SCI - Injury Levels & Outcomes

Question 1

SCI Injury Levels & Outcomes C1-3
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 1

Functionally Relevant Muscles Innervated: SCM, C/S paraspinals, Neck accessories

Possible Movement: Neck flex, ext, rot

Patterns of Weakness: Total paralysis of trunk, UE/LE’s; Ventilator-dependent

Question 2

SCI Injury Levels & Outcomes C4
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 2

Functionally Relevant Muscles Innervated: Upper Traps, Diaphragm, C/S paraspinals

Possible Movement: Neck flex, ext, rot; Scap elevation; inspiration

Patterns of Weakness: Total paralysis of trunk, UE/LE’s; inability to cough 20 lack of intercostals

Question 3

Functional Difference between C1-3 & C4:

Answer 3

Not ventilator-dependent, but ↑↑ risk for respiratory compromise
Ability to verbalize & talk

Limited shoulder movements
Some scapular muscles are available, but only partially innervated
Supraspinatus, infraspinatus, teres major, rhomboids

Question 4

SCI Injury Levels & Outcomes C5
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 4

Functionally Relevant Muscles Innervated: Deltoids, Biceps, Brachialis, Brachioradialis, Rhomboids, Serratus Anterior (partial innervation)

Possible Movement: Shoulder flex/abd/ext; elbow flex/sup; scapular add/abd

Patterns of Weakness: Lack elbow ext/pron, all wrist/hand mvts, total paralysis of trunk/LE’s

Able to incorporate shoulder girdle into balance and mobility tasks

Question 5

C5 at risk for

Answer 5

Secretion management is still key b/c of the lack of intercostals and abdominals for an effective cough

Also at risk of elbow flexion/forearm supination contractures
Splinting, positioning, pt/caregiver education!!!

Question 6

C5 and ADLs and Transfers

Answer 6

Able to perform w/c transfers with max assist via a sliding board

Can propel a w/c short distances with the use of lateral projections, but with high energy cost

Question 7

SCI Injury Levels & Outcomes C6
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 7

Functionally Relevant Muscles Innervated: Pect (clavicular head), ECRL/B, Lats, SA

Possible Movement: Scap protraction, horizontal adduction, forearm supination, radial wrist extension

Patterns of Weakness: Absent elbow extension, wrist flex, hand mvts; total paralysis of trunk/LE’s

Question 8

C6 and ADLs and Transfers

Answer 8

ECRL/ECRB allows for stabilization of wrist 🡪 ability to grasp/lateral pinch via tenodesis

Need full elbow extension to get scapular depression (propping, WS, scooting, transfers, etc)

Independent transfers become possible after setup
Will still require adapted w/c

Question 9

What is the massive difference between C6 and (C7-C8)

Answer 9

Elbow extension

Question 10

SCI Injury Levels & Outcomes C7
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 10

Functionally Relevant Muscles Innervated: Lats, sternal pect, triceps, pronator quadratus; ECU, FCR, FDP/S, EC, abductor pollicis; lumbricals [partially innervated]

Possible Movement: Elbow ext, ulnar/wrist ext, wrist flex, finger flex/ext; thumb flex/ext/abd

Patterns of Weakness: Limited grasp release & dexterity; total paralysis of trunk/LE’s

Question 11

C7 and C8, ADLs and Transfers

Answer 11

Good probability for independent transfers, bed mobility, w/c mobility and most aspects of independent living in an adapted apartment with assistive devices

Without full respiratory accessory muscles, may still be at risk for respiratory complications

C8 has partial innervation of intrinsics
“Intrinsic Minus” hand – active finger flex/ext, but lack lumbricals -> clawed hands

Question 12

SCI Injury Levels & Outcomes T1-9
Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 12

Functionally relevant muscles innervated: Hand intrinsics, intercostals, erector spinae; flexor/extensor/abductor pollicis

Possible Movement: UE fully intact; limited upper trunk stability; endurance ↑ 20 innervation of intercostals

Patterns of weakness: Lower trunk paralysis; Total paralysis LEs

Question 13

T1-9, ADLs and Transfers

Answer 13

Independent in w/c wheelies to negotiate curbs/stairs

Ambulation with H/KAFOs can be attempted, but not functional

Question 14

Trunk control difference between T1-T6 and T7-T9

Answer 14

T1-T6: Partial innervation of intercostals & erector spinae, but still lack stable trunk control

T7-T9:
Intercostals, upper abs & erector spinae
Can use abdominals as hip flexors to assist ambulation
Functional ambulation rare due to high energy cost

Question 15

SCI Injury Levels & Outcomes T10-L1

Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 15

Functionally relevant muscles innervated: Fully intact intercostals; external obliques; rectus abdominis

Movement possible: Good trunk stability

Patterns of weakness: Paralysis of LE’s

Completely normal vital capacity, (I) w/c mob & mgmt indoor/outdoor

Question 16

SCI Injury Levels & Outcomes L2-S5

Functionally Relevant Muscles Innervated:
Possible Movement:
Patterns of Weakness:

Answer 16

Functionally relevant muscles innervated: Fully intact abs & all other trunk muscles; some LE muscles pending level of injury

Movement possible: Good trunk stability; Partial to full control lower extremities.

Patterns of weakness: Partial paralysis of LEs, hips, knees, ankle, foot

L2-L4 a lot are incomplete so you do not see a lot a issues

Question 17

L2, L3 What in innervated and ambulation

Answer 17

L2: Partial innervation of hip adductors (gracilis), rectus femoris and quadratus lumborum ↓ the energy cost of walking, but KAFOs & a walker or LSCs are still required

L3: Same ms available, but now with full innervation

Question 18

L4, L5. S1-S2What in innervated and ambulation

Answer 18

L4: Weak hip abductors & external rotators, weak hamstrings, peroneals, tibialis anterior

L5:
Gastroc & Soleus innervated
Weak innervation of Gluteus Maximus
Ambulation with AFOs only becomes possible

S1-2: Foot muscles and intrinsics partially innervated