back muscles
- Available moment: strong hip and knee flexion, weak knee extension
L4-L5 bed mobility
Independent without bedrail
L4-L5 transfers
Independent via squat pivot transfer
L4-L5 wheelchair mobility
Household and community mobility in light weight manual wheelchair
L4-L5 ambulation
With household and short-mod community ambulation with bracing as needed and assistive device
