Bed Mobility: High Tetraplegia (C1-C5)
-Dependent (C1-C4)
-Moderate to Maximal assistance (C5)
Bed Mobility: Mid-Level Tetraplegia (C6)
-Minimal assistance to modified independent with equipment
Bed Mobility: Low Tetraplegia (C7-C8)
-Independent
Transfers: High Tetraplegia (C1-C5)
-Dependent (C1-C4)
-Maximal assistance with level sliding board transfers (C5)
Transfers: Mid-Level Tetraplegia (C6)
-Minimal assistance to modified independent for sliding board transfers
-Dependent with floor transfers and upright wheelchair
Transfers: Low Tetraplegia (C7-C8)
-Modified independent to independent with level surface transfer
-Maximal to moderate assistance with floor transfers and uprighting wheelchair
Weight Shifts: High Tetraplegia (C1-C5)
-Setup to modified independent with power recline/tilt weight shift
-Dependent with manual recline/tilt/lean weight shift
Weight Shifts: Mid-Level Tetraplegia (C6)
-Modified independent with power recline/tilt weight shift
-Minimal assistance to modified independent with side to side/forward lean weight shift
Weight Shifts: Low Tetraplegia (C7-C8)
-Modified independent with side to side/forward lean, or depression weight shift
Wheelchair Mobility: Mid-Level Tetraplegia (C6)
-Modified independent in smooth, ramp, and rough terrain with power wheelchair
-Dependent to maximal assistance up/down curb with power wheelchair
-Moderate to minimal assistance on ramps and rough terrain with manual wheelchair
-Maximal to moderate assis
Wheelchair Mobility: Low Tetraplegia (C7-C8)
-Modified independent in smooth, ramp, and rough terrain with power wheelchair
-Dependent to maximal assistance up/down curb with power wheelchair
-Modified independent on smooth surfaces and up/down ramps with manual wheelchair
-Minimum assistance to mod
Wheelchair Mobility: Paraplegia
-Minimum assistance to modified independent up/down 6'' curbs with manual wheelchair
-Modified independent with descending steps with manual wheelchair
-Maximum to minimal assistance to ascend steps with manual wheelchair
Feeding: High Tetraplegia (C1-C5)
-Dependent (C1-C4)
-Minimal assistance with adaptive equipment (C5)
Feeding: Mid-Level Tetraplegia (C6)
-Modified independent with adaptive equipment
Feeding: Low Tetraplegia (C7-C8)
-Modified independent with adaptive equipment (C7)
Grooming: High Tetraplegia (C1-C5)
-Dependent (C1-C4)
-Minimal assistance with adaptive equipment for face, teeth, makeup/shaving (C5)
-Maximal/moderate assistance for hair grooming (C5)
-Able to verbally direct
Grooming: Mid-Level Tetraplegia (C6)
-Modified independent with adaptive equipment
Bathing: Mid-Level Tetraplegia (C6)
-Minimal assistance for upper body bathing and drying
-Moderate assistance for lower body bathing and drying
-Use of shower or tub chair
Bathing: Low Tetraplegia (C7-C8)
-Modified independent with all using shower or tub chair
Dressing: Mid-Level Tetraplegia (C6)
-Modified independent for upper body in bed or wheelchair
-Minimal assistance with lower body dressing in bed
-Moderate assistance with lower body undressing in bed
What are the most frequently injured spinal areas
C5, C7, T12, L1
Flexion rotation is the most common (lumbar cervical or thoracic) mechanism of injury
Cervical
Injury to SCI or interruption of blood supply are examples (secondary or primary) SCI
primary
What type of spinal cord syndrome? Loss of more centrally located cervical tracks/arm function, with preservation of more peripherally located lumbar and sacral tracks/leg function; typically caused by hyperextension injuries to the cervical spine
Brown S
Central cord syndrome
What type of spinal cord injury syndrome? Damage is mainly resulting in loss of motor function, pain and temperature with
preservation of light touch, proprioception, and position sense
, typically caused by flexion injuries of the cervical spine
Brown Sq
Anterior cord syndrome
What type of spinal cord injury syndrome? Loss of proprioception, vibration, 2-point discrimination and light touch; extremely rare
Brown Squared syndrome
Posterior Cord syndrome
Anterior Cord syndrome
or
Central Cord Snydrome
Posterior cord syndrome
Spinal shock may last for how long?
several hours up to 24 weeks
Causes of increased muscle tone in SCI - what to look for to correct?
Blocked catheter, tight clothes or straps, body position, environmental temperature, infection, decubitus ulcers
AUTONOMIC DYSREFLEXIA can result
Signs & Symptoms of autonomic dysreflexia
paroxysmal hypertension, bradycardia, headache, diaphoresis, Flushing, diplopia, or convulsions; examine for irritating stimuli; treat as a medical emergency, elevate head, check and empty catheter first.
At what level of SCI does autonomic dysreflexia occur?
above T6
Does spasticity usually occur with complete or incomplete SCI?
Incomplete
Cauda equina lesion vs Lesions above S2-4
Cauda equina = flaccid bladder, emptied through pressure (valsalva)
Above S2-4 (suprasacral) = spastic bladder (emptied by touch)
Spinal shock bladder
Fills without ever emptying - need foley catheter OR intermittent catheterization
Suprasacral SCI bladder
Above S2-S4
Reflex isn't damaged but no brain control. Bladder spasms leading to leakage as reflex constantly kicks in.
THUS SPASTIC BLADDER
But eventually can back up because detrusor muscle not working correctly
Cauda Equina SCI bladder
Damage to sacral nerves - interrupts reflex and there is filling without reflex to empty
THUS FLACCID BLADDER - weak sphincter (leakage with coughing, laughing etc.)