T10 – L1 Levels Expected Functional Outcomes Equipment

Respiratory

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

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

• Hand controls

Homemaking Independent complex meal prep and light housecleaning; some assist for heavy housekeeping

Assist Required • Homecare: 2 hours/day

L2 – S5 Levels Expected Functional Outcomes Equipment

Respiratory

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

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

• Hand controls

Homemaking Independent complex meal prep and light housecleaning; some assist for heavy housekeeping

Assist Required • Homecare: 0-1 hours/day

Hip flexors (L2)Knee extensors (L3)

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

Suppositories, mini-enemas, timed bowel program, digital stimulation, strain with increased intra-abdominal pressure

Neurogenic Bladder 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

Severity of Injury First Year

Each Subsequent Year

25 years old 50 years old

High Tetraplegia (C1-C4)

$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

Average Yearly Expenses(in May 2006 dollars)

Estimated Lifetime Costs ByAge at Injury

Life Expectancy

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

Life Expectancy (years) post-injury by severity and age(for persons surviving at least 1 year after injury)

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

0

10

20

30

40

50

1 2 5 10 15 20 25

paraplegia tetraplegia% Patients

Year Post-injury

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