Physiotherapy Assessment of Spinal cord injury IN acute Rehabilitation

1. ACTIVE REHAB OF SCI
PT ASSESSMENT
BY
Dr SAI PRIYANKA NERUSU (PT)
ASSISTANT PROFESSOR

2. PT EXAMINATION
• 1. Aerobic Capacity/Endurance
- 6-Minute Arm Test (6MAT)
- Submaximal cycling test on an arm ergometer (6 min at steady-state).
- Tetraplegia: 10–30 watts.
- Paraplegia: 30–60 watts.
- Valid and reliable for both groups.

3. PT EXAMINATION
• 2. Arousal, Attention, Cognition
- Up to 60% of SCI patients may also have a TBI.
- Screening tools:
- Mini Mental State Exam (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Referral to neuropsychologist or psychiatrist if TBI suspected.
• 3. Environmental or Work Barriers
- Evaluate home and work accessibility.
- Early home evaluation is essential.
- Guidelines for structural modifications to enable wheelchair access

4. PT EXAMINATION
• 4. Gait, Locomotion, and Balance
- Most SCI patients rely on wheelchairs.
- Wheelchair Skills Test: Assesses 32 skills (indoor, community, advanced).
- Wheelchair Circuit: Evaluates tempo, technique, and capacity.
- Modified Functional Reach Test: For sitting balance.
- Berg Balance Scale (BBS): For standing/walking balance in iSCI.
- Rancho Los Amigos Gait Analysis: For gait deviations.
- WISCI (Walking Index for SCI): Rates assistance/device/bracing for 10m walk.
- SCI-FAI: 2-min observational gait + typical walking patterns.
- 10-Meter Walk Test / 6-Minute Walk Test: Valid for iSCI; MDC for 6MWT = 46 m.
- Key gait speed cutoffs:
- 0.09 m/s: Supervised ambulator
- 0.15 m/s: Indoor walker (wheelchair outdoors)
- 0.44 m/s: Indoor/outdoor walker with device/orthotic
- 0.70 m/s: Independent walker

5. PT EXAMINATION
• 5. Motor Function
- Use ASIA ISNCSCI for lesion level and motor status.
- Assess spasticity using:
- Modified Ashworth Scale (MAS)
- SCI-SET (Spasticity Evaluation Tool) — self-reported impact on 35 daily tasks.
• 6. Muscle Performance
- Manual Muscle Testing (MMT) + Handheld Dynamometry.
- Watch for substitution strategies.
- Consider orthotic/spinal restrictions in test positioning.

6. PT EXAMINATION
• 7. Pain
- Visual Analog Scale (VAS)
- International SCI Basic Pain Data Set — self-reported.
- Wheelchair User’s Shoulder Pain Index (WUSPI) — rates pain during key tasks (0–150 scale).
8. Self-Care and Home Management
- Focus on transfers, bed mobility, pressure relief, etc.
- True independence = task done safely, consistently, timely, and without help.
- Use:
- FIM (Functional Independence Measure) — 8-point scale (1 = total assist; 7 = independent).
- SCIM (SCI Independence Measure) — 19 items across 3 domains, 0–100 scale.
- QIF (Quadriplegia Index of Function) — targets subtle gains in tetraplegia.
- CUE (Capabilities of Upper Extremity Instrument) — UE function, 32–224 score.

7. PT EXAMINATION
• 9. Work, Community, and Leisure Reintegration
- Craig Handicap Assessment and Reporting Technique
- Assessment of Life Habits
- Reintegration to Normal Living Index
• 10. Neuromuscular Recovery
- Neuromuscular Recovery Scale (NRS) — measures function without compensation.
- 14 motor tasks: 4 treadmill (with BWS), 10 overground.
- Phases of Recovery:
- Phase 1: Wheelchair-dependent
- Phase 2: Initiation of standing
- Phase 3: Walking with compensation
- Phase 4: Independent, no compensation
- Tracks how a task is done — not just whether it’s done.