NPTE - SCIs

Types of SCI

Complete

Incomplete

Complete SCI

No motor/sensory ftn in S4-5

Incomplete SCI

Some motor/sensory preserved below lesion

Asia Impairment Scale (AIS)

A: Complete

B: Sensory only preserved below level

C: Motor ftn preserved, majority <3/5

D:Motor ftn preserved, majority >3/5

E: Normal motor and sensory ftn

Central Cord Syndrome

Caused by hyperextension (OAs)

UE > LE weakness

Variable sensory loss

Ant Cord Syndrome

Caused by flexion injury

B motor, p!, temp loss (corticospinal/spinothalamic tracts)

Proprioception spared

Brown-Sequard Syndrome

Caused by Hemisection (stab wound)

IL motor/proprioception loss

CL p!/temp loss

Post Cord Syndrome

Rare

Loss of proprioception

Preserved motor

Cauda Equina Syndrome

LMN injury

L2 and below

Saddle anesthesia

Flaccid B/B

LE flaccid paralysis

Medical emergency

C1-3

SCM, traps

Vent dependent

Sip and puff WC

C4

Diaphragm

Breathing possible

Power WC

C5

Deltoid, biceps

Shoulder abduction, elbow flexion

Power WC with hand controls

C6

Wrist extensors

Tenodesis grip, transfers with AD

Manual WC

C7

Triceps

I transfers, push-up

Manual WC, easier I

C8-T1

Hand intrinsics

Full hand use

I living

T6-L1

Abs

Improved trunk control

KAFOs are possible for ambulation

L2-S5

Hip/knee/ankle ftn

Household ambulation possible

AFOs, canes, walker

Common SCI Complications

Autonomic dysreflexia

Orthostatic hypotension

Spasticity

Pressure ulcers

Respiratory issues

DVT/PE

Neurogenic B/B

Autonomic Dysreflexia

T6 or above

Increased BP, decreased HR, and sweating

Sit up and check for a noxious stimulus

Orthostatic Hypotension

Decreased BP with the upright position

Recline and elevate the legs

Spasticity

UMN lesion

Can aid mobility but may limit ftn

Pressure ulcers

Perform pressure relief every 15-30 mins

Respiratory issues

Above C5: weak diaphragm —> ventilator risk

DVT/PE

Early mobility and compression stockings important

Neurogenic B/B

Require bowel program, catheter management

SCI interventions - Acute Phase

PROM to prevent contractures

Respiratory training (esp C1-5)

Positioning for pressure relief

SCI Interventions - Rehab Phase

Mat training, balance, weight shifts

Transfer training (sliding board for C6-7)

Ftnal strengthening

WC skills training

Orthotic and gait training if appropriate (KAFOs, AFOs)

C1-4 (WC/Mobility Training)

Power WC with head control

Dependent for all care

C5 (WC/Mobility Training)

Power WC with hand control

Assistance needed

C6 (WC/Mobility Training)

Manual WC with rim projections

I Indoors

C7-T1

Manual WC

I in transfers and mobility

Tips for the Boards

C6 = tenodesis grip - DON’T overstretch finger flexors

Autonomic Dysreflexia is a medical emergency - sit them up, check catheter

Pressure relief = every 15-30mins for 1-2mins

SCI is UMN if above conus medullaris; LMN if cauda equina

For gait potential: L2-S1 injuries are most promising

Don’t teach overhead pulley use for flaccid shoulders post-SCI - risk of injury

Outcome Measures

ASIA Scale - Classify SCI completeness

FIM - ADLs and burden of care

SCI Independence Measure - SCI-specific ftn

Walking Index for SCI - Ambulation status