SCI pt function Flashcards
Key muscles intact with high cervical injuries (C1-4)
- face and neck muscles
- CN innervation
- partial innervation of diaphragm if C3-4 injury
available motions for high cervical injuries (C1-4)
- talking
- mastication
- sipping
- blowing
- scapular elevation
Functional capabilities for high cervical injuries (C1-4)
- ADLs → dependent
- independent to direct care
- Dependent bed mobility and transfers
- independent to direct care
- Mod I with pressure relief in chair
- dependent in bed but can direct care
- Wheelchair mobility
- Mod I with PWC using mouth controls
required equipment for high cervical injuries (C1-4)
- PWC with appropriate driving control adaptations
- portable ventilator (C1-2/3)
- Hospital bed with air mattress
- Hoyer lift
- Bathroom DME (TIS shower chair)
High cervical injuries (C1-4) respiratory function
- C1, 2, 3 will be ventilatory dependent
- removes ability to vocalize → adaptive equipment for communication needed
- may elect for phrenic nerve stimulator placement
- C4 should be able to eventually wean off vent
- weak cough, often need cough-assist
- may be able to use CN 9 breathing to assist with cough as well
high cervical injuries care requirements
- around the clock care → will require 1-2 caregivers
- huge burden on family
- dependent for driving
key muscles intact with C5 injuries
- biceps
- brachialis
- brachioradialis
- deltoid
- infraspinatus
- rhomboids
- supinator
available motions for C5 injuries
- elbow flexion and supination
- shoulder ER
- shoulder ABD and flexion to ~90
Functional capabilities for C5 injuries
- ADLs → min A (setup) for feeding and grooming with adapative equipment
- dependent for bathing, bowel/bladder
- Max A bed mobility
- dependent transfers (independent to direct care)
- Mod I pressure relief in PWC, in bed they can direct care
wheelchair mobility for C5 injuries
- Mod I with PWC with use of hand controls
- Mod I short distances/levels and smooth surfaces with MWC
- some to total assist outdoors
required equipment for C5 injuries
- PWC w/appropriate driving control adaptations
- may have lightweight MWC but will need increased trunk supports
- may have power asssit push rims
- hospital bed with air mattress
- hoyer lift
- bathroom DME (TIS shower chair)
- mobile arm supports, adapative ADL equipment, wrist supports with cuffs
key muscles intact with C6 injuries
- ECR
- infraspinatus
- latissimus dorsi
- pec major (clavicular portion)
- pronator teres
- SA
- teres minor
available movements for C6 injuries
- shoulder flexion, extension, ER, IR, and adduction
- scapular ABD, protraction, and UR
- forearm pronation
- wrist extension
ADL functional capabilities for C6 injuries
- Mod I with adapative equipment for feeding, grooming
- Mod I UB dressing, assistance for LB
- likely require assist for bowel/bladder
Functional capabilities and bed mobility in C6 injuries
- Mod I bed mobility with hospital bed components, leg loops
- min A → mod I with level surface transfers
- assistance needed with uneven surface transfers
- Mod I pressure relief in PWC
- mod-max A for pressure relief in bed
wheelchair mobility C6 injuries
- Mod I PWC
- mod I MWC on smooth surfaces and low-grade ramps
- assistance with uneven surfaces, D curbs
required equipment for C6 injuries
- PWC with appropriate driving control adapations
- Lightweight MWC
- Hospital bed w/air mattress
- Slideboard
- Bathroom DME (upright shower chair)
- Adaptive ADL equipment, universal cuffs, tenodesis splints
respiratory function for C5-6 injuries
cough remains weak → will require cough assist
Driving and living conditions for C5-6 injuries
- Should be able to learn driving techniques in van with hand controls and additional adapative electronics
- slideboard for car transfers, assist requried
- C6 may be able to live w/o assistance if well motivated
key muscles intact with C7 injuries
- extensor pollicis longus and brevis
- extrinsic finger extensors
- flexor carpi radialis
- triceps
available movements for C7 injuries
- elbow extension
- wrist flexion
- finger extension
functional capabilities for C7 injuries
- ADLs → Mod I
- Mod I bed mobility (even transfers)
- min-mod I uneven transfers
- independent with pressure relief
- Mod I MWC househould and community → may need asssit with high-grade ramps, curbs
required equipment for C7 injuries
- lightweight MWC
- May not need hospital bed, but still justifiable
- slideboard (uneven surface)
- Bathroom DME (upright shower chair)
- Adpative ADL equipment
respiratory function in C7 injuries
indpendent with cough and secretion clearance
Driving capabilities in C7 injuries
- can progress to standard automobile (heigh-dependent) with installed hand controls and specialized electronics
- slideboard for car transfers, assist required
- can get wheelchair in/out of car
key muscles intact with C8 injuries
- extrinsic finger flexors
- flexor carpi ulnaris
- flexor pollicis longus and brevis
- intrinsic finger flexors
available movements gain in C8 injuries
finger flexion
Functional capabilities for C8 injuries
- ALDs → mod I
- Mod I bed mobility, even transfers
- minA - mod I uneven transfers
- Independent pressure relief
- Mod I MWC household and community
- may need assist with high-grade ramps, curbs
- Assist with floor to wheelchair transfers
required equipment for C8 injuries
- Lightweight MWC
- May not need hospital bed (but still justifiable)
- slideboard (uneven surfaces)
- bathroom DME (upright shower chair)
Driving and home for C8 injuries
- independent in car with hand controls alone
- slideboard for car transfers, should be able to perform mod I
- independent at home except for heavy work
key muscles intact with Thoracic Injuries (T1-12)
- intercostals
- long muscles of back (sacrospinalis, semispinalis)
- Abdominals (~T7 and below)
available movements for Thoracic (T1-12) injuries
- improved trunk control with more caudal SCI
- increased respiratory reserve
- pec girdle stabilization for lifting
functional capabilities for Thoracic (T1-12) injuries
- ADLs → independent/Mod I
- Mod I bed mobility, even and uneven transfers
- Independent with pressure relief
- Mod I MWC household and community, including ramps and curbs
- light assist to mod I floor transfers
Ambulation in Thoracic (T1-12) injuries
- T1-9 no functional ambulation expected
- T10-11 → short distance with assist H/KAFOs may be possible
- T12 → may reach Mod I short distances with H/KAFO
required equipment for Thoracic (T1-12) Injuries
- lightweight MWC
- Orthotics (HKAFO, KAFO)
- AD (RW, forearm crutches most common)
- Bathroom DME (tub chair, shower bench)
key muscles intact with L1-3 injuries
- iliopsoas
- gracilis
- quadratus lumborum
- rectus femoris
- sartorius
available movements with L1-L3 injuries
- Hip flexion and ABD
- knee extension (some)
functional capabilities with L1-L3 injuries
- Ambulation
- Mod I short distances with KAFO, RW/FC → but still largely non-functional
- still often end up preferring MWC, especially in community
required equipment for L1-L3 injuries
- lightweight MWC
- Orthotics (HKAFO, KAFO)
- AD (RW, forearm crutches most common)
key muscles intact with injuries L4 and down
- Quadriceps (L4)
- Anterior tibialis (L5)
- Hamstrings (L5-S1)
- Gastrocnemius (S1)
- Glute Max and Med (L5-S1)
- Extensor digitorum (L5-S1)
- Posterior tib (L5-S1)
- Flexor digitorum (L5-S1)
available movements in injuries L4 and down
- strong hip flexion
- strong knee extension
- knee flexion
- ankle DF/PF
- ankle eversion
- toe extension
functional capabilities for injuries L4 and down
- Ambulation
- mod I household and limited community
- L4 may still use MWC for community
required equipment for injuries L4 and down
- lightweight MWC
- orthotics (AFO)
- AD (forearm crutches, cane)
