#15 Interventions for Complete Paralysis

What does complete paralysis depend on?

Complete paralysis from damage to the spinal cord depends on location

- Not all SCI result in complete paralysis

- Tetraplegia, paraplegia

What are the functional effects of a SCI?

Depends on level of SCI, specifically the motor level

What are concomitant impairments of SCI?

1. Paralysis

2. Sensory deficits

3. Abnormal muscle tone

4. Altered CV and respiratory function, decreased BP

5. Bladder/bowel issues, changes in genital functioning

6. Altered autonomic function

7. Impaired thermoregulation

8. Secondary impairments

What are common secondary impairments?

1. Autonomic dysreflexia

2. DVT

3. GI hemorrhages

4. Heterotopic ossification

5. Joint contractures

6. Osteoporosis

7. Fractures

8. Chronic pain

9. Pressure ulcers

10. PE

11. Pneumonia

12. Respiratory insufficiency

13. UTI

14. Kidney/bladder stones

What are other aspects of complete paralysis that must be looked at in a holistic context?

1. Societal attitudes, support (or lack of), resources (or lack of)

2. Performance of physical tasks and activities is hindered - disability

What are expected bed skills for C1-4 level SCI?

Total A

What are expected transfers for C1-4 level SCI?

Total A

What is the expected w/c for C1-4 level SCI?

Power w/c

What is the expected ambulation level for C1-4 level SCI?

No functional ambulation

What are expected bed skills for C5 level SCI?

Some assist

What are expected transfers for C5 level SCI?

Total A (exceptions)

What is the expected w/c for C5 level SCI?

1. Power w/c

2. Manual w/c with assist

What is the expected ambulation level for C5 level SCI?

No functional ambulation

What are expected bed skills for C6 level SCI?

Some assist (exceptions)

What is the expected w/c for C6 level SCI?

Manual w/c - some assist

What is the expected ambulation level for C6 level SCI?

No functional ambulation

What are expected bed skills for C7-8 level SCI?

Independent

What are expected transfers for C7-8 level SCI?

Independent

What is the expected w/c for C7-8 level SCI?

Manual WC

What is the expected ambulation level for C7-8 level SCI?

No functional ambulation

What are expected bed skills for T1-9 level SCI?

Independent

What are expected transfers for T1-9 level SCI?

Independent

What is the expected w/c for T1-9 level SCI?

Manual w/c

What is the expected ambulation for T1-9 level SCI?

Functional ambulation not typical

What are expected bed skills for T10-L1 level SCI?

Independent

What are expected transfers for T10-L1 level SCI?

Independent

What is the expected w/c for T10-L1 level SCI?

Manual w/c

What is the expected ambulation for T10-L1 level SCI?

Some assist with KAFOs and crutches/walker

What are expected bed skills for L2-5 level SCI?

Independent

What are expected transfers for L2-5 level SCI?

Independent

What is the expected w/c for L2-5 level SCI?

Manual w/c

What is the expected ambulation for L2-5 level SCI?

Independent with KAFO/AFO and crutches/cane

What ASIA levels use compensation vs restoration?

1. Compensation: A, B, C

2. Restoration: C, D

*C is transitional level

What is ASIA A?

Complete

- No motor or sensory function in the lowest sacral segment

What is ASIA B?

Sensory incomplete:

Sensory but no motor below neurologic level and includes sacral segment

What is ASIA C?

Motor incomplete:

More than ½ of the key muscles below the (single) neurological level have a grade less than 3

What is ASIA D?

Motor incomplete:

At least ½ of the key muscles below the (single) neurological level have a grade 3 or better

What is ASIA E?

Sensory and motor function are normal

What are strategies used to maximize functional independence for complete paralysis?

Review Box 26-1:

1. Compensatory movement strategies

2. Strengthening of spared/innervated muscles

3. Development and presentation of ROM

4. Use of equipment

5. Preventive measures to avoid secondary complications

What are different movement strategies after SCI?

1. Substitution

2. Angular momentum

3. Alternate movement patterns

What is substitution?

To regain functional independence

What are common substitutions with muscle substitutions?

1. With agonist muscles; using fixation of distal extremity

2. With gravity

3. With tension in passive structures

What are common substitutions with biomechanical principles?

1. Fixation of distal body segment

2. Momentum

3. Head-hip relationship

How is angular momentum used as a movement strategy?

1. Use of momentum to augment motion at a given joint when muscles are weak (i.e. instead of slowly moving a body part, patient "throws" the body part)

2. Momentum of moving parts results in movements in other areas of the body (i.e. compensatory technique to roll)

What are kinds of alternate movement strategies?

1. Elbow flexors for upper trunk flexion in supine

2. Loops for stabilization of distal segments (supine <> sit in bed)

3. Arm throwback: tripod position for balance

4. Head lateral flexion for controlling lower trunk in quadruped

5. Unweigh the body segment to be moved