SCI 3 - Expected Outcomes

Question 1

what is the potential for recovery in people w a complete injury

Answer 1

often regain 1 or 2 levels below level of injury
- means you often regain control of 1 or 2 levels of ms mvmt

Question 2

what is the potential for recovery in an incomplete injury

Answer 2

more likely than people w complete injury to regain control of more ms mvmt
- no way to know how much, if any

Question 3

what are general rules for predicting chance of improvement

Answer 3

longer you go w/o seeing improvement, chances are lower

as long as seeing some improvement (like regaining ms mvmt), chances are better

Question 4

C1-3: breathing

Answer 4

ventilator dependent

Question 5

C1-3: ADL care

Answer 5

total assist

Question 6

C1-3: pressure relief

Answer 6

total assist except w equipment

Question 7

C1-3: bed mobility/transfers

Answer 7

total assist

Question 8

C1-3: wc mobility

Answer 8

total assist w manual

(I) driving power chair and performing pressure relief (tilt/recline) w head, chin, mouth or breath control

Question 9

C1-3: home health aide needs?

Answer 9

requires 24hr attendant care

Question 10

C4: breathing

Answer 10

may be able to w/o ventilater
total assist to clear secretions
- depends on strength of diaphragm

Question 11

C4: ADL care

Answer 11

total assist

Question 12

C4: pressure relief

Answer 12

total assist except w equipment

Question 13

C4: bed mobility / transfers

Answer 13

total assist

Question 14

C4: wc mobility

Answer 14

total assist w manual

(I) driving power chair and performing pressure relief (tilt/recline) w head, chin, mouth or breath control

Question 15

C4: home health aide needs?

Answer 15

requires 24 hr attendant care

Question 16

C5: key muscles innervated

Answer 16

biceps
brachialis
brachioradialis
deltoid
infraspinatus
rhomboid
supinator

key ms: elbow flexors, shoulder and scap mvmt

Question 17

C5: breathing

Answer 17

(I)

may need (A) to clear secretions
help w self- assist cough techniques

Question 18

C5: ADL care

Answer 18

some to total assist
(esp w dressing)

Question 19

C5: pressure relief

Answer 19

total assist except w equipment
- may be able to use bicep strength for lateral wt shifts

Question 20

C5: transfers

Answer 20

assisted w transfer board
may be able to become (I) w SB depending on function, body habitus, etc.

Question 21

C5: bed skills

Answer 21

assistance required, able to participate in positioning

use of UE on bedrail, use of momentum for rolling/repositioning

Question 22

C5: wc mobility

Answer 22

(I) driving power chair and performing pressure relief w hand control

able to propel manual wc on uncarpeted indoor surfaces (I) or w (A), benefits from plastic coated hand rims or power assist
- using biceps, delt

Question 23

what is a concern of use of manual wc in C5 functional level

Answer 23

worry about repetitive injury/trauma to shoulder
- RC and scap

Question 24

C6: key ms

Answer 24

extensor carpi rad
infraspinatus
lat dorsi
pec major (clavicular)
pronator teres
serratus anterior*
teres minor

Question 25

what specific ms innervated by C6 have important functional implications

Answer 25

serratus anterior - use in bed mobility and other functional mvmts teres minor can also kick in and be used w these mvmts

Question 26

C6: breathing

Answer 26

(I) may need (A) to clear secretions

Question 27

C6: ADL care

Answer 27

some to total (A) - esp bathing, dressing

Question 28

C6: bed mobility

Answer 28

some assist to (I) w adaptive equipment ex: rings on bed - use of biceps and wrist ext

Question 29

C6: transfers

Answer 29

some assist to (I) w SB

Question 30

C6: wc mobility

Answer 30

(I) driving power chair w hand control - may require tilt/recline for pressure relief (I) w indoor manual wc propulsion - partial to total (A) outdoors w manual wc - benefit from power assist wheels

Question 31

C6: driving

Answer 31

(I) car/van w adaptive control

Question 32

C6: home health aide needs?

Answer 32

most people require at least 10hrs/day of personal/home care

Question 33

C7 key ms

Answer 33

extensor pollicus long & brev extrinsic finger ext flexor carpi rad triceps**

Question 34

what specific ms innervated by C7 have significant functional implications

Answer 34

triceps - elbow ext - WB using triceps w/o compensatory techniques

Question 35

C8 key ms

Answer 35

extrinsic finger flexors flexor carpi ulnaris flexor pollicus long and brev intrinsic finger flex

Question 36

why are functional outcomes improved significantly at C7 and C8 levels

Answer 36

greater UE ms capabilities - can more easily pressure relieve

Question 37

C7-8: breathing

Answer 37

(I) may need (A) to clear secretions

Question 38

C7-8: ADL care

Answer 38

some assist to (I)

Question 39

C7-8: pressure relief

Answer 39

(I)

Question 40

C7-8: transfers

Answer 40

(I) may require assist b/w uneven surfaces - ex: "pop over transfer"

Question 41

C7-8: bed skills

Answer 41

(I) may require adaptive equipment - bed rail, leg loops

Question 42

C7-8: wc mobility

Answer 42

(I) in pressure relief (I) manual wc propulsion indoors and level outdoors partial (A) uneven terrain benefit from plastic coated rims and/or power assis assist need dictated by contextual factors

Question 43

C7-8: standing/amb

Answer 43

some (A) to (I) standing amb not indicated - would need orthoses and hang on Y ligs not necessarily functional

Question 44

C7-8: driving

Answer 44

(I) w adaptive controls

Question 45

C7-8: home health aide needs?

Answer 45

may need up to 8hrs /day of personal/ home care

Question 46

T1-12 key ms

Answer 46

intercostals long ms of back - sacrospinalis - semispinalis abs (T7-12)

Question 47

T1-12: breathing

Answer 47

clearing secretions (I) compromised vital capacity and endurance

Question 48

T1-12: ADL care

Answer 48

(I)

Question 49

T1-12: bed mobility

Answer 49

(I)

Question 50

T1-12: transfers

Answer 50

(I) level and non level (I) floor to chair

Question 51

T1-12: wc mobility

Answer 51

(I) w manual indoors and outdoors

Question 52

T1-12: standing

Answer 52

(I)

Question 53

T1-12: amb

Answer 53

physiological standing and amb for exercise in home w lofstrand and KAFO - typically not functional

Question 54

why would we do standing/amb in a pt T1-12 if it isn't funcitonal

Answer 54

mental health and emotional physio benefits - WBing --> loading bone - improved circulation - stretch and dec tone

Question 55

T1-12: driving

Answer 55

(I) w hand controls

Question 56

T1-12: home health aide needs?

Answer 56

may need up to 3hrs / day of personal/home care

Question 57

L1-3. key ms

Answer 57

gracilis iliopsoas quad lumborum rectus fem sartorius (hip flexors)

Question 58

what is a key funcitonal implicaiton of L3 innervation

Answer 58

knee ext (rectus fem)

Question 59

L1-3: breathing

Answer 59

intact respiratory function

Question 60

L1-3: transfers

Answer 60

(I)

Question 61

L1-3: wc mobility

Answer 61

(I) manual indoors and outdoors

Question 62

L1-3: standing

Answer 62

(I)

Question 63

L1-3: amb

Answer 63

some (A) to (I) amb for home short distances w loftstrand crutches and KAFO or AFO depending on innervated ms

Question 64

L1-3: driving

Answer 64

(I) w hand controls

Question 65

L1-3: home health aide needs

Answer 65

may need up to 2hrs / day of personal/home care

Question 66

what is a consideration of the AFO chosen for L1-3

Answer 66

depends on ms innervation - AFO vs KAFO if have rectus fem, can use an AFO set to ensure stability of knee by positioning ankle so that knee isn't hyper-ext

Question 67

when would someone w L1-3 opt for a manual wc over amb

Answer 67

to keep up preserve energy prevent injury to legs community setting *have to weigh benefits vs energy expenditures*

Question 68

L5-S1 key ms & specific level of innervation

Answer 68

quad (L4) hamstring (L5-S1) gastroc (S1) glut med and max (L5-S1) extensor digitorum post tib peroneals flexor digitorum (L5-S1)

Question 69

what functional implications do the key ms innervated by L4-S5 have

Answer 69

hip ext & ankle ms --> more functional amb could opt for cane bc more control of hip ext ms and don't have to hang on Y ligs

Question 70

L4-S5: transfers

Answer 70

(I)

Question 71

L4-S5: wc mobility/usage

Answer 71

(I) L4 may elect to use wc for long distances

Question 72

L4-S5: standing

Answer 72

(I)

Question 73

L4-S5: amb

Answer 73

functional inc ability for community distance (A) to (I) w amb home and community w loft strand crutches, cane, and AFOs

Question 74

L4-S5: driving

Answer 74

(I) w hand controls some functional w foot controls

Question 75

L4-S5: home health aide needs?

Answer 75

may not be in need of any personal / home care