LE Flexor Synergy
• Hip Abduction • Hip External Rotation • Knee Flexion • Ankle Dorsiflexion • Ankle Inversion • Toe Extension
LE Extensor Synergy
- Hip Extension
- Hip adduction*
- Hip Internal Rotation
- Knee Extension *
- Ankle Plantarflexion *
- Ankle Inversion
- Toe Flexion
*Do the exercises that pull them out the MOST of the pattern
UE Flexor Synergy
- Scapular Retraction & Elevation
- Shoulder Abduction
- Shoulder External Rotation
- Elbow Flexion*
- Forearm Supination
- Wrist and Finger Flexion
UE Extensor Synergy
Scapular Protraction
- Shoulder adduction*
- Shoulder Internal Rotation
- Elbow Extension
- Forearm Pronation*
- Wrist and Finger Flexion
Dominant Pattern of Synergy
- Hip Flexion
- Knee Extension
- Ankle Plantarflexion
- Toe Flexion
ASIA Scale
ASIA SCALE
• A = Complete no sensory or motor function
preserved in the sacral segments S4-S5
• B = Incomplete, sensory but no motor function
is preserved below the level of the lesion
• C – Incomplete, more than half of the key
muscles below the NLI have an MMT grade of
less than 3/5
• D = Incomplete, at least half of the key muscles
below the NLI have an MMT of 3/5 or more
• E = Normal Sensory and Motor function
Brunnstrom Stage 1
Flaccidity
Brunnstrom Stage 2
Onset of primitive reflexes/synergies WHICH ARE LIKE BABINSKI, ATNR, MORO. USE THESE REFLEXES TO GET THEM MOVING
Brunnstrom Stage 3
Max spasticity
Brunnstrom Stage 4
Spasticity declines and some movements are performed out of synergy
Brunnstrom Stage 5
Selective control of movement
Brunnstrom Stage 6
Near normal with coordinated
motions out of synergy
Brunnstrom Stage 7
Normal
Functional Independence Measure Scoring
Looking at a patient’s functional status during the recovery process following TBI. It addresses feeding, grooming, bathing, UE dressing, LE dressing, and toileting
FIM Scores
Functional Independence Measure
7 - Complete independence with no helper
6 - Modified independence with no helper
5 - Supervision or setup with helper (Subject = 100%)
4 - Minimal assistance with helper (Subject = 75% or more)
3 - Moderate assistance with helper (Subject = 50% or more)
2 - Maximal assistance with helper (Subject = 25% or more)
1 - Total assistance with helper (Subject = <25%)
**Total will be between 18 and 126
ASIA Scale A
A = Complete no sensory or motor function
preserved in the sacral segments S4-S5
ASIA Scale B
B = Incomplete, sensory but no motor function
is preserved below the level of the lesion
ASIA Scale C
C – Incomplete, more than half of the key
muscles below the NLI have an MMT grade of
less than 3/5
ASIA Scale D
D = Incomplete, at least half of the key muscles
below the NLI have an MMT of 3/5 or more
ASIA Scale E
E = Normal Sensory and Motor function
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C1-C4
C1-C4 SCI
- Key Muscles are for Nodding and Facial (SCM, Facial Muscles, Capital Muscles, Diaphragm, Trapezius)
- PT Implications
- Power Wheelchair with mouth stick or chin control.
- Tilt in space/recline for pressure-relief!!
- Limitations
- Dependent on ventilator (partial
diaphragm only)!! Abdominals are most important to clear secretions and this person does not have this.
• Dependent with all ADL’s, transfers and
bed mobility
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C5
- C5 Level SCI
- Key Muscles (Think “I dunno”)
- Deltoid, Biceps, Rhomboids, External Rotators
- PT Implications
- Mobility
- Power wheelchair with hand controls (preferred)
- Manual wheelchair with rim projections (energy-costly)
- Max Assist with transfers (sliding board)
- Independent forward raise for pressure relief* THIS IS HIGHEST LEVEL YOU CAN DO WITH PRESSURE RELIEF
*ANTERIOR DELTOID CAN LOCK ELBOW INTO EXTENSION
• Limitations
These patient are prone to elbow flexion contractures
AND are dependent with bathing and dressing
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C6
- Key Muscles
- Extensor Carpi Radialis, Pectoralis Major, Teres
*CAN USE TENODESIS GRIP
Major
- PT Implications
- Mobility
- Manual wheelchair with rim projections
- Independent to MinA with sliding board
- Independent pressure relief w/ weight shift
- Independent rolling / feeding
- Limitations
No Elbow extension and are also prone to elbow flexion contractures!
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C7
Key Muscles (Think “The Phelps”)
- Triceps, Lats, Pronator Teres
- PT Implications
- Mobility
- All of the above
- Mod I transfers, wheelchair propulsion,
pressure relief, upper and lower extremity
dressing
• Will eventually achieve independent pop over
transfers without sliding board
- Limitations
- Transfers to floor require mod to maxA because he doesn’t have great grip strength or core strength.
UPPER EXTREMITY SCI FUNCTIONAL OUTCOMES C8
- Key Muscles (Think “Hand Intrinsics”)
- ECU, FCU, Hand intrinsics
- PT Implications:
- Mobility is increased because of the tenodesis grip!
- Same potential as C7
- Wheelies in WC
- Negotiation of 2-4 inch curbs!!
Pressure relief with push up
- Limitations:
- Transfers from WC to floor require minA
