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pt w C1-3 injury - how's the respiration?
- respirator dependent secondary to phrenic nerve involvement
- can be respiratory free for short times w training of accessory muscles
pt w C1-3 injury - how's the facial muscles?
pt w C1-3 injury - if tracheostomy (surgical construction of a respiratory opening in airway) is required, what's a major goal?
pt w C1-3 injury - how's the voice - limited by what?
intact but limited by poor respiratory revserve (there'll be a limited number of words/syllables per expiration)
pt w C1-3 injury - how're the adls, transfers, mobility? -- in one word - but also, how can this pt power a WC?
- sip & puff (possible even when trach'd), or head control
pt w C4 injury - how's the breathing
not vent dependant (or may just use it at night), but still significantly at risk for espiratory compormise bc resp reserve is still very restricted
pt w C4 injury - how's the head/neck mobility, and why?
- can use head/neck for balance and mobility
- trapezius & SCM are invervated
apical breathing pattern
using only the upper chest
pt w C4 injury - how's pt w transfers & adls -- in one word
at what level injury does the shoulder shrug appear?
highest level with limted self feeding, grooming, hygeine?
pt w C5 injury - transfers?
max A w sliding board (this is an improvement from the dependant status of higher injuries)
pt w C5 injury - how's the shoulder?
- reasonably functional -
- can lift & manipulate light things,
- has use of arms for balance & stability (can lock arms and put a hand out)
- can be in a manual WC if wrists are splinted, but it's exhausting, so only for short distances
- long dist - can use a toggle/joy-stick to control a powered WC
the jist of what's innervated in C5
partial innervation of most of the rotator cuff, shoulder muscles, arm flexors
at what level does tenodesis kick in? why?
- be you now hoave ext carp radialis long & brev, putting the wrist in ext, so the stretched flexors handily curl the fingers into a grasping pos
first level where you get indep transfers?
C6 .. well, somewhat indep, and has "improved" function in ADLs
level where you get full scap muscles, RC, sternal pec, lat dorsi
what level gives you protraction?
C6 - bc now you have serratus ant and pec major -- this lets pt position the arm in a way that makes up for loss of triceps - kinda mimics extension?
what level gives you triceps?
C7 gives what muscular additions, in basic terms?
- finger extensors
- wrist flexors
first level where pt can def live indep, w HHA just a few hours a few times a week?
C7 - good for indep transfers, bed mob, WC mob, and most ADLs if in an adapted env w good ADs
C8-T1 SCi - describe UEs, amb, WC
- full UE innervation, including hand intrinsics
- amb feasible w KAFOs
- advanced WC skills, including wheelies
classification of C8-T1
- still a tetra
- but w significant flexion in hands
limitations still seen at C8-T1
T1-T8 pts have segmental innervation of _ _ _
- erector spinae
these pts have improved respiration, trunk control, and balance as the levels go down, and moreso when you get to T9-T12
T12 - name one important muscle that kicks in here, and what it does
quadratus lumborum - hip hiker
T9-T12 - how are these pts w using abs as hip flexors?
can do it,but very high energy expenditure -- these pts may opt not to walk bc a WC is more efficient, leaves them w energy for rest of life
L2 adds partial innervation of _ _
adductors (gracilis) & rectus femoris
what AD does an L2-3 pt need for amb?
KAFO w walker or lofstrand (not axillary) crutches
L3's big addition
- quads - now pt can get into standing and the quads can be strengthened
- stair climbing will remain a challenge til gluts come in at L5-S1
L4 bring in partial innervation of _ _ _ _ _
- hip abductors
- hip ER
- tib ant
L5 bring in what? _ _
partial innervation of glut max & EHL
S1-2 give what? _ _
- foot intrinsics
S3-5 brings what?
bowel & bladder motor
gracilis nerve, root, action
- (ant div of obturator)
- add hip, flex knee, IR
tibialis posterior actions, nerve, root
- stabilize, invert, help with PF
- tibial n.
tibialis anterior action, nerve, root
- DF & inversion
- deep fibular/peroneal nerve
fibularis/peroneus longus and brevis - act, n, root
- eversion & PF
- sup fibular/peroneal n
the longus attaches higher and more medially
C5 key action & muscles
- biceps (musculocutaneous C5-6)
- brachialis (musculocutaneous C5-6)
- brachioradialis (radial C5-6)
C6 key action & muscles
- extensor carpi radialis longus (radial C6-7)
- and brevis too, though it comes in at 6.5 on the chart
C7 key action & muscles
triceps (radial C7-8)
C8 key action & muscles
flexor dig profundus (median C8, T1)
- flexor dig superficialis (median C7, C8, T1)
T1 key action & muscles
finger abd - use the pinky
abductor digiti minimi (deep branch of ulnar n. C8-T1)
dorsal interossei doesn't act on the pinky, only the 3 middle fingers
L2 key action & muscles
iliopsoas (psoas major is innervated by L1-3 branches of lumbar plexus -- iliacus by femoral n L2-4
L3 key action & muscles
quads (femoral n. L2-4)
L4 key action & muscles
tibialis anterior (deep fibular/peroneal nerve L4-5 -- maybe S1 too?)
L5 key action & muscles
extend big toe
extensor hallucis longus (deep fibular nerve (L5-S1 -- maybe L4 too?)
S1 key action & muscles
- gastroc (tibial S1-2)
- soleus (tibial S1-2)