WEEK 3 NOTES

SPINAL CORD INJURIES (SCI)

Classification of SCI
ASIA IMPAIRMENT SCALE
• A SSI A
AA A: No sensory or motor is preserved.
• A SSI A
AB B: Sensory, but no motor is preserved.
• A SSI A
A CC:: Motor is preserved and majority of muscles below level of lesion have MMT less than 3 /5.
• A SSI A
AD D:: Motor preserved, with majority of muscles have MMT greater than or equal to 3/5.
• A SSI A
A EE: Normal sensory and motor
Complete vs. Incomplete
Co
Comple te
te: no motor or sensory function
In
Inco mple te
te: individual has some degree of voluntary motor control or sensation preserved at S4-S5
Dermatomes

c6:
c6: ra
radi
diaall
c7:
c7: me
medidia nn
C8:
C8: ULNA
ULNAR R

SCI: Cervical, Thoracic, Lumbar, and Sacral Injuries

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• SCIs are classified by the level that is still functional

o (i.e., C6 means the muscles innervated by C6 are functional, but levels below this are impaired)
C6 Spinal Cord Injury
• C6 motions
o Has movement in head, neck, shoulders, arms, and
wrist; can shrug shoulders, bend elbow, turn palms
up and down, and extend wrists
• No elbow extension!
• Can use adaptive equipment for bathing, dressing, grooming,
and feeding. Will require mechanical lift or slide board for
transfers.
• Will require device for bowel and bladder emptying
SCI Syndromes
• Ce n tra
trall Co
Cord Syn
Syndro
drome
me:: more damage to ce cennte
terr of cord
than periphery; greater paralysis in hands and arms, sensory
loss below level of injury; most common incomplete injury;
cause is cervical hyperextension
• Brown-S
B row n-Seequq uard
ard SySyndro
ndromm ee:: oonnee ssi de
de oof co
cord
rd iis
da ma
magegedd; loss of motor & proprioception on ipsilateral side; loss of pain, temp & touch on contralateral side;
 cause is gunshot or stabbing
•AAn te ri oor S pi
pin a l C o rd Sy nndro m ee: damage to anterior cord, paralysis and loss of pain, temp., and touch
sensation; prop is preserved
• Co n us MeMedulla ririss Syn
Syndro
dromeme: injury to sacral area and lumbar nerve roots; are reflexive bladder, bowel, and
LEs.
• Ca uda Equi
Equinna Syn drodromeme: damage to peripheral nerves rather than spinal cord; flaccid-type paralysis; variable
and asymmetrical impairments of motor and sensory
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Medical Complications to Observe for During Therapy

Pressure Ulcer Staging
• Sta
Stagege 1
1: skin blanches to the touch
• Sta ge 2 2: skin does not blanch to the touch and is open
• Sta
Stagege 3
3: skin is open; more than one skin layer
• Sta
Stagege 4
4: skin is open and underlying fascia (muscle, tendon,
bone) is visible
• Un ssta
tage
gea ble
ble: Depth or size cannot be determined.
Neurogenic Bowel & Bladder
• Si gn
gns aanndd Sympto
Symptoms:
ms: Nerve Pathways
to the Bladder
o Inability to empty bladder
o Urine incontinence
o Urinary frequency
o UTIs
• Bowel incontinence
• Constipation & impaction
• Spa sti
sticc bla dde
dder:
r: T12
T12 aanndd aabo
bove
ve
o No control when bladder empties
• F la
lacci dd bla
bladde r:
r: T1
T122 to
to L1
L1
o Lose the ability to know when bladder is full
Sexual Functions
• SCI does NOT impact the drive and need for sexual intercourse, but engagement in sexual intimacy is affected.
• Most common issues in men: inability to produce an erection and inability to ejaculate.
o Possible treatments: oral medications, penile injection therapy, vacuum pumps, penile prosthetics,
penile vibrostimulation, and rectal probe ejaculation.
• Women have interruption of menses for weeks to months s/p injury, but fertility is not affected.
• OT Interventions
o Health promotion: educate on changes after SCI
o Remediation: stretching spastic muscles for sexual activities
o Modifications: devices with limited hand function, positioning using pillows
 • Autonomic Dysreflexia can occur during sexual intimacy. Patient and partner education is essential for safety!
• T10 and above- reflex ejection, may have a spontaneous reaction
• T11 and below they can have regular erection
Phases of Recovery
•AAc u te
te P h aassee oof Re
Reh a b
o Preserve joint integrity and mobility with orthotic
o Restore independence with self-care, educate and train caregivers on techniques
o Facilitate communication using call light (with hospital staff) and technology or leisure tasks
o Discuss anticipated needs for DME and home modifications
• Po s t- A
Acute
cute P ha has ee
o This may occur several months after the injury.
o Secondary issues typically develop and require management currently, such as pressure ulcers and joint
contractures.
▪ May require specialized equipment, such as low-pressure mattress.
o Utilize functional activities for rehabilitation: card games, drawing, page turning, and typing. This will
benefit neck ROM and endurance as well as UE.
o Peer mentors can provide motivation and emotional support, demonstrate self-care, and body handling
skills, and share valuable resources and experiences.
• Out
Outpapatitieent
nt ReRehhabi
ab ili
litati
tatioon
n
o Adaptive driving, home management, leisure tasks, and work skill assessments are the focus of therapy.
o Therapists will evaluate clients’ ability to manage their orthotics, devices, accuracy, and work tolerance.
o OTs should support the client’s involvement in support groups.
Areas for OTs to assess:
• Occupational Profile
• Sensory Testing
o Type of testing is based on location of SCI and/or clinical syndrome.
• Pain
• MMT/grip/pinch
• ROM
• Modified Ashworth Scale
o For assessing muscle tone. We will review this later in the semester.
• ADL assessment
• Vision
• Cognition
Examples of OT Interventions
 3
n es
 Clinical Lab in Adult & Geriatrics

LAB NAME: Assistive Devices & Mechanical Lifts.

LEARNING OBJECTIVES:
• Demonstrate 2 and 3 step gait patterns using all assistive devices in lab
• Properly and safety operate all mechanical lifts in the home suite.
• Verbalize appropriate mechanical lifts for a variety of conditions and levels of
functioning.

MATERIALS FOR STUDENT TO BRING:

Please wear your lab shirt and bring posted lab documents.

LAB SET UP FOR THE GA TO HAVE READY:

Please have all lifts charged in preparation for labs. Place all slings out in living room
area of the home suite.
Place these assistive devices in the home suite: 3 straight canes, 2 hemi walker, 3 quad
cane, 3 standard walkers, and 3rolling walkers.

RULES FOR THIS LAB

Please return all items to the way that you found them when you arrived, so that things
are ready for the next lab. Be sure to sanitize any equipment you use (including the
plinths), wipe the mats, and wash your hands before and after all activities. Please use
this time wisely and practice all things asked of you.

SCHEDULE / ACTIVITIES
20 minutes Review the differences and balance
requirements for these devices: straight
cane, hemi walker, quad cane, standard
walker, rolling waler
1 hour Lab instructor to review safety
procedures for operating mechanical
lifts in home suite. Students will practice
using all lifts in small groups.

ASSESSMENT METHODS FOR LAB SKILLS

Mechanical lifts will be on your written exams. Safe and appropriate use of assistive
devices will be on your exams and OSCEs this semester.

RELATIONSHIP OF THIS LAB TO OT PRACTICE IN THE “REAL WORLD”

 Mechanical Lifts are required to help non-ambulatory patients move from one location to
another. Safe operation of these devices is critical to adult/geri practice in home care
and inpatient settings. OTs are responsible for training the patient and caregivers in safe
operation of these devices.
assistive devices
>
walking devices
bend in elbow
◦
wrist height slight ,

for
words used
goals lab measurements

ADLS mod
# of verbal
CGA cues
feeding / eating
SBA attempt
# of
dressing •

1. of time ,

hygiene / toileting
grooming
bathing
fun Ct mobility
.

sexual activity

IADLS
Comm -
mobility
of others
care
shopping
$ mangt .

meal prep
safety / emergency
Goals: There are lots of different acronyms to assist with goal
writing BUT the three important aspects that every goal needs to
include are:
1. Time
2. Measurable
3. What function or area of occupation are you addressing?

ABCDE
1. Audience
2. Behavior
3. Condition
4. Degree
5. Expected time
COAST
1. Client
2. Occupation
3. Assistance level
4. Specific conditions
5. Timeline
RHUMBA
1. Relates
2. How long
3. Understandable
4. Measurable
5. Behavioral
6. Achievable
FEAST
1. Function
2. Expectation
3. Action
 4. Specific condition
5. Timeline
SMART
1. Significant
2. Measurable
3. Achievable
4. Related
5. Time-limited
Examples:
1. Pt will in two weeks increase AROM in B hands all
joints by 5 degrees to increase independence in meal
preparation.
2. Pt in two weeks will present with decreased pain from
5/10-3/10 in B hands to increase ability to participate in
crochet activity.
3. Patient in 4 weeks will open large jars with appropriate
adaptive equipment with min A.
OT 576 Clinical Lab in A&G
Late Spring/Summer 2021
Safety Protocols and Considerations for Safe Patient
Handling and Using Mechanical Lifts

A. Safety Concerns when handling patients:

● Patients can be unpredictable (muscle spasms,
combative, or resistive) and are sometimes heavier
than they appear.
● Patient movements during a lift can create loads
within the lifter’s spine greater than those created by
the slow, smooth lifting of a stable object.

B. Questions to Consider before handling a patient:

● Any precautions due to client’s condition or the
transfer?
● Weight, fluctuating abilities
● Who will be involved in the transfer and to what
extent?
● Client – sufficient trunk control? Cognition?
Muscle tone and weight bearing abilities in legs?
● What is the nature of the transfer and environment?
● E.g. Bed to toilet? Interactions with the
environment?
● Physical space, type of flooring, distance
between transfer locations, steps, door frames,
multiple residences (e.g. cottage)
● What are the transfer goals?
● Where does client need to go? How do goals
interface with the environment?
● Client and caregiver considerations
● Caregiver abilities required (e.g. for
 maneuvering), preferences, weight/safe working
load, weight

C. Sizing of slings:

Size Height Weight

Junior <4’ <110 lbs
Small 4’-5’6” 95 lbs- 150 lbs
Medium 5’-6’ 125 lbs- 250 lbs
Large 6’-7’ 250 lbs- 400 lbs
X- Large 6’-7’ 400 lbs- 480 lbs
XX- Large >6.5’ > 480 lbs

D. Considerations for prescribing an appropriate sling

● Size
o How tall is the client?
o How much does the client weigh?
o What is the measurement from the client’s
greater trochanter to the top of his or her
shoulder?
● Material
o Does the client have skin integrity issues?
o Will the client be using the sling to bathe?
o Will the sling be left under the client (i.e. on the
wheelchair)?
o Are there concerns about infection control?

E. Common types of slings

 Universal sling:
This sling is suitable for most basic transfers. This
sling provides support from the shoulder to under
the thighs, with additional head support as an
option. Hip straps make it more comfortable by
distributing the lifting pressure somewhat off the thighs.

Hygiene and toileting sling. The hygiene sling (as

you can see) has less material than the universal
sling so that it can be used for toileting purposes.
Because this sling offers less support, clients
must be able to bridge and actively extend at the
hip in order to use this sling.

F. Key Points to remember when assisting

1. Encourage the client to assist as much as possible
2. When applying sling in sitting, do not drape the
sling over the chair back (risk for catching on the
chair once you activate the lift)
3. Check straps to ensure correct pairing and security
4. Position mobile lift on an angle when approaching
client
5. Keep the client close to your body
 G. The LITE Assessment:

● A systematic method to assess important factors

impacting each and every moving and handling
situation
● The factors assessed are:
● “Load” – the client or individual being moved
● Individual – the individual moving the client
● Task – the moving and handling activity
● Environment – where the movement is occurring

LOAD: INDIVIDUAL:
● Physical ability ● Physical ability
● Physical impairments ● Physical impairment
● Height ● Injury
● Weight/shape ● Height
● Vision ● Knowledge
● Balance ● Experience
● Cognition ● Comfort level
● Communication ● Fatigue
● Strength ● Training and education
● Endurance ● Number of individuals available to
● Trunk stability perform task
● Attachments

TASK: ENVIRONMENT:
● Type ● Space required
● Frequency ● Space available
● Distance ● Equipment required
● Variability in surface height ● Equipment available
● Mobility aids required ● Floor type
● Risk level ● Door thresholds
 ● Questions to ask self: ● Obstacles
● Does task match client ● Question to ask self:
abilities? ● Are there obstacles in the
● “Do I need to do this?” environment that can be
● “Do I need to do this now?” moved to accommodate the
task in the environment?

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Reference

Duncan, A., Darragh, A., Mechan, P., Rich, A., &

Huntleigh, A. (n.d.). Safe patient handling and mobility
[PowerPoint slides]. Retrieved from
https://blackboard.sacredheart.edu/webapps/blackboa
rd/content/listContentEditable.jsp?
content_id=_692942_1&course_id=_14479_1

Updated by Jaimee Hegge, March 2021

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Spinal Cord Injury
Assisted Shoulder Stretching Exercises

Upper Trapezius

-OR-
Drop one arm to the side and depress the shoulder while gently bending the head towards the other
side.
Or have someone assist to gently stretch
Avoid rotating the head during the stretch.
Hold stretch for 30 seconds, then repeat with the other side.

Pectoralis Major

-OR-
Bend the elbow and bring the arm out to the side into partial abduction (below 90 degrees, keeping
elbow below the shoulder)
Slowly externally rotate the shoulder to stretch.
Or place your forearm on the doorjamb
Hold stretch for 30 seconds, then repeat with the other side.

Pectoralis Minor

Have someone place one hand on the front of each of your shoulder joints then press each
shoulder joint down into the bed to stretch.
Place a towel roll along the spine to increase the stretch
Hold stretch for 30 seconds.

Biceps

-OR-
Straighten the elbow and bring the arm partially out to the side along the bed (into slight
abduction).
Pinch the shoulder blades together then down into depression.
Spinal Cord Injury
Assisted Shoulder Stretching Exercises
Stretch the elbows straighter while maintaining the shoulder blade pinch and depression.
Hold stretch for 30 seconds.

Posterior Capsule

When stretching the Right shoulder, lay in partial side lying in order to stabilize the shoulder blade
on the side to be stretched.
Gently pull the Right arm across the body.
Place a pillow behind the Left shoulder to help maintain partial side lying
Hold the stretch for 30 seconds, then repeat with the opposite side.