SCI Prognosis Flashcards
Which SCI classification has more predictable prognosis
Motor complete SCI - AIS A sometimes B
C1-3 SCI Expected Functional Outcome
- dependent/total A mobility and self care
- possibly independent with power WC
- ventilator or phrenic nerve stimulator
- directs care
C4 SCI Expected Functional Outcome
- 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
C5 SCI Expected Functional Outcome
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.
C6 SCI Expected Functional Outcome
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
C7 SCI Expected Functional Outcome
- 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
C8 SCI Expected Functional Outcome
- independent transfers including floor and unlevel surfaces
- independent toilet/tub transfers
T1-5 SCI Expected Functional Outcome
- 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
T6-8 SCI Expected Functional Outcome
- supervision with walker and KAFOs at home.
- Manual WC for community mobility
starting KAFO training if they meet eligibility requirements!
T9-12 SCI Expected Functional Outcomes
- 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.
T12-L3 SCI Expected Functional Outcome
- 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
L4-5 SCI Expected Functional Outcome
- likely community ambulatory with bracing (AFOs) and possibly assistive devices
- presenting more like LMN injury
Prognosis based on ASIA classification for gait post SCI?
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)
What are positive prognostic indicator for locomotor recovery post SCI
- 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
What kind of PT for injuries above L1?
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
What kind of PT for injury below L1?
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
What kind of gait training for incomplete SCI
RESTORATION - application of experience dependent principles of neuroplasticity
- focus on neurological recovery of walking function
- use different modalities like overground, treadmill, robotics, stairs
Different manual WC types
Rigid
Folding manual
Manual tilt in space
Rigid manual wheelchairs
For full time independent Manual WC users
- usually lower level complete injuries
Folding manual wheelchairs
For part time independent MWC users (some ambulation ability) or Manual WC users who may require assistance.
