A patient with central cord syndrome at C5 currently has 4/5 strength in bilateral lower extremities but only 2/5 strength in bilateral upper extremities. When developing a plan of care, which of the following considerations is MOST important for the therapist to prioritize?

A patient with central cord syndrome at C5 currently has 4/5 strength in bilateral lower extremities but only 2/5 strength in bilateral upper extremities. When developing a plan of care, which of the following considerations is MOST important for the therapist to prioritize?

• A. Ordering bilateral KAFOs to maximize ambulation safety
• B. Emphasizing upper extremity recovery and functional use while incorporating weight-bearing and locomotor training for the lower extremities
• C. Focusing exclusively on wheelchair mobility training since upper extremity weakness will prevent functional ambulation
• D. Delaying all rehabilitation until the patient demonstrates at least grade 3/5 upper extremity strength

Answer: (B)

In central cord syndrome, the arms are typically more weak than the legs because the cervical tracts controlling the upper limbs are more affected. Because upper-extremity function is what most limits independence in daily activities, the most impactful plan of care targets restoring hand and arm function to enable self-care, transfers, and functional tasks. At the same time, the legs are relatively stronger and can participate in rehabilitation through weight-bearing and gait/locomotor training, which supports motor recovery and the potential for ambulation. So the best approach is to emphasize upper-extremity recovery and functional use while incorporating weight-bearing and locomotor training for the lower extremities. This balances maximizing independence now with capacity to improve walking later, rather than locking into wheelchair use or delaying rehab until the upper limbs meet a higher strength threshold.

In central cord syndrome, the arms are typically more weak than the legs because the cervical tracts controlling the upper limbs are more affected. Because upper-extremity function is what most limits independence in daily activities, the most impactful plan of care targets restoring hand and arm function to enable self-care, transfers, and functional tasks. At the same time, the legs are relatively stronger and can participate in rehabilitation through weight-bearing and gait/locomotor training, which supports motor recovery and the potential for ambulation.

So the best approach is to emphasize upper-extremity recovery and functional use while incorporating weight-bearing and locomotor training for the lower extremities. This balances maximizing independence now with capacity to improve walking later, rather than locking into wheelchair use or delaying rehab until the upper limbs meet a higher strength threshold.