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.)