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SCI Lesions, NBCOT Terms: Chapter 12--SCI

Terms in this set (85)

C1-C3 Muscles Innervated
Sternocleidomastoid, Cervical Paraspinal, Neck Accessories
C1-C3 Movements Possible
Neck Flexion, Neck Extension, Neck Rotation
C1-C3 Patterns of Weakness
Total paralysis of trunk, UEs, LEs; dependent on ventilator
C4 Muscles Innervated
Upper trapezius, Diaphragm, Cervical Paraspinal muscles
C4 Movements Possible
Neck flexion, Neck extension, Neck rotation; Scapular elevation; Inspiration
C4 Patterns of Weakness
Paralysis of trunk, UEs, LEs; Inability to cough; endurance and respiratory reserve are low secondary to paralysis of intercostal muscles
C5 Muscles Innervated
Deltoid, Biceps, Brachialis, Brachioradialis, Rhomboids, Serratus Anterior (Partial)
C5 Movements Possible
Shoulder Flexion, Shoulder Abduction, Shoulder Extension; Elbow Flexion and Elbow Supination; Scapular Adduction/Abduction
C5 Patterns of Weakness
Absence of elbow extension, pronation, and all wrist/hand movements; Total paralysis of trunk and LEs
C6 Muscles Innervated
Pectoralis; Supinator; Extensor Carpi Radialis Longus and Brevis; Serratus Anterior; Latissimus Dorsi
C6 Movements Possible
Scapular Protraction (Abduction); Some horizontal adduction; Forearm supination; Radial wrist extension; [TENODESIS GRASP]
C6 Patterns of Weakness
Absence of wrist flexion, elbow extension, and hand movement; Total paralysis of trunk and LEs
C7-C8 Muscles Innervated
Latissimus Dorsi; Sternal Pectoralis; Triceps; Pronator Quadratus; Extensor Carpi Ulnaris; Flexor Carpi Radialis; Flexor Digitorum Profundus and Superficialis; Extensor Communis; Pronator/Flexor/Extensor/Abductor Pollicis; Lumbricals (partial)
C7-C8 Movements Possible
Elbow extension; Ulnar/wrist extension; Wrist Flexion; Finger flexion/extension; thumb movement
C7-C8 Patterns of Weakness
Paralysis of trunk and LEs; Limited grasp and dexterity secondary to partial intrinsic muscle innervation of the hand
T1-T9 Muscles Innervated
Intrinsics of the hand including thumbs; Internal/external intercostals; Erector Spinae; Lumbricals; Flexor/Extensor/Abductor Pollicis
T1-T9 Movements Possible
UEs fully intact; Limited upper trunk stability; Endurance increased secondary to innervation of intercostals
T1-T9 Patterns of Weakness
Lower trunk paralysis; Total paralysis of LEs
T10-L1 Muscles Innervated
Fully intact intercostals (TRUNK STABILITY); External obliques; Rectus Abdominis
T10-L1 Movements Possible
Fair to good trunk stability
T10-L1 Patterns of Weakness
Paralysis of LEs
L2-S5 Muscles Innervated
Fully intact abdominals and all other trunk muscles; Depending on level, some degree of hip flexors, extensors, and abductors; Knee flexors, extensors; Ankle Dorsiflexors, Plantar Flexors
L2-S5 Movements Possible
Good trunk stability; Partial to full control of LEs
L2-S5 Patterns of Weakness
Partial paralysis of LEs, hips, knees, ankle, foot
C1-C3, and C4 Other Information
*May be able to use powered wheelchairs with special controls to move around
*Will not be able to drive a car on their own
*Requires 24 hour a day personal care
C5 Other Information
*Person can raise his/her arms and bend elbows
*Can speak and use diaphragm, but breathing will be weakened
*Will need assistance with most ADLs, but once in a power wheelchair, can move from one place to another independently
C6 Other Information
*Nerves affect wrist extension
*Should be able to bend wrists back
*Still has weakened breathing
*Can move in and out of wheelchair and bed with AE
*May also be able to drive an adapted vehicle
*Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
C7 Other Information
*Nerves control elbow extension and some finger extension
*Most can straighten their arm and have normal movement of their shoulders
*Can do most ADLs by themselves, but may need assistance with more difficult tasks
*May also drive an adapted vehicle
*Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
C8 Other Information
*Should be able to grasp and release objects
*Can do most ADLs by themselves, but may need assistance with more difficult tasks
*May also drive an adapted vehicle
*Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
T1-T5 Other Information
*Arm and hand function is usually normal
*Injuries usually affect the trunk and legs (paraplegia)
*Most likely to use a manual wheelchair
*Can learn to drive a modified car
*Can stand in a standing frame, while others may walk with braces
T6-T12 Other Information
*Usually results in paraplegia
*Normal upper body movement
*Fair to good ability to control and balance trunk while in the seated position
*Should be able to cough productively
*Most likely to use a manual wheelchair
*Can learn to drive a modified car
*Can stand in a standing frame, while others may walk with braces
*Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
L1-L5 Other Information
*Injuries generally result in some loss of function in the hips and legs
*Depending on strength in legs, may need a wheelchair and may also walk with braces
*Most likely will be able to walk
*Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
C1-C3 Muscles
Cervical muscles
C1-C3 Functional Outcomes/Interventions
*Requires respiratory support and total assistance with ADLs
*Focus of interventions on use of environmental controls, adaptive devices, and computer control, orthotics, and direction of care
C4 Muscles
Upper trapezius and diaphragm
C4 Funtional Outcomes/Interventions
*Requires assistance with ADLs but can progress to independence with use of AE and techniques
*Focus of interventions on the use of adaptive devices, assistive technology, and direction of care
C5 Muscles
Deltoids and Biceps
C5 Functional Outcomes/Interventions
*Requires some assistance with the majority of ADLs, but can be set up assistance with self-feeding and some grooming activities
*Focus of interventions on increasing strengthening to maximize ADL and IADL participation, orthotics, AE, assistive technology, functional and bed mobility, and direction of care
C6 Muscles
Wrist extensors
C6 Functional Outcomes/Interventions
*May be able to complete the majority of ADL with modified independence for increased time or use of AE
*Focus of interventions on functional mobility and transfers, adapted dressing techniques, orthotics, bladder and bowel care, and the progression of power to manual wheelchair propulsion
C7 Muscles
Triceps; increased wrist control; and emerging thumb muscles
C7 Functional Outcomes/Interventions
*Will be independent with basic ADL activities with limited use of AE or orthotics
*Focus of interventions on improving manual wheelchair skills, shoulder preservation, dressing, bathing and toileting efficiency and independence, increased challenging transfers and mobility skills, and increased participation in complex IADLs
C8 Muscles
Additional finger flexion/extension and lumbricals
C8 Functional Outcomes/Interventions
*Will be independent with all basic ADLs without the need of AE
*Focus of interventions of efficiency with bowel and bladder care, IADLs, wheelchair skills, lateral transfers and push up pressure reliefs, and shoulder preservation. Driving can now be achieved with only basic hand controls.
T1 Muscles
Hand intrinsics, emerging intercostals, remaining UE muscles, including opponens pollicis
T1 Functional Outcomes/Interventions
*Will be independent with all basic ADLs
*Focus of interventions on efficiency with bowel and bladder care, IADLs, wheelchair skills, lateral transfers and push-up pressure reliefs, and shoulder preservation
T2 to T9 Muscles
Erector Spinae
T2 to T9 Functional Outcomes/Interventions
*Will be independent with all basic ADLs at a wheelchair level
*Focus of interventions on efficiency with bowel and bladder care, IADLs, wheelchair skills, lateral transfers and push-up pressure reliefs, and shoulder preservation. May try standing with the use of KAFOs.
T10 to T12 Muscles
*Will be independent with all basic ADLs at a wheelchair level and can complete ADLs seated with improved balance or need for seated support.
*Focus of interventions on efficiency with bowel and bladder care, IADLs, and shoulder preservation. May begin to incorporate standing with the use of KAFOs into ADLs
L1 Muscles
Additional abdominals
L1 Functional Outcomes/Interventions
*Will be independent with all basic ADLs at wheelchair level and may begin to incorporate standing with ADLs using KAFOs
*Focus of interventions on efficiency with bowel and bladder care, IADLs, and shoulder preservation. May initiate learning ambulation skills.
L2 Muscles
Hip flexors
L2 Functional Outcomes/Interventions
*Will be independent with all basic ADLs at wheelchair level and may incorporate standing with ADLs using KAFOs
*Focus of interventions on efficiency with bowel and bladder care, IADLs, and shoulder preservation. May initiate minimal ambulation skills with KAFOs into ADL routines
L3 Muscles
Knee Extensors
L3 Functional Outcomes/Interventions
*Will be independent with all basic ADLs with standing incorporated as appropriate
*Continue to improve ADL and IADL efficiency. May incorporate ambulation with assitive devices and orthotics with ADLs
L4 Muscles
Ankle Dorsiflexors
L4 Functional Outcomes/Interventions
*Will be independent with all basic ADLs at wheelchair level and may begin to incorporate standing with ADLs using AFOs as appropriate
*Continue to improve ADL and IADL efficiency and increased standing and ambulation with ADLs and IADLs. Progressing to decrease assistive devices and orthotics required.
L5 Muscles
Long Toe Extensors
L5 Functional Outcomes/Interventions
*Will be independent with all basic ADLs at wheelchair level and may begin to incorporate standing with ADLs using AFOs as appropriate
*Continue to improve ADL and IADL efficiency and increased standing and ambulation with ADLs and IADLs. Progressing to decrease assistive devices and orthotics required
Sacral Muscles
Plantar flexors and LE adduction
Sacral Functional Outcomes/Interventions
*Will be independent with all basic ADLs at wheelchair level and may begin to incorporate standing with ADLs using AFOs as appropriate
*Continue to improve ADL and IADL efficiency and increased standing and ambulation with ADLs and IADLs. Progressing to decrease assistive devices and orthotics required.
Preparatory Exercises for SCI
ROM/strengthening
Orthotics
PAMs
Education and training
ROM/Strengthening
Helps maintain joint mobility and improve positioning and cosmesis. A progressive strengthening program should be implemented to improve functional reaching during activities and increase participation in functional mobility skills and transfers.
*Shoulder AROM
*Isometric strengthening
*Shoulder preservation strengthening and stretching program
Orthotics
*Used to promote functional positioning and prevent contractures.
*Can include: short or long opponens, resting hand splint, wrist support, or elbow extension orthotic.
PAMs
Neuromuscular Electrical Stimulation (NMES) for muscle strengthening and neuromuscular reeducaiton is commonly integrated into rehab. NMES can assist to restore useful movement during grasp and gait training with consistent use
Education and Training
Education can prevent secondary conditions and maximize independence and occupational performance
Complications of SCI
Autonomic Dysreflexia
Orthostatic Hypotension
Heterotopic Ossification
Skin Integrity
Pain
Autonomic Dysreflexia
*associated with injuries above T6
*An increase in BP caused by a reflexive action of the ANS. It is a medical emergency and quick action should be taken to resolve the complication.
*Causes can be related to bowel or bladder function or irritation, pain, skin-related disorders, or other medical irregularities.
*Other symptoms that may occur are: a pounding headache, sweating, chills, nasal congestion, and slowing heart rate.
*To treat, make person sit upright and remove or address any irritating condition; for example, draining the bladder and removing tight clothing, shoes, elastic garments, or abdominal binders.
Orthostatic Hypotension
can occur after a SCI at any level; it features a sudden drop in BP typically related to the lack of venous blood return from the abdomen or LEs. It not treated, individual may lose consciousness. Other symptoms include a sudden onset of nausea or dizziness.
*To treat, lay the person back or have the person sit down immediately. Elevate the legs as needed to restore a normal BP. To prevent, medication can be used in addition to elastic stockings or abdominal binders or both to improve venous blood return
Heterotopic Ossification (HO)
The development of ectopic bone below the neurological injury level. Most common occurrence includes the hips, knees, and elbows.
Symptoms include swelling and warmth and decreased ROM in the area of the affected joint.
To treat, early detection is preferred to prevent the progression of the condition. Early ROM exercises are important to maintain joint mobility, and medication may also be beneficial. PROM should be completed to the available end range regularly.
Skin Integrity
Sensory loss increases the risk of experiencing skin breakdown and the development of pressure ulcers. Risk factors include: pressure to an area of skin that results in decreased blood flow to the area, heat, friction, and moisture (incontinence). Most common areas for skin breakdown: sacrum, bilateral greater trochanters, ischial tuberosities, elbows, heels, and other bony prominences where sensation is decreased such as scapulae.
Treatment and prevention includes reducing pressure or restricting weight bearing to the involved area(s), employing a clean catheterization technique, and educating the patient about hydration, dysreflexia, and transfer and mobility techniques that decrease friction and shear forces
Pain
The most common types of pain experienced are nociceptive and neuropathic.
Nociceptive pain is categorized as musculoskeletal pain or visceral pain.
Neuropathic pain is described as sharp, shooting, burning, or electric feeling of pain. Neuropathic pain can be experienced above, at, and below the neurological level of injury.
Tetraplegia (Quadriplegia)
*Motor and/or sensory impairment that involves all four limbs and trunk
*Paralysis of the LEs and trunk and paralysis or partial paralysis of the UEs
Paraplegia
*Motor and/or sensory impairment of the LEs and/or trunk
*Paralysis of the LEs with potential involvement of the hips and/or trunk
Central Cord Syndrome
Greater weakness of the UEs than the LEs; Individual may be ambulatory but present with significant UE weakness, especially proximally. Common mechanism of injury is due to severe cervical hyperextension
Brown-Sequard Syndrome
*Incomplete injury resulting in ipsilateral proprioceptive and motor loss and contralateral loss of pain and temperature sensation
*Most often associated with violently acquired SCI, such as a stab or gunshot wound, resulting in damage to one half of the spinal cord. Presentation occurs when the dorsal column-medical lemniscus tract and corticospinal tract are affected on the ipsilateral side of the spinal injury and the spinothalamic tract contralaterally
Cauda Equina Syndrome
*Lower motor neuron injury of the lumbosacral nerve roots
*Because only peripheral nerves are impacted, not the spinal cord itself, prognosis is greater.
*Common presentation is asymmetric and results initially in a flaccid-like muscle presentation of the LEs
AIS: A
no motor or sensory function is preserved below the level of spinal injury
AIS: B
only sensory function is preserved below the level of injury, including at the S4 and S5 sacral levels
AIS: C
both motor and sensory functions are preserved below the level of injury. More than half of the key muscles below injury level present with a muscle grade less than 3/5 or fair muscle grade
AIS: D
Both motor and sensory functions are preserved below the level of injury. More than half of the key muscles below the level of injury present with a muscle grade of more than 3/5 or more
AIS: E
both motor and sensory functions are intact
Complete SCI
absence of sensory and motor function in the lowest sacral segments of the spinal cord
Incomplete SCI
Preservation of sensory and motor function in the lowest sacral segments of the spinal cord
Precautions After Surgery
NO twisting
NO excessive bending
NO heavy lifting
THIS SET IS OFTEN IN FOLDERS WITH...