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Neuro 2 > SCI Prognosis > Flashcards

SCI Prognosis Flashcards

1
Q

Which SCI classification has more predictable prognosis

A

Motor complete SCI - AIS A sometimes B

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2
Q

C1-3 SCI Expected Functional Outcome

A
  • dependent/total A mobility and self care
  • possibly independent with power WC
  • ventilator or phrenic nerve stimulator
  • directs care
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3
Q

C4 SCI Expected Functional Outcome

A
  • Dependent/total A with mobility and self care
  • Assitance for ADLs with use of mobile arm support or other AE.
  • maybe on ventilator depending on phrenic nerve innervation
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4
Q

C5 SCI Expected Functional Outcome

A

now we can start talking about different levels of assistance for mobility
- mobile arm support for UE ADLs
- min-mod A LE dressing
- min-mod A rolling
- dependent/total A transfers
- independent power WC mobility in the community.
- manual cough assist.

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5
Q

C6 SCI Expected Functional Outcome

A

getting more independence and can now start working with a manual WC skills
- independent slide board transfers
- independent rolling and unsupported sitting
- Mod I with AE for self care
- some assistance for dressing for efficiency
- Manual WC independence is possible with adapted rims in the house since they don’t have grip yet
- Independent manual cough
- probably power WC in community

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6
Q

C7 SCI Expected Functional Outcome

A
  • independent seated self care with likely AE
  • independent transfers without slide board and including floor and un level surfaces
  • independent stowing of Manual WC into the car.

they have triceps now so lots more ability

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7
Q

C8 SCI Expected Functional Outcome

A
  • independent transfers including floor and unlevel surfaces
  • independent toilet/tub transfers
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8
Q

T1-5 SCI Expected Functional Outcome

A
  • curb negotiation with wheelies
    WC sports participation
  • independent car transfers
    T levels you have full UE function and grip so doing more advanced WC skills and recreational activities
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9
Q

T6-8 SCI Expected Functional Outcome

A
  • supervision with walker and KAFOs at home.
  • Manual WC for community mobility
    starting KAFO training if they meet eligibility requirements!
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10
Q

T9-12 SCI Expected Functional Outcomes

A
  • independent floor and tub transfers
  • independent household ambulation with KAFOs
  • manual WC for community mobility
    now we get some core innervation so can really push floor transfers.
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11
Q

T12-L3 SCI Expected Functional Outcome

A
  • independent with gait and forearm crutches and KAFOs
  • may be community ambulator or use Manual WC for energy conservation
    may or may not start walking in community, it depends
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12
Q

L4-5 SCI Expected Functional Outcome

A
  • likely community ambulatory with bracing (AFOs) and possibly assistive devices
  • presenting more like LMN injury
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13
Q

Prognosis based on ASIA classification for gait post SCI?

A

AIS A - poor
AIS B - 33% but variable
AIS C - 75% - def getting them up to walk
AIS D - 100% - DEF walking

Incomplete injuries = restorative gait training (neuroplasticity principles)
Complete injuries = compensatory gait training (KAFOs)

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14
Q

What are positive prognostic indicator for locomotor recovery post SCI

A
  • Age less than 65
  • Lower extremity motor function (any) but specifically L3 and S1
  • Pinprick sensation sparing (bc ALS runs real close to CST) and specifically L3 and S1
  • AIC C or D classification
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15
Q

What kind of PT for injuries above L1?

A

Above L1 = UMN injury = follows recovery patterns for CNS damage like CVA or TBI = experience dependent principles of neuroplasticity

PT SHOULD INCLUDE TASK SPECIFIC, REPETITIVE, HIGH INTENSITY STEPPING TRAINING

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16
Q

What kind of PT for injury below L1?

A

Below L1 - LMN injury = follows recovery pattern for PNS damage = time for regrowth of peripheral nerves is about 1-2mm/day so really slow growth.

PT SHOULD ACCOMMODATE FOR DEFICITS TO MAXIMIZE FUNCTIONAL INDEPENDENCE LIKE WITH BRACING our PT will not change nerve growth

17
Q

What kind of gait training for incomplete SCI

A

RESTORATION - application of experience dependent principles of neuroplasticity

  • focus on neurological recovery of walking function
  • use different modalities like overground, treadmill, robotics, stairs
18
Q

Different manual WC types

A

Rigid
Folding manual
Manual tilt in space

19
Q

Rigid manual wheelchairs

A

For full time independent Manual WC users
- usually lower level complete injuries

20
Q

Folding manual wheelchairs

A

For part time independent MWC users (some ambulation ability) or Manual WC users who may require assistance.

Neuro 2 (8 decks)

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