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Cheatography

SCI - everything you need to know :0 Cheat Sheet (DRAFT) by

asia scale motor function assistance levels function goals and emphasis precautions

This is a draft cheat sheet. It is a work in progress and is not finished yet.

ASIA scale

A - complete
no motor or sensory
B - sensory incomplete
sensory but no motor function below the specific level
C - motor incomplete
motor function is preserved below the specified level with more than half of the key muscles with muscle grade less than 3
D - motor incomplete
motor function is preserved below the specific level with at least half of key muscles with muscle grade more than 3
E - normal

assistance levels

standing
Total assist from C1 to C6. Some assist at C7. Indepe­ndent at T1.
ambulation
Not functional at T1. Functional at T10 (may need some assist­ance).
feeding
Total assist from C1 to C4. Set up at C5, but indepe­ndent with equipment. May require assistance for cutting. Indepe­ndent at C7.
grooming
Total assist from C1 to C4. Functional at C5 with assist­ance. Modified indepe­ndent at C6. Indepe­ndent at C7.
dressing
Total assist from C1 to C5. Modified indepe­ndent for the upper body. Moderate assistance for the lower body. Indepe­ndent at T1.
bathing
Total assist from C1 to C5. Indepe­ndent for the upper body at C6. Assistance for lower extremity. Indepe­ndent at T1.
bowel and bladder
Total assist from C1 to C5. At C6 begin training with A/E. Indepe­ndent at T1.
bed mobility
Total assist from C1 to C4. Max assist at C5. Min to Mod assistance at C6. May be indepe­ndent at C7. Indepe­ndent by T1.
transfers
Total assist from C1 to C5. Some assist at C6. Indepe­ndent at T1.
pressure relief and reposi­tioning
Total assist from C1 to C4. Indepe­ndent at C5 with adaptive equipment.
manual wheelchair propulsion
Total assist from C1 to C4. Some assist at C5. Indepe­ndent indoors at C6. Indepe­ndent also with level outdoor surfaces at C7. Indepe­ndent at T1.
power wheelchair propulsion
Total assist from C1 to C3. Indepe­ndent at C4.
IADLs
Total assist from C1 to C5. Light meal prep at C6. Indepe­ndent at C7 for simple meal prepar­ation and light homema­king. Will require assistance at all levels for heavy housec­lea­ning.
driving
Dependent from C1 to C5. Indepe­ndent at C6.
 

motor function

c1-c3
+Neck flexio­n/e­xte­nsi­on/­rot­ati­on/­lateral flexion +Swall­owing No motor function in trunk, upper & lower extrem­ities Ventilator dependent
c4
+Respi­rat­ion­/In­spi­rat­ion­(Di­aph­ragm) +Scapular elevation No motor function in trunk, upper, & lower extrem­ities
c5
+Shoulder flexio­n/a­bdu­cti­on/­ext­ens­ion­/ro­tation +Elbow flexion +Forearm supination +Scapular adduct­ion­/ab­duction No elbow extension, pronation, wrist, or hand movements Paralysis of trunk and lower extrem­ities
c6
+Scapular protra­cti­on/­upward rotation +Shoulder horizontal adduction +Wrist extension (Tenod­esis) No wrist flexion, elbow extension, or hand movement Paralysis of trunk and lower extrem­ities
c7
+Shoulder internal rotation, adduction, depression +Elbow extension +Forearm pronation +Wrist flexion Paralysis of trunk and lower extrem­ities
c8
+Digit extrinsics (FDS, FDP, EDC) with weak grasp
t1-t6
Full use of hands Some trunk (upper half) control
t7-t12
full trunk control
l1-s5
Partial control of lower extrem­ities Partial paralysis of lower extrem­ities (hips, knees, ankle, foot) Difficulty with bowel & bladder

precau­tions and prevention

respir­ation
Aspira­tion, choking Minimize prolonged sitting for certain levels
autonomic dysref­lexia
T4 or higher Signs & symptoms: elevated blood pressure, pounding headache, perspi­ring, chills, flushed, decreased heart rate. HTN at risk for hemorr­hagic CVA. Activate emergency response Help lower blood pressure Sit upright. Remove abdominal binder Lower legs. Remove compre­ssion hose Check for catheter tube, full ladder, foot plate, feet crossed
orthos­tatic / postural hypote­nsion
Recline Abdominal binder & compre­ssion hose before
pressure injuries
Due to sensation loss Lack of blood flow (necrosis) Ischial tubero­sity, superior aspect of gluteal fold, heels, malleoli, elbows, trocha­nters, scapulae Educate Padding Float heels Reposi­tioning Q-… Minimize shearing
bowel and bladder
Risk for infections with catheters Collab­orate with nursing Reaching may be difficult for hygiene Lack of sensation may be difficult even with A/E
 

functional goals and emphasis

c1-c3
ADLS – Dependent Caregiver education for ADLs & Equipment Ventilator supports (suction, battery) Power wheelchair with head support, reclining, pressure relief cushion, transfer board Mouth stick Bathing – Padded, reclining Pressure relief mattress Mechanical lifts Voice/Eye assistive technology Remote doorbell for caregiver assistance
c4
Shoulder shrugging to activate switch Ventilator – as required Power wheelchair – Sip and puff, head switches, voice control, pressure relief, head support, transfer board Hydraulic standing table, tilt table Call systems, enviro­nmental controls, mouthstick for page-t­urning & computer use
c5
Strengthen biceps Deltoid aid for feeding Potential to self-feed (eccentric contra­ction of elbow flexors to lower hand) Shoulder abduction to pick-up food Plate guard, place dycem under plate Grooming with some assistance (electric razors, electric toothb­rush) Some dressing Dependent with toileting and bathing Typing stick for computer use Wrist cock-up (AM) and Intrinsic plus (PM) splints U-cuff for feeding, long straw, plate guard, mobile arm support
c6
Slideboard transfers Power wheelchair with recliner (pressure relief) for most surfaces Manual wheelchair for smooth level surface ONLY, limited use to decrease scapular dysfun­ction Educate on use of Tenodesis grasp, Tenodesis brace Feeding: Dining with dignity silver­ware, U-cuff, cutting & opening packages Grooming: Adapted grooming aids, U-cuff, large top toothpaste with rubber bands Dressing: dressing indepe­ndently (arm & thumb to hook); dependent with lower body dressing Elastic shoelaces, sock aid Bathing: adapted sponges, mitts, long-h­andle, grab bars, padded chairs Strengthen extensors Passively stretch wrist flexors and extensors with finger flexion Typing stick Driving: adapted hand controls
c7
Training with adaptive equipment Weight shifting
c8
Built-up handles Dycem (gripping utensils, electric toothb­rush, etc.) Streng­thening functional muscles
t1-t6
Manual wheelchair Trunk contro­l/b­ala­nce­/aw­areness Hand mirror for skin checks