Episode 30 – SCI – Functional Outcomes

Watch the video version of this Q&A episode on YouTube - https://youtu.be/qRtAWHw5u3s 

A patient prepares to be discharged from a rehabilitation hospital following a T10 spinal cord injury. Which of the following pieces of equipment should the physical therapist expect to be MOST essential to assist the patient with functional mobility?

1. Lofstrand crutches
2. Lofstrand crutches and ankle-foot orthoses
3. Lofstrand crutches and knee-ankle-foot orthoses
4. Manual wheelchair

Welcome back to the Scorebuilders’ Q and A Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient prepares to be discharged from a rehabilitation hospital following a T10 spinal cord injury. Which of the following pieces of equipment should the physical therapist expect to be MOST essential to assist the patient with functional mobility?

1. Lofstrand crutches
2. Lofstrand crutches and ankle-foot orthoses
3. Lofstrand crutches and knee-ankle-foot orthoses
4. Manual wheelchair

Let’s explore the clinical presentation of a patient with a T10 spinal cord injury. 

T10 SCI – Clinical Presentation

• Paralysis in arms, hands, trunk and legs
• Little or no voluntary control of bowel or bladder
• Independent with bed mobility, transfers, feeding and grooming; modified independent with dressing and bathing

Let’s take a look at each of the options:

Option 1 - Lofstrand crutches
A patient with an incomplete lesion may ambulate without an orthotic using Lofstrand crutches. However, this would not be an option for a complete spinal cord lesion.

Option 2 - Lofstrand crutches and ankle-foot orthoses
A patient with a complete lesion at L4 or L5 would typically ambulate with crutches or canes and bilateral AFOs. The extensor digitorum, medial hamstrings, posterior tibialis, quadriceps, tibialis anterior, and low back muscles would be the lowest innervated muscles.

Option 3 - Lofstrand crutches and knee-ankle-foot orthoses
A patient with a complete lesion at L2 or L3 would typically ambulate with crutches and bilateral KAFOs. 

Patients at this level of injury may also use a manual wheelchair for energy conservation and convenience. The gracilis, iliopsoas, quadratus lumborum, rectus femoris, and sartorius would be the lowest innervated muscles.

Option 4 - Manual wheelchair
A patient with T10 complete paraplegia will require a wheelchair for community ambulation due to the increased energy expenditure associated with ambulation. The lower abdominals and intercostals would be the lowest innervated muscles.

The correct answer is Option 4

Let’s explore the all student data:
3% of students selected Option 1, Lofstrand crutches
6% of students selected Option 2, Lofstrand crutches and ankle-foot orthoses
35% of students selected Option 3, Lofstrand crutches and knee-ankle-foot orthoses
56% of students selected Option 4, Manual wheelchair, the correct response

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 307-309 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!