Lecture Notes: Spinal Cord Injury Levels

Introduction

• Objective: Understanding spinal cord injury levels, focusing on C1 through C8.
• Approach: Demonstration of tackling content, focusing on textbook knowledge but acknowledging clinical variations.

Understanding the Spinal Cord

• Function: Acts as the "Executive Director of Communication" between the brain and body.
• Implications of Injury:
  • Motor and sensory impairments.
  • Bowel and bladder dysfunction.
  • Respiratory difficulties.
• Injury Levels: Higher injury leads to greater impairment.

Injury Levels and Functional Outcomes

C1 through C3

• Key Needs: Ventilator dependency; backup generator essential.
• Movements: Head and neck movement (flexion, extension, rotation).
• Care Requirements: Total assistance for ADLs, respiratory, bladder, and bowel management.
• Equipment:
  • Full electric hospital bed with rails.
  • Total assistance with mechanical lift for transfers.
  • Power wheelchair with tilt and recline; controlled via chin/head/breath.
  • Pressure relief at 30-minute intervals.
  • Communication via assistive technology (e.g., computer for speech).

C4

• New Ability: Independent breathing due to diaphragm function.
• Movement: Shoulder elevation.
• Care Similarity: Similar care as C1 through C3 (24-hour aid).

C5

• Caption: "Universal cuffs please".
• Ability: Elbow flexion (biceps use).
• Independence Possible:
  • Eating with adaptive devices.
  • Some grooming and upper body dressing.
• Limitations: No wrist or hand movement; requires assistance for transfers.
• Adaptive Equipment:
  • Wrist supports, universal cuffs.
  • Mobile arm supports.
  • Power wheelchair with arm drive control.
  • Light manual wheelchair indoors on level surfaces.

C6

• Key Feature: Wrist extension and tenodesis grasp.
• Functional Goal: Develop tenodesis grasp for improved grip.
• Care Enhancements:
  • Potential for using standard bed.
  • Transfer board for independent transfers.
• Adaptive Tools:
  • Front opening clothes, adaptive button hooks.
  • No underwear for ease and safety.
  • Long-handled bath aids.
  • Ability for skin inspection and pressure relief independently.

C7

• Capability: Elbow extension, full shoulder strength.
• Independence: In ADLs with minimal adaptive equipment.
• Unique Ability: Depression transfers.

C8

• Milestone: Greater hand function, finger flexion/extension.
• Outcome: Nearly full independence in self-care and leisure activities.

Important Considerations

Autonomic Dysreflexia

• Description: Life-threatening hypertension.
• Triggers: Painful stimuli like bladder/bowel distention.
• Action: Sit client upright, remove restrictive items, check catheter.

Orthostatic Hypotension

• Description: Blood pressure drop, common in cervical/thoracic injuries.
• Signs: Lightheadedness/dizziness.
• Action: Recline patient, raise legs to increase blood pressure.

Conclusion

• Importance of understanding levels and functional outcomes.
• Use of adaptive tools and technology to enhance independence.
• Encourage creating personal stories and connections to aid memory retention.

• Note: The importance of tailoring care to individual clinical situations and using adaptive strategies for enhanced patient independence.