Tx Considerations for Various SCI Levels

Question 1

The Importance of UE Function

Answer 1

77% of tetraplegics expected an important or very improvement in OL of their hand function improved
The return of arm and hand function is the highest priority among tetraplegics as compared to other functions such as sexual function, trunk stability, or walking

Question 2

C1-C4

Answer 2

Complete Lesions: paralysis neck down 
Ventilator
C1-C3 diaphragm is paralyzed 
C4 may need vent initially then wean 
Paralysis from neck down 
Resting hand splints 
Teaching pt. to direct caregivers 
Selection of technology to aid help (envt. controls) 
Mouth & Head sticks to point, turn pages, type, draw

Question 3

C5

Answer 3

Deltoids & biceps are weak
UE’s need support to fxn
MAS (if strength < 3/5) (MAS = mobile arm support)
Grasp and hold objects
U cuff or long opponens (lack wrist & hand fxn)
Resting hand splint (not permanent)
Tabletop activities (support w/ elbow or forearm function)\
Dependent in drsg, bathing d/t decreased trunk control
Grasp->hook grasp, bilateral grasp, use less invasive stratagies for grasping

Question 4

C5 : Determining Device

Answer 4

Look at MMT
Use trial & error, foods that are easier to minpulation (i.e. spear)
Support elbow then use MAS

Question 5

C6

Answer 5

Radial wrist extensors -> allows for closing of fingers for tenodesis grasp (increase UE independence)
Tenodesis splint (trains pt. to extend wrist & close fingers at same time for pinch)
Short opponens
U-cuff
Max A for bathing/dressing

Question 6

C7

Answer 6

Rotator cuff 
Deltoids, biceps, triceps
Ulnar wrist extension, wrist flexion
Finger flexion, ext; thumb flex, ext, ABD 
Limited grasp/release (slide to edge of the table then pinch item - i.e. coin) 
Increased UE strength/endurance 
Reach above head 
More refined hand function

Question 7

C8

Answer 7

Extrinsic finger ms
Thumb flexors
Grasps w/ MCP’s in ext & IP’s in flexion (claw hand or intrinsic minus)
Ranging: avoid contractors but allow some intrinsic tightness
LE Dressing: short siting w/ rails up.

Question 8

T1-9

Answer 8

UE’s full intact (unless injured previously)
Limited UE trunk stability
Increased endurance (diaphragm is intigrated)
Lower trunk & total LE paralysis (limited in transfers)
No fx’l ambulation
PRE program
Increase UE strength post normal status
Increase balance w/ dynamic gross motor activities
SBT and Depression
Work on LE dressing, bed mobility, community mobility

Question 9

T10-L1

Answer 9

Good trunk stability
LE paralysis
Some fx’l ambulation (in home setting or short distances w/in the community)
increased trunk strength (lateral flexion & rotation w. weights)
May need more PT than OT

Question 10

Focus

Answer 10

Mobility
Transfers (to ALL surfaces including the floor)
Strengthening of UE’s & trunk (PRE, bring strength into daily routine)
Endurance building
Bowl/Bladder (habits & routine)
ADL’s in sitting & standing (look at whole routine from a holistic perspective- grooming, phone use)

Question 11

Pressure Relief

Answer 11

Long handled mirror & ucuff for skin checks daily

J cushions, gel cushions, rohous (pressure relief cushions)

Question 12

Ambulation Categories

Answer 12

Standing only, exercise, household, community

Question 13

Esitm for SCI

Answer 13

Can be used as a neuromuscular retraining w/ goal of returning pt. to activites w/o stim (as a form of exercise or biofeedback) or…
Neuroprosthesis (implanted), combining stimulation w/ the performance of functional activities.