ASIA impairment scale and SCI

ASIA A

Complete: no motor or sensory function in the sacral segments S4-S5

ASIA B

Sensory incomplete: sensation is preserved below the level, including the sacral segments, but no motor function

ASIA C

Motor incomplete: motor function preserved below the level, and more than half of key muscles have a grade under 3

ASIA D

Motor incomplete: at least half of key muscles below the level have a grade of 3 or more

ASIA E

Normal motor and sensory function

Tetraplegia

Injury at the cervical level; arms, trunk, legs, and pelvic organs are affected

Paraplegia

Injury at the thoracic, lumbar, or sacral level; arms are spared

C1-C3

No function below the neck; the diaphragm is impaired, so the client is ventilator dependent

C1-C3 interventions

Power wheelchair with sip-and-puff or head controls, environmental control units, voice or eye-gaze technology, positioning, and training caregivers to give total care while the client directs it

C4

Diaphragm and upper trapezius work; may breathe without a ventilator but weakly; no arm function

C4 interventions

Power wheelchair with chin, head, or sip-and-puff control, mouth stick, environmental control units, mechanical lift transfers, total assistance for ADLs, and a tilt or recline for pressure relief

C5

Deltoid and biceps work; no wrist extension

C5 interventions

Balanced forearm orthosis or mobile arm support for feeding, universal cuff, wrist-hand orthosis, power wheelchair with hand joystick, and setup help with ADLs

C5 independence

Can feed and groom with setup and equipment; needs assistance for transfers (mechanical lift) and most other ADLs

C6

Wrist extensors work, so tenodesis grasp is possible; no triceps

C6 interventions

Preserve tenodesis, universal cuff, wrist-driven or tenodesis orthosis, manual wheelchair with plastic-coated hand rims or projections, and sliding board transfer training

C6 independence

Independent in feeding, grooming, and upper body dressing with equipment; may do sliding board transfers; needs assistance with lower body ADLs and bowel and bladder care

C7

Triceps, wrist flexors, and finger extensors work; hand grasp is still weak

C7 interventions

Triceps strengthening, depression press-ups and independent transfer training, manual wheelchair, and built-up handles

C7 independence

Independent in most ADLs and transfers with equipment; can usually live independently

C8-T1

Finger flexors and hand intrinsics work, so hand function is mostly intact; the arms are normal

C8-T1 interventions

Independent self-care, wheelchair, and transfer training; driving with hand controls; energy conservation and fall prevention from the wheelchair

T2-T12

Arms are normal; trunk control improves lower in the thoracic region

T2-T12 interventions

Trunk balance and strength, wheelchair skills (wheelies, curbs), transfers, standing frame for bone health, and wheelchair sports

T6 and above

At risk for autonomic dysreflexia

Central cord syndrome

Arms weaker than legs; usually from hyperextension of the neck in older adults with spondylosis; better recovery of leg function than hand function

Central cord interventions

Fine motor and hand training, UE strengthening, ADL retraining, and adaptive equipment for hand use

Brown-Séquard syndrome

Hemisection of the cord; same-side loss of motor, proprioception, and vibration; opposite-side loss of pain and temperature

Anterior cord syndrome

Loss of motor, pain, and temperature below the injury; proprioception, vibration, and light touch preserved; poor prognosis

Posterior cord syndrome

Loss of proprioception and vibration with motor and pain preserved; rare

Conus medullaris syndrome

Injury at the end of the spinal cord; mixed upper and lower motor neuron signs, with bowel, bladder, and segsual dysfunction

Cauda equina syndrome

Injury to the lumbosacral nerve roots; lower motor neuron signs, flaccid weakness, and bowel and bladder problems; better recovery potential

Autonomic dysreflexia response

Sit the client up, lower the legs, loosen tight clothing or binder, check the bladder, catheter, bowel, and skin, and call for emergency medical help

Weight shift methods

Depression press-ups (C7 and below), forward lean (C6), side lean (C5), and power tilt or recline (C4 and above)

Triceps and elbow locking

At C6, lock the elbows using shoulder external rotation for stability when there is no triceps

Spinal cord injury question strategy

ind the lowest working muscle and the first missing one, then choose the technique or equipment that replaces what is missing