SCI 1
Your Pt. is classified as a "C5 ASIA A Complete SCI" after having suffered a diving accident 5 months ago. This individual seems to be breathing independently but still struggles in his day-to-day rehabilitation program from poor exercise tolerance from feeling "out of breath".
As a Physical Therapist,
1.) What can we do as PTs to access respiratory function?
2.) What muscular structures are impaired?
3.) What Interventions could be used to improve respiratory function?
1.) Auscultation (breath sounds)
Vital Signs (HR, BP, RR, SaO2)
Measure chest expansion (Normal is 2.5-3 Inches)
2.) Abdominal Muscles (T5-T12) + Intercostals (T1-T12)
3.) - Inspiratory muscle trainer
- UE ROM
- Chest expansion (Use Deltoid, Biceps, rhomboids)
Your patient is a C3 ASIA A Complete SCI.
1.) What key muscles are still innervated?
2.) Do they need a ventilator?
3.) How will this patient communicate?
4.) What type of mobility does this patient require
1.) SCM, Upper Trapezius, Scalenes, Levator Scapulae, Upper Head and neck extensors
2.) Yes! 24-hour assistance
3.) Mouth stick (Used to press keys)
4.) Powered wheelchair + tilt in space for pressure relief
1.) What is the difference between spastic and flaccid bladder?
2.) What SCI levels require fully dependent bladder managment?
1.) Spastic: Bladder does not empty due to tonic contraction of the Internal/external sphincter
Flaccid: Bladder empties due to any increase in abdominal pressure
2.) C1-C5
Your patient is a C8-T1 ASIA A Complete SCI.
1.) What muscles are innervated? (No need to be specific with muscles. Be general)
2.) Level of assistance?
3.) What level of independence does this person have for lightweight wheelchair use?
1.) FULL innervation of UE muscles
2.) Independent in all mobility related ADL's
3.) Fully independent manual lightweight W/C use
Why are patients with SCI more susceptible to contracture formation?
Patient post SCI are more susceptible because lack of normal reciprocal muscle stretching from normal contraction of opposing muscles around joint, spasticity, flaccidity, muscle imbalances.
What is Autonomic Dysreflexia?
What are some S/S?
Sudden Sympathetic nervous system response to a noxious stimulus.
Most common in T6 SCI
S/S= Increases BP + headaches
Your patient is a C4 ASIA A Complete SCI.
1.) What key muscles are still innervated?
2.) What is the most important expected functional outcome?
3.) Do they need assistance?
4.) What type of mobility does this patient require
1.) C1-C3 muscles and Supraspinatus, Infraspinatus, rhomboids, DIAPHRAGM
2.) Independence with powered mobility (Mobility use and tilt in space use)
3.) Yes, 24-hour assistance
4.) Sip and Puff power mobility + Tilt in space
List the ASIA Impairment Scale
A-
B-
C-
D-
E-
A- complete injury with no motor or sensory function preserved at S4-5
B- incomplete- sensory function is preserved below the neurological level including at S4 to 5
C- incomplete- motor function is preserved below the neurological level and more than ½ of the key muscles are less than 3/5
OR the patient meets the criteria for sensory incomplete status sensory function preserved at the most caudal sacral segments S4-5 by LT, PP or DAP) and has some sparing of motor function more than three levels below the ipsilateral motor level on either side of the body (This includes key or non-key muscle functions
D- incomplete- motor function is preserved below the neurological level and at least ½ of the key muscles below the neurological level are > 3/5 strength
E- Normal
What type of syndrome is associated with a hyper flexion injury?
Anterior Cord syndrome
Why are patients with Complete SCI more susceptible to HETROTROPIC OSSIFICATION?
SCI causes a major systemic inflammatory response which creates the exact environment that promotes abnormal bone formation in soft tissue
Your patient is a T12 ASIA A Complete SCI. You are looking to perform pressure mapping in order to determine what wheelchair cushion would be best suited for his needs. You proceed to educate the patient on pressure relief techniques.
1.) How often should he perform these techniques for?
2.) How often should he be partaking in a turning schedule when in bed?
1.) Every 20-30 minutes
2.) Every 2-4 hours
Your patient is a C5 ASIA A Complete SCI.
1.) What key muscles are still innervated?
2.) Expected functional outcome? (Most important)
3.) Level of assistance?
4.) What should be targeted in terms of strength?
1.) All C1-C4 + Elbow flexors (Biceps, brachialis, brachioradialis)
Pec Major + LIMITED Serratus anterior + supinator
2.) Independent with powered mobility using HAND DRIVE.
3.) Personal Care 10 hours + self-care 6 hour
4.) Postural strength to prevent forward flexed posture (Excessive IR and poor scapular stability)
What is the Zone of Partial preservation?
No motor or sensory function present at S4-S5 but there is motor or sensory function present below the neurological level.
What are the most common MOI related to a SCI?
Flexion: C5-C6
Hyperextension: C3-C4
Compression
Shearing
Your patient is a T6 ASIA B incomplete SCI. The last physical therapists on shift in your acute care facility failed to turn your current patient over and has been complaining of a weird sensation on the side of his hip. You and the nurse on duty turn the patient over and notice excessive red/pink granulation, yellow fat visible, and a deep open wound.
1.) What stage pressure ulcer is this?
Stage 3- Full thickness skin loss involving damage or necrosis down to the subcutaneous tissue layer
Your patient is a C6 ASIA A Complete SCI.
1.) What key muscles are still innervated? What Movements can this individual perform?
2.) Expected functional outcome? (There are 2 very important ones)
3.) Level of assistance?
4.) What are some expected outcomes for powered or lightweight mobility?
1.) C1-C5 muscles + ECRB/ECRL, latissimus dorsi, serratus anterior, teres minor
Movements: Shoulder flexion, adduction, IR, scapular upward rotation, wrist pronation and extension.
2.) Wrist extension with tenodesis grip + Independent level sliding board transfer
3.) 6-hour personal care + Home care 2-4 hours
4.) INDEPENDENT pressure relief using LAETRAL/FORWARD lean
List the Motor Levels tested in the ASIA Scale
C5- Elbow flexion
C6- wrist extension
C7- Elbow extension
C8- finger flexion
T1- Finger abduction
L2- Hip flexion
L3- Knee extension
L4- Dorsiflexion
L5- Big toe extension
S1- Plantarflexion
What syndrome is Flexion + rotation MOI commonly associated with?
Brown-Sequard
A patient has been wearing a HALO vest for post-surgical spinal immobilization for the past 12 weeks. You want to progress him on to a Cervical Orthosis.
1.) What cervical orthosis could you progress them on to? (I only put the 2 most common ones)
Aspen Collar
Miami J collar
Your patient is a C7 ASIA A Complete SCI.
1.) What key muscles are still innervated? Available Movements?
2.) Expected functional outcome? (There are 2 very important ones)
3.) Level of assistance?
4.) What is a rehabilitation goal for wheelchair use and transfers?
1.) C1-C6 Muscles + Flexor carpi radialis + Thumb extensors + PARTIAL Triceps
Movements: ELBOW EXTENSION + wrist flexion + finger extension
2.) Bowl/Bladder independence + Dressing
3.) First SCI level in which they may possibly live alone
4.) Advanced Wheelchair skills + Floor transfers
List the signs/symptoms related to UMN vs LMN damage
UMN
- Flaccidity
- Hyporeflexia (decreased DTR)
- Muscle weakness
LMN
- Spasticity + muscle spasms
- (+) Babinski sign
- (+) clonus
-Hyperflexion (Increased DTR)
What type of SCI syndrome is associated with hyperextension?
Central Cord syndrome