-
pt w C1-3 injury - how's the respiration?
- respirator dependent secondary to phrenic nerve involvement
- can be respiratory free for short times w training of accessory muscles
-
pt w C1-3 injury - how's the facial muscles?
intact
-
pt w C1-3 injury - if tracheostomy (surgical construction of a respiratory opening in airway) is required, what's a major goal?
secretion management
-
pt w C1-3 injury - how's the voice - limited by what?
intact but limited by poor respiratory revserve (there'll be a limited number of words/syllables per expiration)
-
pt w C1-3 injury - how're the adls, transfers, mobility? -- in one word - but also, how can this pt power a WC?
- dependant
- sip & puff (possible even when trach'd), or head control
-
pt w C4 injury - how's the breathing
not vent dependant (or may just use it at night), but still significantly at risk for espiratory compormise bc resp reserve is still very restricted
-
pt w C4 injury - how's the head/neck mobility, and why?
- can use head/neck for balance and mobility
- trapezius & SCM are invervated
-
apical breathing pattern
using only the upper chest
-
pt w C4 injury - how's pt w transfers & adls -- in one word
dependant
-
at what level injury does the shoulder shrug appear?
C4
-
highest level with limted self feeding, grooming, hygeine?
C5
-
pt w C5 injury - transfers?
max A w sliding board (this is an improvement from the dependant status of higher injuries)
-
pt w C5 injury - how's the shoulder?
- reasonably functional -
- can lift & manipulate light things,
- has use of arms for balance & stability (can lock arms and put a hand out)
- can be in a manual WC if wrists are splinted, but it's exhausting, so only for short distances
- long dist - can use a toggle/joy-stick to control a powered WC
-
the jist of what's innervated in C5
partial innervation of most of the rotator cuff, shoulder muscles, arm flexors
-
at what level does tenodesis kick in? why?
- C6
- be you now hoave ext carp radialis long & brev, putting the wrist in ext, so the stretched flexors handily curl the fingers into a grasping pos
-
first level where you get indep transfers?
C6 .. well, somewhat indep, and has "improved" function in ADLs
-
level where you get full scap muscles, RC, sternal pec, lat dorsi
C6
-
what level gives you protraction?
C6 - bc now you have serratus ant and pec major -- this lets pt position the arm in a way that makes up for loss of triceps - kinda mimics extension?
-
what level gives you triceps?
C7
-
C7 gives what muscular additions, in basic terms?
- triceps
- finger extensors
- wrist flexors
-
first level where pt can def live indep, w HHA just a few hours a few times a week?
C7 - good for indep transfers, bed mob, WC mob, and most ADLs if in an adapted env w good ADs
-
C8-T1 SCi - describe UEs, amb, WC
- full UE innervation, including hand intrinsics
- amb feasible w KAFOs
- advanced WC skills, including wheelies
-
classification of C8-T1
- still a tetra
- but w significant flexion in hands
-
limitations still seen at C8-T1
-
T1-T8 pts have segmental innervation of _ _ _
- abs
- intercostals
- erector spinae
these pts have improved respiration, trunk control, and balance as the levels go down, and moreso when you get to T9-T12
-
T12 - name one important muscle that kicks in here, and what it does
quadratus lumborum - hip hiker
-
T9-T12 - how are these pts w using abs as hip flexors?
can do it,but very high energy expenditure -- these pts may opt not to walk bc a WC is more efficient, leaves them w energy for rest of life
-
L2 adds partial innervation of _ _
adductors (gracilis) & rectus femoris
-
what AD does an L2-3 pt need for amb?
KAFO w walker or lofstrand (not axillary) crutches
-
L3's big addition
- quads - now pt can get into standing and the quads can be strengthened
- stair climbing will remain a challenge til gluts come in at L5-S1
-
L4 bring in partial innervation of _ _ _ _ _
- hip abductors
- hamstrings
- peroneals/fibulars
- hip ER
- tib ant
-
L5 bring in what? _ _
partial innervation of glut max & EHL
-
S1-2 give what? _ _
- foot intrinsics
- gastroc/soleus
-
S3-5 brings what?
bowel & bladder motor
-
gracilis nerve, root, action
- (ant div of obturator)
- L2-3
- add hip, flex knee, IR
-
tibialis posterior actions, nerve, root
- stabilize, invert, help with PF
- tibial n.
- L5-S1
-
tibialis anterior action, nerve, root
- DF & inversion
- deep fibular/peroneal nerve
- L4-5
-
fibularis/peroneus longus and brevis - act, n, root
- eversion & PF
- sup fibular/peroneal n
- L5-S1
the longus attaches higher and more medially
-
C5 key action & muscles
elbow flexion
- biceps (musculocutaneous C5-6)
- brachialis (musculocutaneous C5-6)
- brachioradialis (radial C5-6)
-
C6 key action & muscles
wrist extension
- extensor carpi radialis longus (radial C6-7)
- and brevis too, though it comes in at 6.5 on the chart
-
C7 key action & muscles
elbow extension
triceps (radial C7-8)
-
C8 key action & muscles
finger flexion
flexor dig profundus (median C8, T1)
- and?
- flexor dig superficialis (median C7, C8, T1)
-
T1 key action & muscles
finger abd - use the pinky
abductor digiti minimi (deep branch of ulnar n. C8-T1)
dorsal interossei doesn't act on the pinky, only the 3 middle fingers
-
L2 key action & muscles
hip flexion
iliopsoas (psoas major is innervated by L1-3 branches of lumbar plexus -- iliacus by femoral n L2-4
-
L3 key action & muscles
knee extension
quads (femoral n. L2-4)
-
L4 key action & muscles
dorsiflexion
tibialis anterior (deep fibular/peroneal nerve L4-5 -- maybe S1 too?)
-
L5 key action & muscles
extend big toe
extensor hallucis longus (deep fibular nerve (L5-S1 -- maybe L4 too?)
-
S1 key action & muscles
PF
- gastroc (tibial S1-2)
- soleus (tibial S1-2)
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