SCI Levels

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brau2308
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272485
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SCI Levels
Updated:
2014-05-01 11:31:49
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sci
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review of sci levels lecture 4/2
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  1. C1-3 Muscles
    • infrahyoid mm
    • head and neck extensors
    • rectus capitus anterior and lateral
    • sternocleidomastoid
    • longus colli, longus capitus
    • scaleni
  2. C1-3 Breathing
    • people need a ventilator, respirator or phrenic nerve stimulator b/c the diaphragm is innervated at C3, 4, 5
    • require maximal assistance w/ respiratory hygiene including coughing and deep breathing
    • monitor closely for upper respiratory illness
    • abdominal binders may assist w/ forced voice production
    • suctioning devices are required for clients who are ventilator dependent due to increased amounts of secretions that occur from irritation caused by the artificial airway and secondary to suctioning
  3. C1-3 Function: care (bed mobility, transfers, feeding and eating, driving, and hygiene)
    independent
  4. C1-3 Equipment:
    • power WC w/ tilt, recline, and power elevating leg functions
    • adapted van
    • lifts in the home
    • ventilator trays and ventilator transport
  5. C1-3 Pressure relief:
    • in power WC use power fxns (tilt and recline) for pressure relief
    • change position every 15 minutes
    • Roho cushion
  6. C1-3 ROM
    • pay special attention to 2 joint mm:
    • hamstrings
    • heelcords
    • elbows
    • wrists
    • shoulders
  7. C4 muscles added:
    • trapezuis
    • levator scapulae
    • diaphragm
    • upper cervical paraspinals
  8. C4 Breathing
    • max assist for respiratory hygiene including coughing and deep breathing
    • require close monitoring w/ upper respiratory illness
    • abdominal binders may assist w/ forced voice production
  9. C4 Wheelchairs and function:
    same as C3, but no need for ventilator/respirator/suction device
  10. C5 muscles:
    • deltoid
    • rhomboids
    • biceps
    • teres minor
    • supraspinatus
    • infraspinatus
  11. C5 Breathing
    • breathing, respiratory control, and respiratory toilet are still the biggest concerns
    • pneumonia and pulmonary embolism are largest cause of death at this level
    • monitor coughing and deep breathing
    • abdominal binders can assist w/ forced voice productino
  12. C5 is the first level w/ elbow:
    flexion
  13. At C5, elbow extension is not present, thus...
    contractures occur easily (make sure you keep elbows protected for propping)
  14. At C5, the posterior portion of the rotator cuff is:
    innervated (missing only subscapularis)
  15. At C5, shoulder external rotation is _______ than internal rotation.
    stronger (b/c there are no internal rotators)
  16. A client w/ "weak C5 quadriplegia" has biceps =
    fair or less and those shoulder mm present also equal a fair or less
  17. A client w/ "strong C5 quadriplegia" hads biceps/deltoid grades =
    F+ or better and those shoulder mm present are strong
  18. C5 Wheelchairs
    • to conserve energy, use power w/ tilt, recline and power elevating legrests
    • use quad knobs to push manual chair only short distances
    • use U joystick
    • wrist extension splint can help hold wrist in neutral
    • Roho
    • high WC back and head supports
    • dependent for management
  19. C5 Bed Mobility
    • totally dependent
    • instruct care giver
  20. C5 transfer:
    • dependent
    • begin to assist w/ sliding board
    • use hydraulic lift and body sling
    • can do swivel bar transfer (if low weight, good ROM, etc)
  21. C5 pressure relief:
    • side to side shifting method, or the leaning forward method using the push bar on the back of the WC for stability
    • straps attached to selected sites in the WC may assist w/ independent pressure relief
    • power WC use power functions
  22. C5 bed pressure relief
    turning schedule
  23. C5 feeding/grooming/bathing/bowel/bladder -
    • dependent
    • some able to do some upper body dressing
    • most brush teeth and wash face
    • shaving and brushing hair requires max assist
    • feeding possible w/ mobile arm support and sling suspension system or w/ wrist extension splint w/ palmar clip
  24. C6 Quadriplegia Muscles
    • brachialis
    • supinator
    • brachioradialis
    • subscapularis
    • teres major
    • coraco-brachialis
    • extensor carpi radialis longus
    • serratus anterior
    • latissimus dorsi
    • pectoralis major
  25. At C6 what does it mean to get extensor carpi radialis longus?
    tenodesis grip of the hand becomes available w/ the addition of this muscle
  26. At C6 what is innervated at the rotator cuff?
    full innervation
  27. What movements are available at C6?
    • full scapular stability and strength
    • strong internal rotation, adduction, and extension of the GH joint
    • full elbow flexion
    • no elbow extension
    • wrist extension
    • possibility of total independence
  28. What is the first level with any wrist function?
    C6
  29. C6 Breathing:
    no function in thoracic mm required for breathing
  30. C6 manual WC management:
    • first level people have the possibility of using a manual WC for all mobility
    • must be an ultralight weight chair
    • use pull to mobility
    • roho
    • some can manage own parts
  31. C6 power WC management:
    • continue to require a power WC
    • use power tilt, recline, and power elevating legrests
    • regular joystick is usually appropriate in the standard position
    • roho
    • some can manage own parts
  32. C6 Bed Mobility:
    • independent in rolling, sitting up from supine and WC push-ups (using a triceps substitution method)
    • some use a ladder trapeze, loops, or straps
  33. C6 Sitting balance in non-supported position:
    • fair, esp in short sitting
    • supported balance is usually good
  34. C6 Transfers
    • super clients have potential for independence w/ slide board to bed and car
    • most require assistance to commode or bath bench
    • need assistance getting onto and off the floor
  35. C6 Pressure Relief:
    • independent w/ side to side method, or leaning forward method using the push bar on the back of the WC for stability
    • triceps substitution push-up method for pressure relief
  36. C6 ROM
    hypermobility:
    • hamstrings
    • heelcords
    • elbows
    • wrists
    • shoulders
  37. C6 ROM
    hypomobility
    • allow long fingers to become tight for a tenodesis grip
    • allow back extensors to becomes tight to allow for passive sitting control (hamstrings at 110 degrees)
  38. C6 feeding/grooming/bathing/bowel/bladder-
    • dependent, however some clients are able to do some of their upper body dressing, most are able to brush their teeth and wash their face
    • shaving and brushing their hair requires max assist
    • feeding is possible w/ mobile arm support and sling suspension system or w/ wrist extension splint w/ palmar clip; universal cuff
  39. C7 Muscles
    • latissimus dorsi
    • pectoralis major
    • triceps
    • pronator teres
    • flexor carpi radialis
    • flexor digitorum superficialis
    • extensor digitorum
    • extensor pollicus longus, brevis
  40. C7 Movements:
    • all shoulder and shoulder girdle prime movers are innervated
    • full elbow extension
    • full wrist extension
    • no wrist flexion
    • very poor finger dexterity and strength, still use tenodesis
    • people hav eMP extension but no PIP or DIP extension
    • finger flexion is so weak a tenodesis grip is necessity
  41. What is the first consistent potential of living independently?
    C7
  42. C7 Breathing
    still no function in thoracic mm required for breathing
  43. C7 manual WC management:
    • first level to be independent w/ WC mobility on all levels including wheelies
    • must have ultralight weight chair
    • use push mobility
    • roho
    • manage WC parts
  44. C7 bed mobility:
    independent in all bed mobility
  45. C7 transfers:
    • independent w/ or w/o slideboard
    • exceptions may be bath bench and floor transfers
    • super clietns first potential for floor to chair transfers
  46. C7 pressure relief:
    completely independent using push up method on WC arm rest or wheels
  47. C7 ROM hypermobility:
    • hamstrings
    • heelcords
    • wrists
    • shoulders
  48. C7 ROM hypomobility
    • allow long fingers to become tight for a continued tenodesis grip
    • allow back extensors to become tight to allow for passive sitting control (hamstrings at 110)
  49. C7: clients at this level and below are _______ w/ all self-care, feeding, eating, and hygiene.  Some require assistance w/ bowel and bladder care.
    independent
  50. C8 Muscles
    • flexor digitorum profundus and superficialis
    • flexor pollicus longus and brevis
    • abductor pollicus longus
    • opponens pollicus
    • adductor pollicus
    • partial lumbricals
    • extensor carpi ulnaris
    • flexor carpi ulnaris
  51. C8 Movements:
    • can flex fingers, but cannot extend them
    • can extend MP joint
    • almost full function of the thumb
    • lumbricals are too weak to be funcitonal for strong grip
    • ulnar side of wrist is now present (first for lifting in push-ups)
    • lack lumbricals and interossei
  52. C8 breathing:
    still no function in thoracic mm required for breathing
  53. C8 manual WC management:
    • totally independent
    • ultralight weight chair
    • Roho
  54. C8 bed mobility:
    independent
  55. C8 Transfers:
    • independent w/o slide board
    • most can do floor to chair
  56. C8 Pressure relief:
    completely independent using push up method on WC armrests or wheels
  57. C8 ROM
    selective hypermobility:
    • hamstrings
    • heelcords
    • wrists
    • shoulders
  58. C8 ROM
    selective hypomobility:
    • allow long fingers to become tight for a continued tenodesis grip
    • allow back extensors to become tight to allow for passive sitting control (hamstrings at 110 degrees)
  59. C8 self-care
    feeding, eating, hygiene, bowel and bladder
    • independent
    • most w/o equipment
  60. T1-T6 muscles
    • dorsal and palmar interossei (T1)
    • lumbricals are strong at this level
    • abductor pollicus brevis (T1)
    • long mm of upper back
    • intercostal mm
  61. At what level does full hand function occur?
    T1
  62. T1-6 breathing
    • as before, however, as more thoracic levels are added, there is better and better breathing patterns
    • respiratory toilet is NOT complete until abdominals are completely innervated at T12
  63. T1-6 wheelchair management
    bed mobility
    transfers
    ADLs
    independent
  64. Can clients at level T1-6 do floor to chair transfers?
    yes, unless weight, age, or other factors interfere
  65. T1-6 Pressure relief
    completely indendent using push up on armrests or wheels
  66. T1-6 ROM
    selective hypermobility:
    • hamstrings (110 degrees until T12)
    • heelcords
    • wrists
    • shoulders
  67. T1-6 ROM
    selective hypomobility
    until trunk is strong, allow back extensors to become tight to allow for passive sitting control
  68. When do you no longer need tenodesis grip?
    T1

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