SCI Expectations

AV

SCI PT Considerations for All Patients

• Know what the “next level” of innervation is to watch for improvement

• Maintain functional ROM

• Address respiratory health

• Reinforce education from other providers

• Timing of ordering a wheelchair based on expected size and level

Family and caregiver education

• Autonomic dysreflexia

• skin integrity

• bowel and bladder issues

• body mechanics

• equipment

High Cervical

C1-C4

Mid cervical

C5-C7

Low Cervical

C8-T1

Characteristics of patients with high cervical injuries

no UE usage

totally dependent for all care (focus on training and patient being able to direct care)

needs power chair with a special control

try to wean off ventilator at C4

Mobility expectations from C1-C4

dependent for all except independent with pressure relief if they have a power chair

ADL expectations with C1-C4

all dependent

directs care when assist is needed

Equipment needs with C1-C4

power adjustable bed

mechanical lift

power with adaptive controls

portable ventilator

hand splits

commode chair

Key muscles with C1-C4

face and neck muscles

cranial nerves

diaphragm (partial innervation at C3-4)

Avaliable motions with C1-C4

talking

mastication

sipping

blowing

scapular elevation

If C1-2 are damaged what happens to breathing

loss of spontaneous respiration due to loss of phrenic nerve

only have the SCM and upper trap for active breathing

need phrenic nerve stimulator or artificial ventilator

-require assistance with airway clearance

C5 mobility expectations

assistance to dependent with bed mobility

dependent with transfers (mechanical lift or slide board)

can perform power mobility

can stand with power frame

can propel wheelchair on even surfaces

C5 ADLs

set up and assistance needed for: feeding, grooming, dressing, bathing, driving

Dependent with bowel and bladder

Equipment needed for C5

power chair

Power adjustable bed

Mechanical lift

Manual wheelchair with modifications

adapted utensils

Shower chair

Accessible car with adaptive controls

Key muscles with C5 injuries

biceps, brachialis, deltoid, infraspinatus, rhomboids and supinator

Motions with C5 injuries

elbow flexion and supination

shoulder ER, abd and flexion to 90 degrees

C6 Mobility expectations

independent with some bed mobility, transfers, pressure relief and standing with tilt table

Power or manual wheelchair: I or assist

unable to walk

C6 ADL Expectations

Assistance - independent level for feeding, grooming, dressing, bathing, bowel, driving, home management, direct care when assistance is needed

Equipment needs for C6

power chair for community

power adjusted bed

adaptive utensils

transfer board

Adaptive equipment for feeding, dressing and bathing

Accessible car with adaptive controls

Key muscles for C6

ext carpi radilais, infraspinatus, latissimus dorsi, pec major, pronator teres and serratus anterior

Motions for C6

shoulder flexion, ext, IR and ADD

Scapular abd, protraction and upward rotation

Forearm pronation and wrist extension

Tenodesis grip

C7 mobility expectations

independent with all except amblation

C7 ADL expectations

independent with all

Equipment needs for C7

bed rails

transfer board

manual wheelchair

wheelchair cushion

hand splints

C7 key muscles

extensor pollicis longus and brevis, extrinsic finger extensors, felxor carpi radialis and triceps

C7 motions gained

elbow flexion, wrist flexion and finger extension

C8 mobility expectations, ADL expectations, equipment needs

similar to C7

Why does C8 need less equipment than C7

because they have increased hand function

Key muscles with C8

extrinsinc funger flexors, flexor carpi ulnaries, flexor pollicus longus and brevis, intrinsic finger flexors

Avaliable motion gained with C8

finger flexion

T1-T12 mobility expectations

can be independent within the household with assistive device

high thoracic injuries require less assistance

Equipment needs for T1-T12

orthotic for ambulation

vechiles with adaptive controls

Key muscles of T1-T12

intercostals, long muscles of back and abdominal muscles

Motions with T1-T12

improved trunk control with more caudal SCI

increased respiratory reserve

pectoral girdle stabilization

What level is neede to use an exoskeleton

C7 to hold themselves up

L1-3 mobility expectations

wheelchair for long distance but can ambulate with assitive devices

Equipment needs for L1-L3

assistive debices for ambulation or orthoses depending on motor function

Key muscles for L1-3

gracilis, iliopsoas, quadratus lumborum, rectus femoris and sartorius

Motions for L1-3

hip flexion, hip adduction and knee extension

Mobility expectations for L4-S1

independent with all when using an assistive device and orthotics

Equipment needs for L4-S1

orthoses and assistive device for ambulation

Key muscles with L4-S1

quads, anterior tib, hamstrings, gastroc, gluteus medius and maximus, toe extensors

Avaliavle motions with L4-S1

strong hip flexion, strong knee ext, knee flexion, dorsiflexion and plantarflexion

ankle eversion and toe extension