Functional Implications

Question 1

High Cervical Injuries (C1-C4)

Key Muscles

Answer 1

• Face and neck, CN innervation
• Partial innervation of diaphragm (if C3-C4 injury)

Question 2

High Cervical Injuries (C1-C4)

Functional Capabilities

Answer 2

Dependent
* ADLs
* Bed Mobility
* Pressure relief in bed

Mod I
* Pressure relief in chair
* PWC w/mouth controls

Independent to Direct Care
* ADLs
* Pressure relief in bed

Question 3

High Cervical Injuries (C1-C4)

Available Movements

Answer 3

• Talking
• Mastication
• Sipping
• Blowing
• Scapular elevation

Question 4

High Cervical Injuries (C1-C4)

Required Equipment

Answer 4

• PWC w/driving control adaptations
• Portable vent (C1-2/3)
• Hospital bed with air mattress
• Hoyer lift
• Bathroom DME (TIS shower chair)

Question 5

High Cervical Injuries (C1-C4)

How do C1-C3 and C4 injuries differ in their vent requirements?

Answer 5

C1-3 will be ventilatory dependent.
C4 should be able to eventually weak off vent.

Question 6

What is an important consideration when a patient is ventilatory dependent?

Answer 6

Removes their ability to vocalize, requires adaptive communication equipment.

Question 7

What is a Phrenic N. Stimulator and what level SCI might opt in?

Answer 7

AKA “diaphragm pacing”
- Electrical stimulation of the phrenic nerve (C3-C5) with surgically implanted devices that causes rhythmic contraction of diagphragm to improve breathing function.

C1-C3

Question 8

C5

Key Muscles

Answer 8

• Biceps
• Brachialis
• Brachioradialis
• Deltoid
• Infraspinatus
• Rhomboids
• Supinator

Question 9

C5

Functional Capabilities

Answer 9

Dependent
- Pressure relief in bed
- Transfers
- Bathing
- Bowel/bladder
- Outdoor WC mobility

MaxA
- Bed mobility

MinA
- Feeding and grooming w/adaptive equipment (set up)

ModI
- Pressure relief in PWC
- PWC mobility (hand controls)
- MWC short-distances/level and smooth surfaces

Ind to Direct Care
- Transfers
- Bed pressure relief

Question 10

C5

Available Movement

Answer 10

• Elbow flexion and supination
• Shoulder ER, ABD, FLEX to 90º

Question 11

C5

Required Equipment

Answer 11

• PWC w/appropriate driving control adaptations
• Lightweight MWC w/increased trunk supports (power assist push rims)
• Hospital bed w/air mattress
• Hoyer lift
• Bathroom DME (TIS shower chair)
• Mobile arm supports, adaptive ADL equipment, wrist supports with cuffs

Question 12

C6

Key Muscles

Answer 12

• ECR?
• Infraspinatus
• Latissimus dorsi
• Pec major (claviclar portion)
• Pronator Teres
• Serratus Anterior
• Teres Minor

Question 13

C6

Functional Capabilities

Answer 13

ModA - MaxA
- Pressure relief with hospital bed

MinA - ModI
- Level surface transfers

Mod I
- ADLs with adaptive equipment
- Bed mobility with hospital bed components/leg loops
- Pressure relief in PWC
- PWC
- MWC on smooth surfaces and low-grade ramps

Assistance
- LE dressing
- Bowel/bladder
- Uneven surface transfers
- Uneven surfaces/D-curbs with MWC

Question 14

C6

Available Movements

Answer 14

• Shoulder FLEX, EXT, ER/IR, ADD
• Scapular ABD, protraction, UR
• Forearm pronation, wrist extension

Question 15

At what level could you teach a patient the tenosynovitis grip?

Answer 15

C6

Question 16

C6

Required Equipment

Answer 16

• PWC with adaptive driving controls
• Lightweight MWC
• Hospital bed w/air mattress
• Slideboard
• Bathroom DME (upright shower chair)
• Adaptive ADL equipment, universal cuffs, tenodesis splints

Question 17

C5-C6

What is an important part of C5-C6 training as it relates to the respiratory function?

Answer 17

Cough is weak - requires cough assist

Question 18

At what level can a pt with SCI return to driving, what adaptations are needed?

Answer 18

C5-C6; van with hand controls + adaptive electronics, slideboard for transfers (assistance)

Question 19

At what level might a patient be able to live alone if they are motivated?

Answer 19

C6

Question 20

C7

Key Muscles

Answer 20

• Extensor pollicis longus + brevis
• Extrinsic finger extensors
• Flexor Carpi Radialis
• Triceps

Question 21

C7

Functional Capabilities

Answer 21

MinA- ModI
- Transfers (uneven surface)

ModI
- ADLs
- Bed mobility
- Transfers (even surface)
- MWC household/community (may need Assist with high-grade ramps/curbs)

Independent
- Pressure relief

Question 22

C7

Available Movements

Answer 22

• Elbow extension
• Wrist flexion
• Finger extension

Question 23

C7

Required Equipment

Answer 23

• Lightweight MWC
• May not need hospital bed, but justifiable
• Slideboard (uneven surfaces)
• Bathroom DME (upright shower chair)
• Adaptive ADL equipment

Question 24

C7

Respiratory Considerations

Answer 24

Independent with cough and secretion clearance

Question 25

# C7 Driving

Answer 25

- Can progress to standard auto with hand controls and specialized electronics - Slideboard for car transfers, assist required - Can get w/c in and out of car.

Question 26

# C8 Key Muscles

Answer 26

* Extrinsic finger flexors, Flexor Carpi Ulnaris * Flexor Pollicus Longus and Brevis * Intrinsic Finger Flexors

Question 27

# C8 Functional Capabilities

Answer 27

**MinA-ModI** * uneven transfers **ModI** - ADLs - Bed mobility, even transfers - MWC household/community (assist with high-grade ramps/curbs) **Assistance** - Floor to W/C transfers **Independent** - Pressure relief

Question 28

# C8 Available movements

Answer 28

Finger Flexion

Question 29

# C8 Required Equipment

Answer 29

- Lightweight MWC - May not need hospital bed, but justifiable - Slideboard (uneven surfaces) - Bathroom DME (upright shower chair)

Question 30

# C8 Driving

Answer 30

Independent with hand controls alone, slideboard to transfer

Question 31

# Thoracic T1-T12 KEY Muscles

Answer 31

- Intercostals - Long muscles of back (sacrospinalis, semispinalis) - Abdominals (~T7 and below)

Question 32

# Thoracic T1-T12 Functional Capabilities

Answer 32

**ModI/Ind** - ADLs **ModI** - Bed mobility, even and uneven transfers - MWC household and community, including ramps/curbs **Light Assist to ModI** - Floor transfers **Indep** - Pressure relief

Question 33

# Thoracic T1-T12 Ambulation Abilities

Answer 33

T1-T9: no functional amb. T10-T11: short distance with assist (H/KAFOs) T12: May reach ModI short distances with H/KAFO

Question 35

# Thoracic T1-T12 Available Movements

Answer 35

- Improved trunk control with more caudal SCI - Increased respiratory reserve - Pec girdle stabilization for lifting

Question 36

# Thoracic T1-T12 Required Equipment

Answer 36

- Lightweight MWC - Orthotics (H/KAFO) - AD (RW/ forearm crutches) - Bathroom DME (tub chair, shower bench)

Question 37

# Lumbar Injuries L1-3 Key muscles

Answer 37

* Iliopsoas * Gracilis * Quadratus Lumborum * Rectus Femoris * Sartorius

Question 38

# Lumbar Injuries L1-3 Functional Capabilities

Answer 38

**ModI** - Ambulation short distances with KAFO, RW/FC (largely non-functional) - Often prefer MWC (esp in community)

Question 39

# Lumbar Injuries L1-3 Available Movements

Answer 39

- Hip FLEX/ABD - Knee EXT

Question 40

# Lumbar Injuries L1-3 Required Equipment

Answer 40

- Lightwieght MWC - Orthotics (H/KAFO) - AD (RW/FC)

Question 41

# Lumbar/Sacral: L4 down Key Muscles

Answer 41

- Quadraceps (L4) - Anterior Tibialis (L5) - Hamstrings (L5-S1) - Gastrocnemius (S1) - Glute Max/Med, Extensor Digitorium, Posterior Tib, Flexor Digitorium (L5-S1)

Question 42

# Lumbar/Sacral: L4 down Functional Capabilities

Answer 42

**Mod I** - Ambulation household/limited community (L4 may still use MWC for community)

Question 43

# Lumbar/Sacral: L4 down Available Movements

Answer 43

- Strong hip FLEX - Strong knee EXT - Knee FLEX - Ankle DF/PF - Ankle Eversion - Toe extension

Question 44

# Lumbar/Sacral: L4 down Required Equipment

Answer 44

- Lightweight MWC - Orthotics (AFO) - AD (FC/Cane)