SCIs & function

Question 1

C1–C3
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 1

Ms: C = Cervical, so neck muscles must be impaired!
-Sternocleidomastoid
-Cervical paraspinal
-Neck accessory muscles

Movement:
-Neck flexion, extension, & rotation

Patterns of weakness:
-Total paralysis of trunk, UEs & LEs, & dependent on ventilator

Functional Expectations:
-Respiratory: Likely ventilator dependent
-ADL dependent
-Wheelchair mobility: Power WC with alternative control–idependent. Manual wheelchair ought to be a tilt-in-space WC, providing postural support for those who can’t hold themselves up.

Question 2

C4
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 2

Ms:
-Upper trapezius; diaphragm; cervical paraspinal Ms.

Movement:
-Neck flexion, extension, rotation; scapular elevation; inspiration.

Patterns of weakness
-Paralysis of trunk, UEs, LEs, inability to cough/forced expiration, low endurance & respiratory reserves secondary to paralysis of intercostals.

Respiratory:
- Able to be weened off ventilator.

Wheelchair mobility:
- Power WC – Independent with alternative control
- Manual WC – Tilt in space WC – Dependent.

ADLs:
-Dependent

Wheelchair mobility:
-Power wheelchair with *alternative control (sip & puff, or chin control): Independent
-Manual wheelchair: dependent with a tilt-in-space WC (postural support provided

Question 3

Therapy focus for C1-C4 injuries

Answer 3

Pt Education: Teaching patient how to direct their own care.

Caregiver training: Training others on the proper techniques for dressing, hygiene, wheelchair positioning & maintenance.

Question 4

C5
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 4

Ms:
-Deltoid, biceps, brachialis, brachioradialis, rhomboids, serratus anterior (only partially innervated)

Movement possible:
-Shoulder abduction, flexion & extension
-Scapular abduction & adduction
-Elbow flexion & supination

Patterns of weakness:
-Absence of elbow extension & pronation, all wrist & hand movement, & total paralysis of trunk & LEs.

Functional expectations:
-Respiratory: May require assistance to clear secretions
-ADLs:
*Feeding: setup
*Grooming: Partial to total assist
*Dressing: UEs = partial assist; LEs = total assist
*Toileting: total assist
*Bathing: total assist
*WC mobility: Power WC for community mobility. Manual WC–adapted WC on level surfaces; may require total A outdoors.

Question 5

Adaptive equipment for C5 injury?

Answer 5

For feeding:
*U-cuff with dorsal wrist support, with fork attachment.
*Plate guard.
*Mobile arm support.

For dressing:
*Buttoner zipper pull

Question 6

C6
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 6

Ms:
-Clavicular pectoralis supinator (superior pec major); extensor carpi radialis longus & brevis; serratus anterior; latissimus dorsi.

Movement possible:
-Scapular protraction; some horizontal adduction, forearm supination, & radial wrist extension.

Patterns of weakness:
-Absence of wrist flexion, elbow extension, & hand movement; total paralysis of trunk & LEs.

Functional Expectations:
ADLs
*Feeding: Setup to independent

*Grooming: partial A to independent

*Dressing:
–UE: Independent
–LE: Partial A to independent

*Bowel Management: Partial A to independent

*Bladder management: Partial A to independent

*Bathing:
–Upper body: independent
–Lower body: partial A to independent

*WC Mobility:
–PWC: Independent
–MWC: Partial A to I with custom setup.

*Transportation:
–Can independently load WC into vehicle & drive

Question 7

Adaptive Equipment for C6

Answer 7

-Built up handle utensils
-Rocker knife
-U-cuff
-Button hook
-Steering wheel knob adaptation

To assist general hand weakness, & absence of wrist flexion & elbow extension.
-WC motorized loader into car

Bathing:
-Tub transfer bench or rolling shower commode

Question 8

C7–8
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 8

Ms:
-Latissimus dorsi; sternal pectoralis; triceps; pronator quadratus;
extensor carpi ulnairs; flexor carpi radialis; flexor digitorum profundus & superficialis; extensor collective; pollicis collective; lumbricals.

Movement possible:
- Elbow extension
- Wrist extension
- Finger flexion/extension–thumb flexion/extension/abduction.

Patterns of weakness:
– Paralysis of trunk & LEs;
– Limited dexterity/intrinsic muscles of the hand

Functional expectations:
* ADLs
–Feeding: I
–Grooming: I
–Dressing: UE, I. LE, partial A to I.
* Bowel management:
–Partial A to I
* Bladder management:
–Partial A to I
* Bathing:
–UD: I
–LE: Partial A to I

WC Mobility:
– Manual = I

Transportation:
– I with Car if able to transfer.

Question 9

T1–T9
Muscles innervated
Movement possible
Patterns of weakness
Functional expectations

Answer 9

Ms:
– Intrinsics of the hand, internal & external intercostals; erector spinae; lumbricals; flexor/extensor/abductor policis.

Movement Possible:
– UEs fully intact
– Limited upper trunk stability
– Intercostals fully intact = endurance increased.

Patterns of weakness:
– Lower trunk paralysis – needing to brace when leaning.
– Total paralysis of LEs.

Functional expectations
–ADLs: Independent with all
–W/C: I
–Transportation: I