SCI levels, standardized exam tools, etc
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| Describe the functional outcome of C1-C3 SCI | -Face and neck innervated
-Ventilator to breathe
-Power wheelchair with mouth control on most surfaces
-Dependent for ADLs and transfers
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| Describe the functional outcome of C4 SCI | -Face, neck, diaphragm, trapezius innervated
-Dependent for ADLs and transfers
-Independent mobility with power chair with mouth/head controls
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| Describe the functional outcome of C5 SCI | -Biceps, deltoid innervated
-Max assist for transfers and bed mobility, maybe sliding board (maxA)
-Independent mobility with power wheelchair, joystick
-Mod I mobility with manual chair in forward direction on smooth surface only
-Min assist ADLs
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| Describe the functional outcome of C6 SCI | -ECRL, pecs, serratus, rotator cuff innervated
-Independent with power chair, joystick
-Can be mod I with manual wheelchair, transfers, bed mobility, ADLs
-Can drive a car with hand controls
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| Describe the functional outcome of C7 SCI | -Finger extensors and triceps innervated
-Mod I with manual wheelcahir, ADLs, transfers (even without slide board)
-Independent with cough
-Can drive car with hand controls
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| Describe the functional outcome of C8-T1 SCI | -Finger flexors innervated
-Independent with manual wheelchair with STANDARD RIMS!
-I with ADLs, transfers, skin, driving with hand controls
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| Describe the functional outcome of T4-T6 SCI | -Upper half of intercostals and spinal muscles innervated
-Independent with manual chair, WHEELIES, wheelchair sports
-I with transfers, ADLs
-Stand with standing frame
-May amb short distances with KAFOs
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| Describe the functional outcome of T9-T12 SCI | -All abdominals and intercostals innervated
-Independent with ADLs, transfers, manual wheelchair sports
-May amb household distances with KAFOs, high energy consumption
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| Describe the functional outcome of L2-L4 SCI | -Quads, quadratus lumborum, most ant thigh muscles innervated
-Independent with manual wheelchair on most terrains
-Independent with FLOOR TRANSFERS
-Amb with KAFOs
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| Describe the functional outcome of L4-L5 SCI | -Tib ant/post, medial hamstrings innervated
-Independent with almost everything
-May NOT need manual wheelchair- amb with AFOs
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| Describe the functional outcome of Central Cord Syndrome SCI | -Normal LE, UE weakness with minimal spasticity
-MinA to mod I with ADLs, transfers, and wheelchair
-Ambulation SBA to Independent
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| Describe the functional outcome of Brown Sequard Syndrome SCI | -Paresis on side of lesion, sensation loss on other side
-Independent with ADLs, wheelchair, transfers
-Amb with minA to mod I
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| What is the highest level of SCI that could operate a power chair with hand controls (joystick)? | C5
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| What is the highest level of SCI that could drive a car with hand controls? | C6
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| What is the highest level of SCI that can cough independently? | C7
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| What is the highest level of SCI that could use a manual wheelchair with standard hand rims? | C8
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| What is the highest level of SCI that can potentially amb short distances with orthotics and would be able to perform wheelies (wheelchair sports, uneven terrain)? | T4
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| What is the highest level of SCI that could amb household distances with KAFOs? | T9 (still high energy comsumption)
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| What is the highest level of SCI that ambulation as primary mode of mobility would be possible (with orthotics)? | L4
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| Anterior Cord (anterior spinal artery) Syndrome | -Cortiocopinal tract affected (motor function)
-Vestibulospinal and Lateral Spinothalamic Tracts most affected (light touch, proprioception, pain, temperature)
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| Central Cord Syndrome | -UE affected, LE not really
-LST (pain and temp) most affected
-Motor more affected than sensory tracts
-Most can walk and have some bowel/bladder control
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| Brown-Sequard Syndrome | -Similar to stroke presentation!
-Hemiparesis on side of lesion, also loss of vibration and joint position sense
-Loss of pain and temp on opposite side (LST)
-Usually recover pretty well
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| Posterior Cord Syndrome | -Rare
-Motor fxn ok
-Pain, proprioception, 2 pt discrim, and stereognosis deficits
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| Cauda Equina Sydnrome | -Below L1, usually incomplete
-Lower motor neuron injury= flaccid paralysis
-Full recovery not typical
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| CVA Standard Tests | NIH Stroke Scale (assessment of impairment)
FIM (level of assist with mobility and ADLs)
Stroke Impact Scale (level of physical and social disability)
Fugl-Meyer (motor, sensory, balance, pain, ROM)
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| Bobath theory | -NDT, key points of control
-Postural control
-Facilitation and inhibition
-Reflex inhibiting postures (inhibit abnormal tone/movement)
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| Brunnstrom theory | -Hemiplegia
-Synkinesis and phenomenons
-Seven stages of recovery
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| Kabatt, Knott, and Voss theory | -PNF
-Mass movement, overflow
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| Rood theory | -Use sensory system to facilitate/inhibit motor
-Goal of homeostasis
-Heavy vs light work
-Ex: brushing, icing, approximation
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| At what age do infants start rolling? | 4-5 months supine<->sidelying
6-7 months supine<->prone
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| At what age do infants st independently? | 6-7 months
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| At what age do infants start to crawl and cruise? | 8-9 months
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| At what age do infants start to walk without support? | 12-15 months
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| RLA Level I | No response
Appears to be in deep sleep, no response to any stimuli
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| RLA Level II | Generalized response
Inconsistent, non-purposeful reaction to stimuli
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| RLA Level III | Localized response
Inconsistent, but specific reaction to stimuli
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| RLA Level IV | Confused-Agitated
Bizarre, non-purposeful behavior. Unable to cooperate directly with treatment efforts.
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| RLA Level V | Confused-Inappropriate
Can respond to simple commands ONLY, most of the time. Severe memory impairment, unable to learn new info.
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| RLA Level VI | Confused-Appropriate
Follows simple commands consistently. Shows carryover of relearned tasks. Memory still impaired.
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| RLA Level VII | Automatic-Appropriate
Automatic daily routine, robotic. Slow carryover for new learning. Impaired judgement.
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| RLA Level VIII | Purposeful-Appropriate
Aware and appropriately responsive to normal environment. Independent with re-learned activities. May still have deficits relative to PLOF (reasoning, judgement, stress response)
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| Glasgow Coma Scale- Eye Opening | Spontaneous 4
To speech 3
To pain 2
Nil 1
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| Glasgow Coma Scale- Best Motor Response | Obeys commands 6
Localizes pain 5
Withdraws 4
Abnormal flexion 3
Extensor response 2
Nil 1
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| Glasgow Coma Scale- Verbal Response | Oriented 5
Confused conversation 4
Inappropriate words 3
Incomprehensible sounds 2
Nil 1
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| Glasgow Coma Scale- What do the scores mean? | 8 or less= severe brain injury
9-12= moderate brain injury
13-15= mild brain injury
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| Brunnstrom Stage 1 | No volitional movement
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| Brunnstrom Stage 2 | Limb synergies appear. Spasticity begins.
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| Brunnstrom Stage 3 | Synergies performed voluntarily. Spasticity increases.
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| Brunnstrom Stage 4 | Movement patterns begin outside of synergies. Spasticity decreases.
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| Brunnstrom Stage 5 | Independence from synergies. Spasticity continues to decrease.
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| Brunnstrom Stage 6 | Isolated joint movements with coordination
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| Brunnstrom Stage 7 | Normal movement is restored
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| What are the superficial sensations? | Pain, temp, touch, pressure
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| What are the deep sensations? | kinesthesia, proprioception, vibration
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| What are the cortical sensations? | stereognosis, 2 pt discrim, grapthesthesia, barognosis
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| MMSE scoring | 27-30= normal cognition.
19-27= mild
10-18= moderate
9 or less= severe impairment
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| Barthel Index- describe | Performance of ADLs (how independent) including continence
Score 0-20 with lower scores indicating more disability, need for assist.
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| Modified Rankin Scale | Post-CVA general level of disability, scored 0-6
0= No symptoms
3= Moderate disability
6=Dead
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| Does cerebellar pathology cause hypo or hypertonia? | HYPO
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| Which NDT techniques are used for strengthening? | Repeated contractions
Alternating Isometrics
Resisted Progression
Timing for emphasis
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| What is the timeframe for the Landau reflex? | 3 mo-2 years
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| What is pusher syndrome? | More common in R CVA
Lateral deviation TOWARD hemiplegic side
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