Management of Specific Diagnoses
no single way to treat a specific diagnosis
What is the foundation of treatment
Assessment
Complete SCI
- No function below level of injury
- Symmetrical deficits
Incomplete SCI
- Some function below the level of injury
- Asymmetric deficits
Determinants of deficits
Level and Severity
- more proximal lesion = more ox control
- complete lesion inferior to C4 = more complex than same at C7
seems intuitive
How does severity play into presentation?
Level and Severity
Incomplete will have variable function
* incomplete C5 = more function than complete C7
How many spinal nerves are there?
8 spinal nerves
C4
Pattern Deficits and Function
May require a ventilator
C5
Pattern Deficits and Function
often result in shoudler/bicep contol, but no wrist/hand control
C6
Pattern Deficits and Function
yield wrist control, but no hand control
C7-T1
Pattern Deficits and Function
can straighten arm, but still may have issues with their hand
C4 lesion and superior
Presentation
- trunk instability
- UL deficits
Tx: Static Ox (positioning and contractures); Environmental control systems
C4 Quadriplegia
Mobile Arm Supports
C5 Lesions
Presentation
- Loss of wrist and elbow extensors
- Predisposed to elbow contractures (use gravity to extend elbows)
Flexors intact
C5-C6 Quadriplegia
Asymmetrical pattern of deficits and function
C5 Ox Recommendation
- Ratchet Driven WHO
- Mobile Arm Support
C6-C7 Lesion
Presentation
Inability to Grasp; Wrist Extensors present
(radial nerve)
C6-C7 Ox Recommendation
Wrist Driven Tenodesis Ox
* mechanical linkage (rancho or prefab)
* cable system (RIC)
C8-T1 Lesion
Presentation
- Loss of opposition and intrinsic muscle function
- atrophy of the thenar and hypothenar eminences
C8-T1 Ox Recommendation
- No Ox - patient can use natural tenodesis and lateral prehension pattern
OR
- Static HO
A
ASIA Scale
Complete
* Motor - no function
* Sensory - complete deficit
B
ASIA Scale
Incomplete
* Motor - no function
* Sensory - incomplete deficit
C
ASIA Scale
Incomplete
* Motor - preserved (more than 1/2 muscles below level have a MMT less than 3)
* Sensory - incomplete deficit
D
ASIA Scale
Incomplete
* Motor - preserved (at least 1/2 muscles below level have a MMT of 3 or more)
* Sensory - incomplete deficit
