SCI Functional Classifications and Prognostic Insights During PT Management

0-72 hrs after SCI

neuro exam may evolve, spinal shock and edema can affect classification

0-6 months after SCI

period of greatest neurologic recovery (most rapid in first 3 months)

6-12 months after SCI

neurologic recovery slows; functional gains continue thru rehab, motor learning

initial severity favorable indicator

incomplete injury (AIS B, C, D); preserves sacral pinprick sensation at 72 hr

initial severity unfavorable indicator

complete injury (AIS A); absent sacral sensory/motor function

neurological level and injury pattern favorable indicator

lumbar/incomplete cervical/central cord syndrome

neurological level and injury pattern unfavorable indicator

complete thoracic injury

age favorable indicator

younger (

age unfavorable indicator

older (≥50)

in the first year post rehab discharge, patients avg 4.7 complications, most commonly...

UTI, autonomic dysreflexia, pressure ulcers

lower injuries - more or less available muscles

more available muscles and therefore greater independence

C5 biggest functional gain

elbow flexion allows self feeding with setup and adaptive equipment

C6 biggest functional gain

wrist extension creates tenodesis, dramatically improves transfers and independence

C7 biggest functional gain

triceps provide independent pressure relief and much easier transfers

C8-T1 biggest functional gain

finger flexion allows near normal hand use for many ADLs

mobility with high cervical SCI

power wheelchair

mobility with mid cervical SCI

manual wheelchair with adaptations

mobility with thoracic SCI

independent manual wheelchair

mobility with low thoracic/lumbar SCI

household --> community ambulation

independence in high cervical SCI

direct care; dependent for most ADLs

independence in mid cervical SCI

increasing independence using compensatory strategies and adaptive equipment

independence in lower cervical SCI

independent wheelchair mobility and many can complete transfers

independence in thoracic SCI

independent living with wheelchair mobility

independence in lumbar/sacral SCI

walking becomes increasingly functional; wheelchair needs decrease, but many may need for community mobility

5 variables of Van Middendorp clinical prediction rule for ambulation outcomes after SCI

age, quadriceps femoris motor grade, gastrocsoleus motor grade, light touch at L3, light touch at S1

scoring for clinical prediction rule for ambulation outcomes after SCI

10-40, higher total score = higher liklihood of independent ambulation (30-35)

central cord syndrome MOI

hyperextension injuries in cervical region or degenerative narrowing

most common spinal cord syndrome

central cord

central cord clinical presentation

UE>LE, intrinsic hand function likely to have residual deficits, sensory

central cord prognosis

best prognosis for return to walking of all SCI syndromes (lower if over 50), favorable for independent ADLs and bowel/bladder recovery

factors that predict functional recovery in central cord syndrome

age, absence of spasticity, higher education

brown sequard syndrome MOI

hemi section of SC, most commonly from penetrating trauma

brown sequard clinical presentation

ipsilateral weakness/paralysis, loss of FPV; contralateral pain/temp loss 1-2 levels below lesion

brown sequard functional prognosis

excellent prognosis for functional recovery, many patients regain independent ambulation, preservation of motor function predicts better outcomes

anterior cord syndrome MOI

injury to anterior 2/3 of SC; most commonly caused by anterior spinal artery ischemia; may occur following flexion injuries or aortic surgery

anterior cord syndrome clinical presentation

bilateral motor paralysis below lesion, loss of pain/temp, preservation of prop/vibration/deep pressure

anterior cord prognosis

poorest prognosis among incomplete SCI syndromes, limited motor recovery, walking recovery often poor

rare, injury to dorsal columns, may result from hyperextension injury, _____ artery infarction

posterior cord syndrome MOI

posterior cord clinical presentation

loss of prop/vibration, ataxic gait, motor strength relatively preserved

cauda equina syndrome MOI

injury to lumbosacral nerve roots (PNS); common causes include large lumbar disc herniation, trauma, tumors, spinal stenosis

cauda equina syndrome clinical presentation

flaccid LE weakness, saddle anesthesia, areflexia, areflexic bowel/bladder, sexual dysfunction

cauda equina syndrome functional prognosis

peripheral nerve regeneration is slow and often incomplete

SCI at or above T6 disrupts...

sympathetic control of the heart and blood vessels

autonomic dysreflexia definition

sudden increase in systolic BP of ≥20mmHg above the individuals usual baseline

common causes of autonomic dysreflexia

full/kinked bladder/catheter, constipatino, pressure areas, restrictive clothing, injury

common sx of autonomic dysreflexia

above = HTN, bradycardia, HA, sweating, piloerection, flushed skin, blurred vision; below = chills, clammy, pale

when is orthostatic hypotension most prominent in SCI

first 2 months

orthostatic hypotension sx

blurred vision, dizziness, light headed, fainting, nausea

medication for chronic low BP

midodrine

with autonomic dysreflexia, do you want to sit the pt up or lay them down

sit up (BP up = sit up)

muscle adaptations post SCI

generalized atrophy, mitochondrial dysfunction, fiber type shift from slow oxidative to fast glycolytic, increased fatiguability

spastic hypertonia

umbrella term including spasticity, spasms, increased tone, clonus

spasticity

velocity dependent increase in stretch reflex

spasticity is more common in which level SCIs

cervical

spasticity timeline

emerges after spinal shock, increases over 6 months, plateaus approx 1 yr

meds for spasticity

baclofen, tizanidine, diazepam, dantrolene

UMN/spastic characteristics`

suprasacral SCI, reflexes intact, increased sphincter tone, constipation, reflex bladder, high bladder pressures

LMN/flaccid characteristics

conus medullaris or cauda equina injury, reflexes absent, flaccid sphincters, overflow incontinence, flaccid bladder, urinary retention

without triceps, shoulder elevation is limited to ___ to avoid facial contact

45 deg

patients with C5-C6 injuries can use which motions to assist with rolling

ER and shoulder flexion to 45 deg

ensure pt has ___ of PROM hip flexion for long sitting

90 deg

where to guard SCI pt

in front or on the side pt is rolling towards; give pt enough room to swing arms