Incomplete SCI
sensory loss related to damage within specific spinal tracts
classifications
Quadraplegia and tetraplegia- occurs above the thoracic vertebrae (C1-C8)
Paraplegia- occurs at T1 or below
Central Cord Syndrome
incomplete SCI that results in more weakness in the UEs than in the LEs.
-A lesion to the centrally located structures of region, that produces sacral sparing and greater weakness in the upper limbs than in the lower limbs.
neurological and functional classification of SCI
Grade the amount of “key muscle” strength of the body.
- determine the key points of “light touch” and “pin prick” sensation of the body
- the neurologic level of injury is the lowest level on the spinal cord where key muscles test at least 3/5 and sensation intact for this level dermatome
- Functional level lowest segment which strength of key muscles graded at 3+/5 or higher and sensation intact.
Brown-Sequard Syndrome
Hemisection of the cord which produces ipsilateral (same sided) proprioceptive and motor loss and contralateral (other side) loss of pain and temp.
-gunshot knife wound
Posterior Cord Syndrome
Rare, results from compression by tumor or infarction of the posterior spinal artery. Proprioception, stereognosis, two point discrimination, and vibration sense are lost below the lesion.
Anterior cord syndrome
A lesion that produces variable loss of motor function and of sensitivity to pain and temperature, while preserving proprioception, touch and vibration
Conus Medullaris Syndrome
Injury of the sacral cord (conus) and lumbar nerve roots within the neural canal that usually results in nonreflexive bladder, bowel and lower limbs. Sacral segments may occasionally show preserved reflexes.
Cauda Equina Syndrome
Injury to the lumbosacral nerve roots within the neural canal resulting in nonreflexive bladder, bowel and lower limbs.
in both the equina and medullaris are LMN injuries- bladder is flaccid. better prognosis for recovery since it is peripheral and there is regeneration capacity.
C1, C2, and C3
Muscles innervated:
- Sternocleidomastoid
- Cervical paraspinal
- Neck accessory
Movement:
- Neck flexion
- Neck extension
- Neck rotation.
- Complete paralysis of arms, body. legs.
- possibility of autonomic dysreflexia.
- electric wheelchair (sip and puff)
- hoyer lift often used.
- Inability to breathe using chest muscles or diaphragm, ventilator breathing.
- assistance required to clear secretions from trachea and assistance in coughing.
Complete personal assistance is required in personal care (washing, dressing, and bowel/bladder management
- complete homemaking is required
- a computer may be operated using iris recognition, mouth stick or voice recognition. Telephone can be used using voice recognition and headset.
Primary goal (communication and wheelchair management)
C4
Muscles:
- Upper/Lower Trapezius
- Diaphragm
- Cervical paraspinal muscles
- Levator Scapulae
Movement:
- Neck flexion
- Neck extension
- Neck rotation
- Scapular elevation
- Inspiration
- Full head and neck movement depending on muscle strength. Limited shoulder movement.
- complete paralysis of body and legs. no finger, wrist, or elbow flexion/extension.
- sympathetic nervous system compromised and possible autonomic dysreflexia.
- electric wheelchair, sip and puff
- total assistance for transfer
- complete assistance required for meal time
- able to breathe without a ventilatory using diaphragm.
- assistance required to clear secretions and in coughing.
dependent in personal assistance (washing, dressing, B and B management)
- Complete homemaking is required
- voice recognition and iris recognition, also mouth stick for communication.
- may operate an adjustable bed with an adapted controller.
C5
Muscles:-
- Deltoid
- Biceps
- Brachialis
- Brachioradialis
- Rhomboids
- Serratus anterior
- Teres minor/major
Movement:
- Shoulder flexion
- Shoulder abduction
- Shoulder extension
- Elbow flexion
- Supination
- Scapular adduction and abduction
- Full head and neck with good shoulder movement. Good elbow flexion (no finger or wrist movement and no elbow extension.
- sympathetic nervous system compromised.
- ELECTRIC WHEELCHAIR CONTROLED WITH A HAND CONTROL. manual wheelchair used for short distances.
- total assistance for transfer
- ability to feed self using feeding strap
- assistance required to clear secretions and cough
- personal assistance is required, may be able to assist with UE dressing.
- Complete homemaking is required.
- communication- voice recognition used to communicate with phones or computers.
Functional goals= independence with eating, drinking, face washing, tooth brushing, face shaving, and hair care, after assistance in setting up specialized equipment.
-driving possible after being evaluated by professional to determine special equipment needs.
C6
Muscles:
- Pectoralis
- Supinator
- Extensor carpi radialis longus and brevis
- Latissimus dorsi
Movement:
- Scapular protraction
- Horizontal adduction (some)
- forearm supination
- radial wrist extension
- Full head and neck movement, good shoulder movement, good wrist extension, good elbow flexion.
- passive key grip (tenodesis) may be present by flexing the wrist backwards but will be weak.
- sympathetic NS compromised
- electric wheelchair controlled by hand control.
- total assistance with transferring (slide board may be used)
- ability to feed self using food strap
- ability to dress upper body, assistance may be needed for lower body.
- ability to shave, brush hair brush teeth with adaptive equipment
- personal assistance needed (may be able to empty own leg bag)
- homemaking assistance required for some tasks (cleaning, washing clothes and kitchen duties)
- ability to help with simple meal prep
-writing with use of Wanchik writer, splint, or tenodesis. voice recognition still used for phone and computer.
Functional goals: greater independence in feeding, bathing, grooming, personal hygiene, and dressing. some may perform bowel and bladder management.
C7 and C8
muscles:
- Sternal pectoralis
- Triceps
- Pronator quadratus
- Extensor carpi ulnaris
- Flexor carpi radialis
- Flexor digitorum profundus and superficialis
- Extensor Communis
- Pronator/flexor/extensor/abductor pollicus
Movement:
- Elbow extension
- Ulnar wrist extension
- Wrist flexion
- Finger flexion and extension
- Thumb flexion, extension, and abduction
- full head and neck movement, good shoulder movement, partial finger movement, full elbow extension and flexion, full wrist flexion and extension.
- C7 will have movement in the thumbs
- Sympathetic NS compromised
- electric wheelchair
- ability to transfer independently
- ability to drive car with hand controls.
- feed self independently
- assistance required to clear secretions and coughing
- coughing techniques (leaning forward)
- ability to manage bowel and bladder independently.
- independent in Upper body showering and dressing, may still need assistance with lower body.
- some assistance for heavy household cleaning, home maintenance, and complex meal prep.
- can prepare simple meals.
-communication with computer can be used by typing tick or voice recognition. voice recognition for telephone.
goal= daily use of manual wheelchair, greater ease in performing household work and transferring, wheelchair pushups for pressure relief.
T1-T4
Muscles:
- Intrinsic of hand including thumb
- Internal and external intercostals
- Erector spinae
Movement:
- Upper extremity
- Limited trunk stability
- Increasing lung capacity.
- Full head, neck, shoulder, elbow, wrist, and finger movement.
- T4 will have good strength chest muscles but will get weaker the closer you get to T1.
- sympathetic NS may be compromised
- manual wheelchair used for every day living, electric for long distances.
- independent transfer ability but may need some assistance from chair to car depending on UE strength.
- ability to feed self independently
- breath normal though respiration capacity and endurance may be compromised.
- should be independent in personal care
- Partial domestic assistance such as heavy household cleaning and home maintenance.
- ability to prep complex meals
-normal communication skills
C8-T1
*added movements include developing strength and precision of the fingers that result in natural hand function.
functional goals: living independently without assistive devices in feeding, bathing, grooming, oral and facial hygiene, dressing, transferring, B and B management.
T2-T6
goals= increasing use of ribs and chest muscles, or trunk control
T10-L1
Muscles:
- Fully intact intercostals
- External obliques
- Rectus abdominus
Movement:
-trunk stability
L2-S5
Muscles:
- Full abdominals
- Full trunk musculature
- Hip flexors, extensors, abductors
- Knee flexors and extensors
- Ankle dorsiflexors
- plantar flexors
Movement:
- Trunk stability
- Partial to full control of LE
weakness= coordination, endurance, balance, sexual functioning.
functional implications for T7-T12
added motor function of increased abdominal control.
Functional goals= improving cough effectiveness and increasing ability to perform unsupported seated activities.
walking with SCI
attempts to walk can lead to damage of the upper joints. practically everyone with a complete T level injury will rely on a manual wheelchair for primary mobility.
L2-L5
Individuals with motor function in the hip flexors, or iliopsoas are classified as
those with motor function in the knee extensors, or quadriceps femoris, are classified L3
L4- motor function in the ankle dorsiflexors, or tibialis anterior
L5- motor function in the long toe extensors, or extensor hallicus longus, are L5. to be classified at any of these levels the person must score 3 or better on the classification form at that level.
Functional goals= walking can be a viable functional goal for some people with the help of specialized leg and ankle braces. the level is also a factor. Individuals with lower levels of injury will walk with greater ease with the help of assistive devices.
S1
to classify as S1, motor function of the ankle plantar flexors, specifically the gastrocnemius, must score 3 or better on the classification form.
S1-S5
Functional goals: increased ability to walk with fewer or no supportive devices. Depending on the level of injury, there are also various degrees of return of voluntary bladder, bowel, and sexual functions. Greater improvements in function occur the lower the level of injury
education on SCI process
- Variety of learning modalities and patient/support team
- Provide instruction on
- -levels and outcomes
- -positioning to manage tone
- -body mechanics to minimize injury
- -sensory awareness
- -sexual counseling
- -managing complications
Autonomic dysreflexia
- occurs at level T6 and above
- can lead to life threatening hypertension
Orthostatic hypotension.
Adjustment to SCI
- we are only there for the short term- find those who will be there for the long term and get them involved
- treatment will bring awareness of the effect of the injury (changes in mood, control, independence, changes in career plans, life roles, relationships)
- watch for body image and self esteem issues
- let them contribute to their plans
- may just need to be someone for them to talk through things to.
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OT process PPT9
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Medical Neurological Assessment34
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Motor Control Theory53
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Traditional Motor Control Theory43
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Task-oriented approach17
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Sensation14
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Vision50
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Lab values2
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Apraxia27
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Aphasia23
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Team collaboration4
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Neurologically impaired UE12
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Cognitive capacities and abilities33
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Cognitive approaches10
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Cognition and interventions16
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Adult Dysphagia48
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feeding and eating17
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vestibular rehabilitation33
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the vestibular system27
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SCI medical management26
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SCI26
