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• 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.
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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.
• 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
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BLADDER - Empty bladder just before exercise. BOWELS -Regular bowel maintenance program. *To avoid autonomic dysreflexic symptoms (hypertension) in PXw/quadriplegia.
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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
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PAIN - Discontinue e.g. Shoulder pain(overuse syndrome) ORTHOPEDIC -Bone or joint welling discomfort my indicate fracture or sprain.
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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.)