SCI prognosis Flashcards
C2/3
ventilator dependent, speak on= inspiration, expiration, both function, verbally independent, independent swallow, physically dependent, 24 hour care, assistive technologies (voice/switch)- restricted head control: neck flexion/ ext/ rotation/ side flex. wheel hairs must have high back supports and a saftey belt which is able to stablize the body and is available for reclining or tilting position.
C4
respiratory: likely to wean off ventilator in the day, function same as C1-3
shoulder retraction, shoulder girdle stabilisation, good head control. elbow flex and deltoid muscles are moderately powerful in C4. static wrist orthosis can be used to maintain the normal position of the hand and wrist and reduce the risk of contractures and deformities.
C5
respiration= independent, standing- high support electric standing frame, mobility= power wheelchair with joystick control and wrist stabilisers/ power assist/ self-propelling
(with wrist supports and adapted aids) able to carry out feeding/drinking/grooming activities), partial innervation of all muscles of Sh (lat dorsi, elbow flex, supination). ROM and stretching exercises are important to prevent elbow flex and supination contractures. transfer= dependent, need assistance with ADLs
can raise arms and bend elbows
C6
Independent grooming, showering with equipment and environmental adaptation and dressing in bed (fatigue and time taken are limiters), independent intermittent catheterisation, meal prep and light domestic activities. active wrist ext is possible and hand grip can be achieved with a tenodesis effect. usually independent in activities such as nutrition, care and hygiene and dressing for UL. dynamic triceps orthosis is helpful for reading, books, eating, teeth and hair care activities in the case of weak proximal muscles and strong distal muscles. transfer= transfer board.
C6- bed mobility and transfers
Independent bed mobility using electrically profiling bed, level transfers with board mobility, lightweight wheelchair with rubbersied hand rims, advanced wheelchair skills, wheelchair sports
C6- standing and driving
standing- grandstand/ electric OSF, driving= automatic car with hands- radial wrist ext (tenodesis grip/release, good scap/ GHJ control, pronation
C7
independent self-care in bed
mobility and transfers= independent split level transfers, explore floor to wheelchair
standing- electric OSF
elbow ext, strong wrist flex, radial wrist flex, PIP and DIP flex, MCP extension, thumb ext and thumb abduction.
patients independent in ADLs except LL dressing.
C8-T1
function- independent bowel management, standing- electric OSF (for shoulder protection)
forearm pronation, ulnar deviation, MCP flex, PIP and DIP ext, finger add/abd, thumb flex, opposition and adduction
should be able to grasp and release objects
T2-T6
full arm function, partial trunk stability, improved endurance due to increased respiratory capacity
all muscles of ULs, partial innervation of intercostals, partial abdominal, long muscles of the back (sacrospianlis and semi spinalis)
affects chest muscles
T7-T12
moving towards a normal cough as level descends, improving trunk stability and balance as level descends- intercostals fully innervated, abdominals partially to fully innervated.
L1/2
majority of time wheelchair user, explore walking with callipers and crutches= potential complications, hip flex contractures, shoulder pain/ carpal tunnel from crutch walking,
hip flex and hip abd
L3
wheelchair for convience, energy conservation and sport, ambulate with ankle foot orthoses and crutches, sit to stand with UL assistance, static activities in standing, partial quads (L2-4), knee ext
L5
mobility- ambulating with in shoe orthoses +/- walking sticks, ankle eversion, hip abd, hip IR, hip ext, hip ER, knee flex, toe ext, first toe ext
S1-3
mobile independently, bladder, bowels and sexual function remain disrupted, PF and toe flex
L4
wheelchair for long distance/ outdoor mobility, ambulating with ankle support, insoles and walking sticks, flexed gait pattern, positive trendelenburg, explore foot pedal driving- hamstrings- knee flex, ankle DF and INV, ER hip, partial tib ant
S3-S5
mobile independently, bladder, bowels and sexual function remain disrupted, cauda equina pain+cramp
acute stage rehabilitation
6-12 weeks bed period to stabilise patients neurological state. aim is to prevent complications that may occur long term. passive exercises should be done= resolve contractures, muscle atrophy and pain. positioning is important= protect the articulary structure and maintain the optimal muscle tone. Orthosis used for ankle foot, knee-ankle, static. Stretching should be done to protect the tenodesis effect
isometric, active or active assisted truncal exercises should be done in patients bed if partial movements are present
breathing exercises to protect lung capacity
tilt table to practice sitting unsupported on end of bed= important for transfers- practie sitting balance- static and dynamic
what is important for complete paraplegia in early stage
strengthening of upper extremities to the maximal level in the acute period. empowering exercises for shoulder rotation are proposed for using crutches/ swimming. strong UL needed for transfers. should be activated ASAP.
how to prevent ulcers- Acute stage
posisition changed every 2-3 hours. hip flex contractures- from lying on side or sitting in wheelchair.
chronic stage- ambulation
patents with an injury above T10= ambulate for exercise, T11-L2= ambulate in home (domestic), L2= social
patients with pelvic control can walk with an orthosis or crutches outside the parallel bars. if quad strength is normal= walk with elbow crutches and orthosis- no wheelchair.
patients with complete C8-T12= walk with parawalker
reciprocating gait orthosis- for effective use patients excess weight reduction and increased aerobic capacity must be maintained and muscle mass increased. this has been deeveloped into ARGO
chronic stage
restore psychological state- increased incidence in depression and PTSD
break down of different levels of thoracic spinal cord injuries
T1-5 affects muscles, upper chest and mid-back and abdominal muscles. helps to control rib cage, lungs, and diaphragm. arm function normal
T6-12- affects abdominal and back muscles- important for back and posture
