OVERVIEW: FUNCTIONAL OUTCOMES: THORACIC, LUMBER, AND SACRAL INJURIES - PARAPLEGIA

     T-1 injuries are the first level with normal hand function. They can perform all functions of a non-injured person, with the exception of standing and walking, although this is also possible for some T-1 patients. As thoracic levels proceed caudally, intercostal and abdominal musculature recovery is present, and there is improved respiratory function and trunk balance as a result. T2-5 patients have partial trunk movement and may be able to stand, with long leg braces and a walker, and may be able to walk short distances with assistance. T6-12 patients also have partial abdominal muscle strength, and may be able to walk independently for short distances with long leg braces and a walker or crutches.

     There are three mechanical bracing systems in widespread use to restore upright mobility following SCI: the knee-ankle-foot orthosis (KAFO), the Louisiana State University reciprocal gait orthosis (RGO), and the adult hip guidance orthosis (HGO or Parawalker). All three systems involve increased energy expenditure and decreased walking speed, compared with a non-injured person, and are frequently abandoned for wheelchair mobility outside the home. Although bracing systems can improve bone density, urinary drainage, bowel function, spasticity, respiratory mechanics, contractures, and psychological health, they are perceived by some to be less safe and more difficult to use than wheelchairs (Formal, et al 1997).

     Although functional electrical stimulation (FES) has enabled standing since the 1980's, the only FDA-approved lower extremity system currently available enables only limited periods of standing and walking, in certain patients (Chen; 1997 Klose, et al 1997)

     Most lumbar patients are wheelchair-independent and can ambulate. L2 patients have all movement in the trunk and hips, and L-3 patients have knee extension. They may be able to walk independently with long leg braces and crutches for community distances. L-4 patients have ankle dorsification and L-5 patients have extensor hallucis longus function. They are able to walk independently with ankle braces and canes, and may use wheelchairs for long distances.

     S-1 and S-2 patients have function of the gastrocnemius and soleus muscles and walk independently on all surfaces, usually without bracing. Baseline lower-extremity pinprick preservation and sacral pinprick preservation at 4 weeks postinjury are associated with an improved prognosis for ambulation (Oleson, et al 2005).

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