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Neuro 2 > SCI pt function > Flashcards

SCI pt function Flashcards

1
Q

Key muscles intact with high cervical injuries (C1-4)

A
  1. face and neck muscles
  2. CN innervation
  3. partial innervation of diaphragm if C3-4 injury
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2
Q

available motions for high cervical injuries (C1-4)

A
  1. talking
  2. mastication
  3. sipping
  4. blowing
  5. scapular elevation
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3
Q

Functional capabilities for high cervical injuries (C1-4)

A
  1. ADLs → dependent
    • independent to direct care
  2. Dependent bed mobility and transfers
    • independent to direct care
  3. Mod I with pressure relief in chair
    • dependent in bed but can direct care
  4. Wheelchair mobility
    • Mod I with PWC using mouth controls
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4
Q

required equipment for high cervical injuries (C1-4)

A
  1. PWC with appropriate driving control adaptations
  2. portable ventilator (C1-2/3)
  3. Hospital bed with air mattress
  4. Hoyer lift
  5. Bathroom DME (TIS shower chair)
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5
Q

High cervical injuries (C1-4) respiratory function

A
  1. C1, 2, 3 will be ventilatory dependent
    • removes ability to vocalize → adaptive equipment for communication needed
    • may elect for phrenic nerve stimulator placement
  2. 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
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6
Q

high cervical injuries care requirements

A
  1. around the clock care → will require 1-2 caregivers
    • huge burden on family
  2. dependent for driving
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7
Q

key muscles intact with C5 injuries (7)

A
  1. biceps
  2. brachialis
  3. brachioradialis
  4. deltoid
  5. infraspinatus
  6. rhomboids
  7. supinator
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8
Q

available motions for C5 injuries

A
  1. elbow flexion and supination
  2. shoulder ER
  3. shoulder ABD and flexion to ~90
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9
Q

Functional capabilities for C5 injuries

A
  1. ADLs → min A (setup) for feeding and grooming with adapative equipment
    • dependent for bathing, bowel/bladder
  2. Max A bed mobility
  3. dependent transfers (independent to direct care)
  4. Mod I pressure relief in PWC, in bed they can direct care
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10
Q

wheelchair mobility for C5 injuries

A
  1. Mod I with PWC with use of hand controls
  2. Mod I short distances/levels and smooth surfaces with MWC
    • some to total assist outdoors
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11
Q

required equipment for C5 injuries (6)

A
  1. PWC w/appropriate driving control adaptations
  2. may have lightweight MWC but will need increased trunk supports
    • may have power asssit push rims
  3. hospital bed with air mattress
  4. hoyer lift
  5. bathroom DME (TIS shower chair)
  6. mobile arm supports, adapative ADL equipment, wrist supports with cuffs
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12
Q

key muscles intact with C6 injuries (7)

A
  1. ECR
  2. infraspinatus
  3. latissimus dorsi
  4. pec major (clavicular portion)
  5. pronator teres
  6. SA
  7. teres minor
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13
Q

available movements for C6 injuries

A
  1. shoulder flexion, extension, ER, IR, and adduction
  2. scapular ABD, protraction, and UR
  3. forearm pronation
  4. wrist extension
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14
Q

ADL functional capabilities for C6 injuries

A
  1. Mod I with adapative equipment for feeding, grooming
  2. Mod I UB dressing, assistance for LB
  3. likely require assist for bowel/bladder
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15
Q

Bed mobility, transfers, and pressure relief functional capabilities in C6 injuries

A
  1. Mod I bed mobility with hospital bed components, leg loops
  2. min A → mod I with level surface transfers
  3. assistance needed with uneven surface transfers
  4. Mod I pressure relief in PWC
  5. mod-max A for pressure relief in bed
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16
Q

wheelchair mobility C6 injuries

A
  1. Mod I PWC
  2. mod I MWC on smooth surfaces and low-grade ramps
  3. assistance with uneven surfaces, D curbs
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17
Q

required equipment for C6 injuries (6)

A
  1. PWC with appropriate driving control adapations
  2. Lightweight MWC
  3. Hospital bed w/air mattress
  4. Slideboard
  5. Bathroom DME (upright shower chair)
  6. Adaptive ADL equipment, universal cuffs, tenodesis splints
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18
Q

respiratory function for C5-6 injuries

A

cough remains weak → will require cough assist

19
Q

Driving and living conditions for C5-6 injuries

A
  1. Should be able to learn driving techniques in van with hand controls and additional adapative electronics
  2. slideboard for car transfers, assist requried
  3. C6 may be able to live w/o assistance if well motivated
20
Q

key muscles intact with C7 injuries (4)

A
  1. extensor pollicis longus and brevis
  2. extrinsic finger extensors
  3. flexor carpi radialis
  4. triceps
21
Q

available movements for C7 injuries

A
  1. elbow extension
  2. wrist flexion
  3. finger extension
22
Q

functional capabilities for C7 injuries

A
  1. ADLs → Mod I
  2. Mod I bed mobility (even transfers)
  3. min-mod I uneven transfers
  4. independent with pressure relief
  5. Mod I MWC househould and community → may need asssit with high-grade ramps, curbs
23
Q

required equipment for C7 injuries

A
  1. lightweight MWC
  2. May not need hospital bed, but still justifiable
  3. slideboard (uneven surface)
  4. Bathroom DME (upright shower chair)
  5. Adpative ADL equipment
24
Q

respiratory function in C7 injuries

A

indpendent with cough and secretion clearance

25
Q

Driving capabilities in C7 injuries

A
  1. can progress to standard automobile (heigh-dependent) with installed hand controls and specialized electronics
  2. slideboard for car transfers, assist required
  3. can get wheelchair in/out of car
26
Q

key muscles intact with C8 injuries

A
  1. extrinsic finger flexors
  2. flexor carpi ulnaris
  3. flexor pollicis longus and brevis
  4. intrinsic finger flexors
27
Q

available movements gain in C8 injuries

A

finger flexion

28
Q

Functional capabilities for C8 injuries

A
  1. ALDs → mod I
  2. Mod I bed mobility, even transfers
  3. minA - mod I uneven transfers
  4. Independent pressure relief
  5. Mod I MWC household and community
    • may need assist with high-grade ramps, curbs
  6. Assist with floor to wheelchair transfers

(exactly the same as C7 but now adding floor transfers)

29
Q

required equipment for C8 injuries

A
  1. Lightweight MWC
  2. May not need hospital bed (but still justifiable)
  3. slideboard (uneven surfaces)
  4. bathroom DME (upright shower chair)
30
Q

Driving and home for C8 injuries

A
  1. independent in car with hand controls alone
  2. slideboard for car transfers, should be able to perform mod I
  3. independent at home except for heavy work
31
Q

key muscles intact with Thoracic Injuries (T1-12)

A
  1. intercostals
  2. long muscles of back (sacrospinalis, semispinalis)
  3. Abdominals (~T7 and below)
32
Q

available movements for Thoracic (T1-12) injuries (3)

hint: not so much specific movements as general strengths

A
  1. improved trunk control with more caudal SCI
  2. increased respiratory reserve
  3. pec girdle stabilization for lifting
33
Q

functional capabilities for Thoracic (T1-12) injuries (not including ambulation expectations)

A
  • ModI to Independent for ADL’s
  • ModI for Bed Mobility & Transfers
  • Light Assist to ModI for floor to wheelchair transfers
  • Independent with pressure relief
  • ModI for wheelchair including ramps and curbs
34
Q

Ambulation in Thoracic (T1-12) injuries

A
  1. T1-9 no functional ambulation expected
  2. T10-11 → short distance with assist H/KAFOs may be possible
  3. T12 → may reach Mod I short distances with H/KAFO
35
Q

required equipment for Thoracic (T1-12) Injuries

A
  1. lightweight MWC
  2. Orthotics (HKAFO, KAFO)
  3. AD (RW, forearm crutches most common)
  4. Bathroom DME (tub chair, shower bench)
36
Q

key muscles intact with L1-3 injuries (5)

A
  1. iliopsoas
  2. gracilis
  3. quadratus lumborum
  4. rectus femoris
  5. sartorius
37
Q

available movements with L1-L3 injuries

A
  1. Hip flexion and ABD
  2. knee extension (some)
38
Q

functional capabilities with L1-L3 injuries

A
  1. Ambulation
    • Mod I short distances with KAFO, RW/FC → but still largely non-functional
  2. still often end up preferring MWC, especially in community
39
Q

required equipment for L1-L3 injuries

A
  1. lightweight MWC
  2. Orthotics (HKAFO, KAFO)
  3. AD (RW, forearm crutches most common)
40
Q

key muscles intact with injuries L4 and down (8)

A
  1. Quadriceps (L4)
  2. Anterior tibialis (L5)
  3. Hamstrings (L5-S1)
  4. Gastrocnemius (S1)
  5. Glute Max and Med (L5-S1)
  6. Extensor digitorum (L5-S1)
  7. Posterior tib (L5-S1)
  8. Flexor digitorum (L5-S1)
41
Q

available movements in injuries L4 and down

A
  1. strong hip flexion
  2. strong knee extension
  3. knee flexion
  4. ankle DF/PF
  5. ankle eversion
  6. toe extension
42
Q

functional capabilities for injuries L4 and down

A
  1. Ambulation
    • mod I household and limited community
    • L4 may still use MWC for community
43
Q

required equipment for injuries L4 and down

A
  1. lightweight MWC
  2. orthotics (AFO)
  3. AD (forearm crutches, cane)

Neuro 2 (30 decks)

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