Positioning and General Management of Upper Limbs in Spinal Cord Injury: Difference between revisions
No edit summary |
No edit summary |
||
Line 19: | Line 19: | ||
=== Positioning in Supine <ref>Oelofse W. Positioning and General Management of Spinal Cord Injury - Occupational Therapy Course. Plus 2022</ref> === | === Positioning in Supine <ref>Oelofse W. Positioning and General Management of Spinal Cord Injury - Occupational Therapy Course. Plus 2022</ref> === | ||
The following are recommended positions for the upper limb when a person with tetraplegia is in bed: | |||
'''Shoulders''' | '''Shoulders''' | ||
Line 53: | Line 55: | ||
* forward head posture | * forward head posture | ||
* reliance on the upper extremities to maintain balance | * reliance on the upper extremities to maintain balance | ||
'''Recommended posture improvement''' strategies: | |||
* wheelchair seating system adaptations | |||
* arms out to the side | |||
Revision as of 21:05, 30 November 2022
Original Editor - User Name
Top Contributors - Ewa Jaraczewska, Jess Bell, Tarina van der Stockt and Naomi O'Reilly
Introduction[edit | edit source]
Range of motion (ROM) limitations and joints contracture can significantly limit functional abilities in patients with a spinal cord injury. Shoulder ROM problems are related to functional limitations, disability, and perceived health. In addition patients with tetraplegia can suffer from upper limb spasticity which is reported to be one of the most difficult health complications after SCI.[1][2]These complications include restriction in activities of daily living (ADLs), pain and fatigue, sleep disturbance, and safety, leading to the development of contractures, pressure ulcers, infections, and negative self-image. [2]This article will discuss therapeutic strategies including appropriate positioning, stretching, strengthening, the tenodesis grasp and spasticity management which can help to maintain range of motion and facilitate function.
Maintaining Range of motion[edit | edit source]
Upper Limb Positioning[edit | edit source]
Goals:
- To increase and/or maintain range of motion
- To prevent and/or decrease upper limb (UL) pain
- To prevent UL injury
Positioning in Supine [3][edit | edit source]
The following are recommended positions for the upper limb when a person with tetraplegia is in bed:
Shoulders
- Crucifix position with shoulders in external rotation. Avoid extreme position and use progression ("serial positioning) to reach end range and eliminate stressing the tissue
- In open position
- Some shoulder abduction and external rotation, with positions alteration as needed
- Shoulders in a mid-position or in slight protraction
- Scapula "pulled back"
Elbows
- Extension, but not hyperextension.
- With overactive biceps maintain extension of the elbow using a soft splint, a vacuum splint, or a pillow wrapped around the forearm.
Wrist
- Extension or dorsiflexion up to 45 degrees
- Appropriate position maintained using the splint, or the pillow
Thumb
- Position in the opposition to maintain the web space
- Night splint vs hand resting splint at night, or
- Rolled-up towel placed in the web space to maintain the web space.
- Position the hands higher than the shoulders to prevent gravitational swelling
Positioning in Sitting[edit | edit source]
A wheelchair sitting posture of a person with cervical level spinal cord injury is often characterised by:
- rounded shoulders with increased thoracic kyphosis
- tendency to progress to more slouched posture throughout the day
- forward head posture
- reliance on the upper extremities to maintain balance
Recommended posture improvement strategies:
- wheelchair seating system adaptations
- arms out to the side
adequate support for the weight of the upper limb
Upper Limb Stretching and Strengthening Programs[edit | edit source]
Stretching[edit | edit source]
Strengthening[edit | edit source]
Tenodesis Grasp[edit | edit source]
Upper Limb Spasticity Management[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ Reinholdt C, Fridén J. Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia. Journal of Plastic Surgery and Hand Surgery. 2011 Apr 1;45(2):83-9.
- ↑ 2.0 2.1 Saxena A, Sehgal S, Jangra MK. Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients. Asian Spine J. 2021 Aug;15(4):498-503.
- ↑ Oelofse W. Positioning and General Management of Spinal Cord Injury - Occupational Therapy Course. Plus 2022