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SCI

QuestionAnswer
Zone of partial perservation complete injuries that have some innervation of dermatomes below level of injury
Spinal shock initial stage, lasting between 24 hours and 6 weeks, reflex activity ceases resulting in spasticity
C1-C4 respiratory assist dep for ADL limited head and neck movement sympathetic system compromised, autonomic dysreflexia, no bowel or bladder control electric wheelchair with sip and puff
C5 breathing with diaphragm dep for ADL full head and neck movement, raise arms and flex elbows, no extension sympathetic compromised, autonomic dysreflexia, no bowel or bladder control electric wheelchair with hand controls
C6 mod assist for personal care full head and neck movement ability to raise arms and flex elbows, no extension some wrist extension little bowel or bladder control electric w/c w/ hand controls manual chair for short distances drive with hand contr
C7 limited assist for personal care extend elbows wrist flexion and extension partial finger movement little bowel/bladder control independent transfer
C8 independent with personal care
T1-5 normal UE ROM and strength little bowel or bladder manual wheelchair
T6-T12 stand in standing frame or walk with braces
L1-L5 normal respiratory partial paralysis in hips and legs
s1-s5 some loss of function in hips and legs able to walk with assist or aids though slowly with difficulty can load wheelchair into car independently
orthostatic hypotension position in supine, elevate legs above heart move slowly for supine to sit
autonomic dysreflexia stand person loosen restrictive clothing check catheter for obstruction
heterotopic ossification maintain ROM
DVT check color, size, temperature
Bowel and bladder affected for all injuries above s2-s5
Approach recommended top-down approach
Acute recovery phase education, environmental control, UE ROM
UE ROM emphasis in acute recovery scapular rotation, shoulder scaption, shoulder external rotation, elbow extension, forearm pronation
Positioning in acute recovery 80 deg shoulder abduction external rotation with scapular depression full elbow extension forearm pronation
Tenodesis splint dorsal, wrist in extension, thumb in opposition wrist drive wrist-hand orthosis
C5 tetraplegia physical intervention mobile arm support grasp and hold require wrist stabilization and use of an assistive device such as u-cuff or c-clamp
C6/7 tetraplegia physical intervention greater innervation of shoulder girdles greater force for rolling in bed and crossing midline tenodesis grasp wrist-drive wrist-hand orthosis (tenodesis splint) maximize pinch strength
C8 tetraplegia physical intervention grasping with MCP extension and DIP/PIP flexion