PT MANAGEMENT of SPINAL CORD INJURY

• As a PT we must know the level of the lesion in the spinal cord

FUNCTIONAL OUTCOME OF THE PATIENT WITH SCI

• HIGH TETRAPLEGIA ( C1- C4) – -no movement of UE & LE.

• -C1-C3: ventilators support .– *Loss of nerve control in diaphragm. – -Dependent most in everything.– -Requires a live-in caregiver & a power

wheelchair w/ head and neck controls.

• C5 TETRAPLEGRA– -Have elbow flexion.– -W/ use of specialized assistive device can

achieve independent feed & basic self-care– -Dressing upper body is possible – -Side to side weight shift.– -Assistance still required for other ADL &

transfer.

• C6 TETRAPLEGRA

• -Have added use of wrist extension

• -Grasping items.

• -Can dress upper body if well motivate the lower body.

• -Forward weight shift.

• -Manual wheel chairs may be used w/some enhancement for gripping.

• -Can perform some basic transfer independent.

• C7-C8 TETRAPLEGIC

• -Have potential for independence in performance of transfer mobility and AP.

• -Ability to extend elbows & grip the hand.

• -Independent in feeding, dressing, bathing w/ adaptive equipment & built up handles.

• -Independent in bed mob.

• -Propel wheelchairs.

• -Bowel & bladder care w/ set

• THORACIC PARAPLEGRA

• -Independent on BADL & Mobility skills @ the wheelchair level on even surfaces carbs, ramps, wheelies.

• T1

• -full innervations of upper extremities

• T2-T5

• -has improved trunk control and maybe able to stand on bilateral knee-ankle-foot orthoses. (KAFO)

• -can ambulate on short distance

• T6-T12

• -Partial abdominal strength.

• - Can Ambulate short distances independently

• Lumbar Paraplegia

• -KAFO’s ankle-foot-orthoses (AFO’s)

• Often prescribed.

MANAGEMENT

• Skin• -Proper bed

positioning. (Supine, side lying, prone, sitting)

• -Avoid pressure area.• -To avoid

complication

• BONES• -SCI PX has an increased risk

for fractures secondary to osteoporosis.

• -Be careful with transfer

• STABILIZATION• -Because of loss of

trunk control & balance sufficient strapping & seatbelt should be used

• BLADDER

• - Empty bladder just before exercise.

• BOWELS

• -Regular bowel maintenance program.

• *To avoid autonomic dysreflexic symptoms (hypertension) in PX-w/quadriplegia.

• ILLNESS

• -Postpone the activity

• HYPERTENSION

• -Should wear elastic support stocking & an abdominal binder or both to elevate resting BP.

• -Possible in quadriplegia PX.

• -Above T6 quadriplegia

• PAIN

• - Discontinue

• e.g. Shoulder pain(overuse syndrome)

• ORTHOPEDIC-Bone or joint welling discomfort my indicate fracture or sprain.

• PATIENT with SCI

• -Has depressive disorder

• -Sexual functions and fertility

• In women: does not affect

• In man: impotency

• As a PT• Be supportive and set realistic

goals• Be patient and expect small

improvements• Follow all the safety precaution in

managing the patient• Supervise and monitor the patient• Follow up (consult physician and

appropriate allied health personnel’s)

• Educate the patient and the family about SCI

• Give appropriate activity. (stretching, ROM etc.)