UL Orthotics - SCI

Question 1

Tetraplegia vs paraplegia

Answer 1

Tetra - injury of the cervical spinal cord; pt can usually still move arms using segments above the injury

Para - injury of thoracic or lumbo-sacral cord, or cauda equina

Question 2

ASIA A C4 injury, myotome

Answer 2

Deltoids

Question 3

ASIA A C5 injury, myotome

Answer 3

Biceps

Question 4

ASIA A C6 injury, myotome

Answer 4

Wrist extensors

Question 5

ASIA A C7 injury, myotome

Answer 5

Triceps

Question 6

ASIA A C8 injury, myotome

Answer 6

Finger flexors (FDP & DIP)

Question 7

How do rehab doctors define the level of SCI?

Answer 7

The lowest spinal segmental level that is normal.

Eg., if. Patient has normal C3 sensation and absent C4, the level of injury would be C3

Question 8

What is the pattern of upper limb weakness for a C1-4 spinal cord injury?

Answer 8

Total paralysis of extremities

Question 9

What is the pattern of upper limb weakness for a C5 spinal cord injury?

Answer 9

Absent elbow extension and pronation, all wrist and hand movements

Question 10

What is the pattern of upper limb weakness for a C6 spinal cord injury?

Answer 10

Absent wrist flexion, elbow extension, and hand movement

Question 11

What is the pattern of upper limb weakness for a C7-8 spinal cord injury?

Answer 11

Limited grasp release and hand dexterity due to intrinsic weakness

Question 12

What are the orthotic long-term biomechanical goals for SCI?

Answer 12

• depends on the neurological level (wrist extensor strength), time after injury and desired goals,
• prevent secondary medical complications such as joint contractures or wounds,
• provide joint stability

Question 13

How do you achieve the long-term orthotic biomechanical goals?

Answer 13

• Static protective splinting,
• static functional orthoses,
• dynamic functional orthoses, or
• functional electrical stimulation,
• mobile arm supports

Question 14

ASIA A

Answer 14

A = complete

No sensory or motor function is preserved in the sacral segments S4-S5

Question 15

ASIA B

Answer 15

B= Sensory Incomplete
Sensory but no motor function is preserved below the neurological level and includes the sacral segments S4-S5, no motor function is preserved more than three levels below the motor level on either side of the body

Question 16

ASIA C

Answer 16

C = motor incomplete

Question 17

ASIA D

Answer 17

D = motor incomplete

Motor function is preserved below the neurological level, at least half of key muscle functions have a muscle grade >3

Question 18

ASIA E

Answer 18

E = normal

Question 19

Brown Sequard Syndrome

Answer 19

• Contralateral loss of pain and temperature below the level of the lesion,
• loss of voluntary movement/motor control on same side,
• loss of pain/temperature sensation on the opposite side

Question 20

Autonomic Dysreflexia

Answer 20

A condition and medical emergency characterized by uncontrolled hypertension and bradycardia. A mass reflex.

Most commonly associated with SCI at or above T6 level