12 Potential benefits include increased ease in patient transfers improved

12 potential benefits include increased ease in

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[12] Potential benefits include increased ease in patient transfers, improved speech, reduced anxiety, improved sense of well-being, reduced need for nursing care, and reduced overall costs. Candidates must have an intact phrenic nerve and be free of clinically significant lung disease. Robotic exoskeleton devices (eg, ReWalk, Ekso) have been designed to allow standing and ambulation for patients with paraplegia and are still undergoing clinical trials. They use backpack battery–powered mechanical joints and have emerged as the next step in the technological evolution of exoskeleton devices. [20, 21] Surgical Reconstruction To Aid Upper-Extremity Function Surgical reconstruction can improve upper extremity function in individuals with tetraplegia. Tendons from proximal, functioning muscles can be surgically transferred to enhance distal, nonfunctioning parts, often improving an individual's motor function by 1 level. In patients with an injury at the C5
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9/13/2017 Functional Outcomes per Level of Spinal Cord Injury: Overview, Neurologic Level and Completeness of Injury, C1-C4 Tetraplegia (High Tetraple… 9/13 level, tendon transfers may enable wrist and elbow extension. In persons with an injury at the C6 level, tendon transfers may provide for elbow extension and tenodesis, allowing these patients to grasp and release. When the injury is at the C7 level, tendon transfers can restore active grasp and improve hand dexterity. Careful patient selection and the use of experienced hand surgeons and therapists are essential for successful outcomes. Appropriate candidates for these procedures must be neurologically stable and well motivated to participate in postoperative rehabilitation (immobilization, edema and scar management, mobilization, functional skills training, and strengthening). SCI Clinical Syndromes and Outcomes The prognosis for enhanced functional outcomes is most favorable for patients with incomplete spinal cord injury (SCI). Six clinical syndromes resulting from anatomically distinct SCIs are often discussed. Central cord syndrome Central cord syndrome, which is a relatively common cervical incomplete injury, is characterized more by weakness of the upper extremities (especially of the hands) than of the lower extremities. Individuals with central cord syndrome may also have sensory and bladder dysfunction. This syndrome is frequently seen in elderly individuals with degenerative spinal stenosis and is associated with hyperextension injuries. In general, patients with central cord syndrome have a favorable prognosis for functional ability in ADLs, bladder and bowel control, and ambulation. Residual upper extremity weakness may persist and can affect basic self-care. Moreover, the patient may need to use assistive devices for ambulation. Favorable prognostic factors are age younger than 50 years (at the time of injury), good initial hand or lower extremity motor score, education, decreased comorbidities, decreased spasticity, and rapid early improvement.
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  • Spring '08
  • Herzog,A

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