Neurological Conditions: Spinal Cord Injury (SCI) Summary

These flashcards cover important terms and concepts related to spinal cord injuries, rehabilitation phases, functional expectations, and the ASIA Impairment Scale.

Spinal Cord Injury (SCI)

A condition that impacts motor, sensory, and autonomic functions.

Complete SCI

A condition where there is no motor or sensory function preserved below the level of injury (S4-S5).

Incomplete SCI

A condition where some sensory or motor function is preserved below the level of injury.

ASIA Impairment Scale (AIS)

A classification system for spinal cord injury severity.

AIS A

Complete SCI with no preserved motor or sensory function.

AIS B

Incomplete SCI with preserved sensory function but no motor function.

AIS C

Incomplete SCI with motor function less than 3 in the majority of muscles.

AIS D

Incomplete SCI with motor function greater than or equal to 3 in the majority of muscles.

AIS E

Normal motor and sensory function following spinal cord injury.

Central Cord Syndrome

A type of incomplete SCI characterized by upper extremity deficits greater than lower extremity.

Brown-Séquard Syndrome

A type of incomplete SCI resulting in ipsilateral motor/proprioception loss and contralateral pain/temp loss.

Anterior Cord Syndrome

A type of incomplete SCI with motor and pain/temp loss but intact proprioception.

Cauda Equina Injury

Injuries to the nerve roots at the end of the spinal cord, often with a better prognosis.

Acute Phase Rehabilitation

The initial rehabilitation phase focused on spine/skin protection and preservation of range of motion.

Post-Acute Phase Rehabilitation

Inpatient rehabilitation focusing on functional training and management of daily activities.

Functional Expectations C1–C3

Requires a ventilator and total assistance with a powered chair.

Functional Expectations C4

Some shoulder shrug and ability to use a powered chair with limited self-care.

Functional Expectations C5

Use of deltoids and biceps, with assistance for self-care tasks.

Functional Expectations C6

Wrist extension allows for tenodesis; able to perform level transfers.

Functional Expectations C7–C8

Triceps and finger function for independent ADLs and manual wheelchair use.

Functional Expectations T1–T9

Full upper extremity function allowing independent ADLs and use of standing frames.

Functional Expectations T10–L1

Trunk and hip control enabling household ambulation.

Functional Expectations L2–S5

Variable recovery of lower extremity function enabling functional ambulation with orthoses.

access to environmental control system (sip and puff, head array, voice activation) to support autonomous decision making

What is the main independence focus for client with C1-C3

shoulder elevation and diaphragmatic breathing, able to use sip and puff voice or head controls for power mobility; able to direct care but dependent for all ADLs and transfers. 

What functional abilities are expected at c4

mobile arm supports, power wc, limited manual wc propulsion on smooth surfaces 

What functional abilities are expected at c5

wrist extension, tenodesis, increased independence in transfers with slide board, ind pressure relief using UE. 

What functional abilities are expected at c6

elbow extension for ind pressure relief, ind transfer without slide board

What functional abilities are expected at c7 

Finger flex for strong grasp, full ind in ADL, ind wc set up, improved FM 

What functional abilities are expected at c 8

C4 can not use UE at all and c5 is biceps

What is key functional limitation at c4 and differ from c5

c5 can not perform slide board transfer ind, C6 can perform slide board transfers with training because wrist extension provides tenodesis stability. 

What is difference in transfer limitation between c5 and c6

c7 struggles with fine intrinsic hand control, c8 has full grasp strength and can complete FM tasks.

what limitation distinguishes c7 form c8 ADLs.

adaptive feeding/grooming, mobile arm supports, universal cuff elbow flex/strengthening, training CG

what should OT prioritize at c5

tenodesis grasp, slide board transfer, ind pressure relief, AE dressing 

what should OT prioritize at c6

advance transfer training, UE strengthening, Ind wc mobility skills, minimizing reliance on AE

what should OT prioritize at c7

FM strengthening, efficient ADL, IADL task performance, wc SU ind and EC  

what should OT prioritize at c8

Full UE strength allows Ind ADLs and mobility, but limited trunk control requires training in dynamic sitting, unsupported reaching and safety during IADLs. 

Why does trunk control at T1-T6 reshape OT goals compared to cervical levels

ambulation is limited by fatigue and bracing (AFO) needs, OT targets efficiency, endurance, safe transitions and balancing walking vs wc use for long distances.  

Why does L1-L3 require EC focused OT even though ambulation is possible 

Power WC with sip and puff, chin or head controls, no fxn UE movement is available for propulsion of joy stick

What adaptive equipment does c4 rely on for mobility and why

built up pend or friction based writing tools, intrinsic muscle weakness can limit endurance

which adaptive equipment is most appropriate for c8 clients during handwriting 

limited trunk stability to bend forward 

Why is a reacher important for T1-T6 clients even though UE function is intact