T10 – L1 Levels
Expected Functional Outcomes
Equipment
Bowel
Independent
• Elevated or standard padded toilet seat
Bladder
Independent
Bed Mobility
Independent
• Full to king standard bed
Transfers
Independent
• May need transfer board
Pressure relief
Independent
 W/C pressure-relief cushion
 Postural support devices as indicated
 Pressure-relief mattress or overlay may be
indicated
Eating
Independent
Dressing
Independent
Grooming
Independent
Respiratory
T10 – L1 Levels
Expected Functional Outcomes
Equipment
Bathing
Independent
• Handheld shower
• Padded tub transfer bench
W/C propulsion
Independent
• Manual lightweight rigid or folding W/C
Standing/
Ambulation
Standing: Independent
Ambulation: some assist to
independent
• Standard standing frame
• Forearm crutches or walker
• Knee, ankle, foot orthosis (KAFO)
Communication
Independent
Transportation
Independent in car, including W/C
loading/unloading
Homemaking
Independent complex meal prep
and light housecleaning; some
assist for heavy housekeeping
Assist Required
• Homecare: 2 hours/day
• Hand controls
Hip flexors (L2)
Knee extensors (L3)
L2 – S5 Levels
Expected Functional Outcomes
Equipment
Bowel
Independent
• Standard padded toilet seat
Bladder
Independent
Bed Mobility
Independent
• Full to king standard bed
Transfers
Independent
• May need transfer board
Pressure relief
Independent
• W/C pressure-relief cushion
• Postural support devices as indicated
Eating
Independent
Dressing
Independent
Grooming
Independent
Respiratory
Hip flexors (L2)
Knee extensors (L3)
L2 – S5 Levels
Expected Functional Outcomes
Equipment
Bathing
Independent
• Handheld shower
• Padded tub transfer bench
W/C propulsion
Independent
• Manual lightweight rigid or folding W/C
Standing/
Ambulation
Standing: Independent
Ambulation: some assist to
independent
• Standard standing frame
• Forearm crutches or cane as indicated
• Knee, ankle, foot orthosis (KAFO) or ankle,
foot orthosis (AFO)
Communication
Independent
Transportation
Independent in car, including W/C
loading/unloading
Homemaking
Independent complex meal prep and
light housecleaning; some assist for
heavy housekeeping
Assist Required
• Homecare: 0-1 hours/day
• Hand controls
Medical Treatment after SCI

Methylprednisolone “steroids” for
traumatic SCI within 8 hours of injury

standard of care vs. experimental
Medical Treatment after SCI




Respiratory/pulmonary
Gastrointestinal
Nutrition
Neurogenic Bowel


Neurogenic Bladder



Suppositories, mini-enemas, timed bowel program, digital
stimulation, strain with increased intra-abdominal pressure
Intermittant catheterization, indwelling catheter, condom
catheter, vasalva or crede
Vascular/DVT
Skin
FES bike

Potential benefits:






Cardiovascular
Circulation
Bone density
Muscle mass
Sense of well-being
Neurological
improvement
FES = functional electrical stimulation
Surgical Management

Spine stabilization


Instability: under normal physiologic
loads there is potential for deformity,
additional neurologic deficit, or
incapacitating pain
Spinal cord decompression
Surgical Management

Tendon transfers


Gain function
Eliminate need for assistive devices
Surgical Management

Experimental Neural Transplantation
(regenerative & reconstructive cellular
strategies)



Adult stem cells
Embryonic stem cells
Olfactory mucosal cells
Length of Stay

Acute care unit (hospital)



25 days – 1974
18 days – 2004
Rehab unit


115 days – 1974
39 days – 2004
Lifetime Costs
Average Yearly Expenses
(in May 2006 dollars)
Estimated Lifetime Costs By
Age at Injury
Severity of Injury
First Year
Each Subsequent
Year
25 years old
50 years old
High Tetraplegia (C1C4)
$741,425
$132,807
$2,924,513
$1,721,677
Low Tetraplegia (C5-C8)
$478,782
$54,400
$1,653,607
$1,047,189
Paraplegia
$270,913
$27,568
$977,142
$666,473
Incomplete Motor
Functional at Any Level
$218,504
$15,313
$561,827
$472,392
Life Expectancy
Life Expectancy (years) post-injury by severity and age
(for persons surviving at least 1 year after injury)
Age at
Injury
No SCI
Para
Low Tetra (C5-C8)
High Tetra (C1-C4)
Ventilator Dependent
20
58.4
46.3
41.7
37.9
23.3
40
39.5
28.6
24.7
21.6
11.1
60
22.2
13.5
10.8
8.8
3.1
Social Aspects of SCI

Quality of social support has a positive
relationship with adjustment &
enhancing independent functioning
Psychological counseling for
coping and adjustment

Patients can have difficulty maintaining
relationships with friends they had
before their injury




Embarrassed
feel their friends’ discomfort
let friendships “drift away”
Socially isolated
Psychological counseling for
coping and adjustment

Family effects:






loss of personal space & time
Financial concerns
Loss of spontaneity
Worry about the present & future
Family member role changes/role confusion
Patient’s anger - often directed at loved ones
Vocation


64% employed at time of injury
(if between 16 – 59 years old)
Post-injury employment increases with time
paraplegia
tetraplegia
% Patients
50
40
30
20
10
0
1
2
5
10
15
Year Post-injury
20
25
Vocation

Predictors of postinjury employment:







Younger age
Greater functional capability
(paraplegia > tetraplegia)
Able to drive
Greater elapsed time since injury
Physical intensity of preinjury
occupation/secondary gain considerations
Social support
Internal locus of control
Vocation

Job assessment (VR counselor or OT)






Functional assessment
Work environment/physical factors
Job tasks
Production needs/expectations
Adaptive equipment
State/community agencies, support groups,
state/county employment programs
Vocation

Benefits


Economical
Quality of life




Self esteem
Self identity
Life satisfaction/well being
Psychological adjustment to disability
Assistive technology resources


www.agrabilityproject.org/assistivetech/
www.abledata.com
Factors impeding expected functional
outcome










Pre-existing medical conditions
Concomitant injuries
Secondary complications
Cognitive impairment (pre-existing or injury-related)
Age
Body type
Psychological factors
Social factors
Availability of financial resources
Cultural factors