Question

Patient:

Ted is a 23-year-old male who was in a car accident 4 years ago. He survived a cervical spinal cord injury resulting in a complete C7 tetraplegia. He has marked spasticity in the hip flexors, knee flexors, and ankle plantar flexors. The muscle strength of his shoulders, elbow flexors, and wrist extensors is normal, but his elbow extensors, wrist flexors, and finger muscles are weak. His latissimus dorsi, pectoralis major, and triceps brachii muscles are all partially innervated. Ted gained 40 lbs. over the previous 4 years since his discharge from rehabilitation. He lived independently without assistance, but transferred independently with great difficulty using a sliding board. He pushed a manual wheelchair independently in the community and drove an adapted van.

1.   Explain the difference between tetraplegia and paraplegia, and complete versus incomplete spinal cord injury.

2.   What is Ted’s American Spinal Injury Association Impairment Scale degree of impairment, and what are the conditions of impairment?

Answer 1

TETRAPLEGIA: -also known as QUADRIPLEGIA. -It refers to a SPINAL CORD INJURY above the FIRST THORACIC VERTEBRA or within the CERVICAL SECTIONS OF C1-C8. - It results in some degree of paralysis ( depending on the nature and the extent) in all 4 limbs -the legs and arms. - It can be so severe that it interferes with the injured person's ability to breathe on his or her own. PARAPLEGIA: -It occurs in spinal cord injuries below the first THORACIC SPINAL SECTIONS ( T1-L5). -Paraplegics can able to fully use their arms and hands, but the degree to which their legs are disabled depends on the injury. - Some paraplegics are completely paralyzed from the waist down and others with minor mobility issues. COMPLETE SPINAL CORD INJURY: - It happens when the spinal cord is completely compressed or severed. - It completely eliminate the brain's ability to send signals below the point of injury. INCOMPLETE SPINAL CORD INJURY: - It happens when the spinal cord is compressed or injured, but the brain's ability to send signals below the site of injury is not fully removed. AMERICAN SPINAL INJURY ASSOCIATION (ASIA) IMPAIRMENT SCALE: A- Complete. No sensory or motor function in sacral segments of S4-S5. B - Sensory Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segment S4-S5, and no motor function is preserved more than 3 levels below the motor level on either side of the body. C - Motor Incomplete. Motor function is preserved at sacral segments for voluntary and anal contraction or the patient meets the critria for sensory incomplete status. D - Motor Incomplete. Motor function is preserved at sacral segments and the skey muscle functions below or having a muscle gradeless than or equal to 3. E- Normal.