Spinal Cord Injury (SCI)

Question 1

C1-C4 SCI Functional Outcomes

Answer 1

• Think nodding and facial muscles
• Key muscles = SCM, facial muscles, capital muscles, diaphragm, and trap
• PT implications — power w/c with mouth stick or chin control
• Tilt in space / recline for pressure relief
• Limitations — dependent on ventilator and dependent on all ADLs, transfers, and bed mobility
• Primary muscles responsible for clearing secretions = abdominals

Question 2

C5 SCI Functional Outcomes

Answer 2

• Think the “I dunno” pose
• Key muscles = deltoid, biceps, rhomboids, and ERs
• PT implications = power wheelchair with hand controls or manual wheelchair with rim projections, max assist with transfers, independent forward raise for pressure relief
• Limitations = common elbow flexion contractures, dependent with bathing and dressing

Question 3

C6 SCI Functional Outcomes

Answer 3

• Key muscles = extensor carpi radialis, pec major, teres major
• These patients have tenodesis grip
• PT implications = manual wheelchair with rim projections, I-mod A with sliding board transfer, independent pressure relief with weight shift, independent rolling and feeding
• Limitations = no elbow extension

Question 4

C7 SCI Functional Outcomes

Answer 4

• Think Michael Phelps doing butterfly
• Key muscles = lats, pronator teres, triceps
• PT implications = can do all C6 can do but they can propel wheelchair, mod-I with transfers, wheelchair propulsion, pressure relief, can dress themselves, and will eventually achieve independent pop-over transfers without sliding board

Question 5

C8 SCI Functional Outcomes

Answer 5

• Key muscles = extensor carpi ulnaris, flexor carpi ulnaris, and hand intrinsics
• PT implications = same as C7 but can do a wheelie and negotiate 2-4” curb
• Limitations = transfers from wheelchair to floor requires minA

Question 6

T12-L2 SCI Functional Outcomes

Answer 6

• Key muscles = quadratus lumborum and iliopsoas
• PT implications = household ambulation with HKAFOs or KAFOs but wheelchair used for all community activities
• Limitations = no quad control

Question 7

L3 SCI Functional Outcomes

Answer 7

• Key muscles = quads and hip adductors
• PT implications = community ambulation with orthoses (GRAFO) and wheelchair for independence and efficiency
• If SCI is complete, patient will need more restrictive AFO to prevent ankle instability
• Limitations = no glut max function or foot clearance

Question 8

L4-5 SCI Functional Outcomes

Answer 8

• Key muscles = tib anterior, extensor digitorum, and extensor hallucis
• PT implications = community ambulation with AFO and canes
• Limitations = no glut max function

Question 9

Function of Anterior Horn Cells

Answer 9

• Carries motor information

Question 10

Function of Dorsal Root Ganglia

Answer 10

• Carries sensory information (posterior part of spinal cord)

Question 11

Dorsal Column Medial Lemniscus (DCML)

Answer 11

• Vibration (tuning fork)
• Proprioception (place your extremity in space and have patient mimic it)
• Kinesthesia (move one extremity in position and have patient mimic with other extremity)
• 2pt discrimination (caliber device)
• Fine touch (monofilaments)
• Stereognosis (ability to detect object) — astereognosis is inability to detect object

Question 12

Lateral Spinal Thalamic Tract

Answer 12

• Pain and temperature

Question 13

Anterior Spinal Thalamic Tract

Answer 13

• Crude touch — diffuse, non-discriminatory touch (use fingertip or cotton swab)

Question 14

Brown Sequards Syndrome

Answer 14

• Male, young
• Gun shot wounds, piercing object
• Hemisectional injury
• Impaired DCML ipsilat
• Impaired motor ipsilat
• Impaired pain and temp contralat
• Impaired pain and temp ipsilat same level of lesion

Question 15

Anterior Cord Syndrome

Answer 15

• Hyperflexion, herniated disc, osteophyte formation, or AA instability
• Impaired motor bilat (LE>UE)
• Impaired pain, temp, and crude touch bilat

Question 16

Central Cord Syndrome

Answer 16

• Hyperextension injury (hemorrhage, edema, SC compression)
• Impacted pain and temp bilat
• Impacted motor bilat (UE>LE)
• Ataxia is common

Question 17

Posterior Cord Syndrome

Answer 17

• Bone spurs or ischemia — lack of blood flow
• Impacted DCML bilat

Question 18

Sensory Level

Answer 18

• Lowest level in body that patient still has intact sensation bilat
• Light touch and pin prick sensation tested bilat (down the dermatomes)

Question 19

Motor Level

Answer 19

• Lowest level with anti-gravity strength bilat (3/5 or greater)
• Also, must have every level above it with 5/5 strength bilat

Question 20

Neuro Level of Injury (NLI)

Answer 20

• Lowest level with intact sensation (2/2) and anti-gravity strength (3/5 or greater) bilaterally

Question 21

Zone of Partial Preservation

Answer 21

• Lowest level with at least 1/2 sensory or greater than 0/5 of MMT (lowest level without 0 sensory or 0 MMT)