During rehabilitation, a patient with spinal cord injury begins to ambulate with long leg braces. Which level of injury does the nurse associate with this degree of recovery?

A. Estrogen and progesterone. These hormones regulate the reproductive system and do not play a direct role in Parkinsonism. While some studies suggest estrogen may have a neuroprotective effect, an imbalance between estrogen and progesterone is not the primary defect in Parkinson’s disease.
B. An autosomal dominant genetic defect. Parkinson’s disease can have a genetic component, but idiopathic Parkinsonism occurs without a clear genetic cause. Most cases are sporadic and result from dopamine depletion, rather than an inherited genetic mutation.
C. Dopamine and acetylcholine. Parkinsonism results from a deficiency of dopamine in the basal ganglia, leading to an imbalance between dopamine (inhibitory) and acetylcholine (excitatory). This imbalance causes motor symptoms such as tremors, rigidity, and bradykinesia. Benztropine (Cogentin) is an anticholinergic medication that helps reduce acetylcholine activity, restoring balance and improving symptoms.
D. Atherosclerosis and lack of blood supply. While vascular issues can contribute to stroke-related movement disorders, idiopathic Parkinsonism is caused by neurodegeneration, not blood flow problems. Atherosclerosis is not the primary cause of the dopamine-acetylcholine imbalance seen in Parkinsonism.

A. L1-2. Clients with a lumbar spinal cord injury at L1-L2 may have partial function of the lower extremities, allowing for ambulation with long leg braces and assistive devices. This level of injury typically spares some hip flexor and knee extensor function, enabling limited walking with support.
B. T6-7. A thoracic spinal cord injury at T6-T7 results in paralysis of the lower extremities (paraplegia), making independent ambulation unlikely. Clients with mid-thoracic injuries require a wheelchair for mobility, though some may use braces for short-distance standing or walking with extensive support.
C. C7-8. A cervical spinal cord injury at C7-C8 leads to quadriplegia with partial upper limb function but no voluntary lower extremity movement. These clients rely on wheelchairs for mobility and cannot ambulate with braces.
D. T1-2. A T1-T2 injury results in complete lower extremity paralysis, preventing functional ambulation. Clients at this level typically use manual wheelchairs for mobility and retain full arm and hand function for self-care and wheelchair propulsion.