Upper Limb Management in Lower Tetraplegia and Central Cord Syndrome: Difference between revisions

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Goals for upper limb(UL) management:
Goals for upper limb(UL) management:


The typical C6 complete tetraplegic patient can be expected to eat and drink with food provided and dress with clothes provided. Patients at this level would also have a greater likelihood of doing more complex tasks such as cutting meat, buttering bread, pouring liquids and opening milk containers. The C6 tetra­ plegic patient can usually groom himself, assist with bathing, and may manage his own urinary drainage devices and perform his bowel programme independ­ ently. Transfers are usually with assistance, but exceptional patients can perform them independently. Wheelchair propulsion on both flat surfaces and inclines could be performed independently. The occasional C6 complete tetraplegic patient who is well-motivated and living in an accessible environment can live independently without assistance, but this is relatively unusual.
* To prevent upper limb secondary complications, including development of contractures and deformities. <ref name=":1">Arsh A, Anwar Z, Zeb A, Ilyas SM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994917/pdf/PJMS-36-96.pdf Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study.] Pak J Med Sci. 2020 Jan-Feb;36(2):96-99.</ref>
* To optimise independence with activities of daily living (ADLs), including eating, dressing, meal prep, grooming, bladder and bowel programme.<ref>Yarkony GM, Roth EJ, Heinemann AW, Lovell L. [https://www.nature.com/articles/sc198828.pdf?origin=ppub Rehabilitation outcomes in C6 tetraplegia.] Paraplegia. 1988 Jun;26(3):177-85.</ref>
* To gain community integration through learning transfers with assistance and independent wheelchair propulsion<ref name=":1" />


Such factors as motivation, physique, psychosocial status, and complications of spinal cord injury, play a major role in determining actual functional outcomes of patients. Although not addressed specifically, these factors may explain the varied outcomes of many of these patients.
Such factors as motivation, physique, psychosocial status, and complications of spinal cord injury, play a major role in determining actual functional outcomes of patients. Although not addressed specifically, these factors may explain the varied outcomes of many of these patients.
=== Prevention of Development of UL Deformities ===
=== Activities of Daily Living ===
=== Wheelchair Mobility ===


== C7 Tetraplegia ==
== C7 Tetraplegia ==
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== Central Cord Syndrome ==
== Central Cord Syndrome ==
== Upper Limb Splinting ==
'''Short opponens'''
* Almost exclusively custom-made
* Facilitates tenodesis by opposing the thumb and preventing thumb overstretching during functional tasks.
* Worn as needed to increase function
* Facilitates tenodesis for individuals with wrist extension 3-5/5 and digitise 0-2/5
* Recommended for individuals with C6, C7-8 SCI


== Resources  ==
== Resources  ==

Revision as of 20:59, 26 November 2022

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Introduction[edit | edit source]

Upper limb function is a key element in regaining autonomy for patients with a cervical spinal cord injury. A conservative treatment may transition into a surgical pathway, and treatment strategy is based on the type of damage present (upper vs lower motor neuron). It includes positioning, splinting, passive and active range of motion, functional training, and training with adaptive equipment with aim to offer the best possible benefit to the individual patient.[1]Prevention must be considered when treatment strategies are selected. Claw hands, contractures, or inadequate closing or opening of the fingers may occur as a result of lower level cervical spinal cord injury.[1]This article will discuss upper limb function with lower level cervical spinal cord injury and its impact on the patient's functional abilities.

C6 Tetraplegia[edit | edit source]

  1. Innervated upper limb muscles
    • Deltoid, biceps, brachialis, brachioradialis (C5 level)
    • Pectoralis (clavicular head only)
    • Supinator
    • Radial wrist extensors (extensor carpi radialis longus and/or brevis)
  2. No elbow extension
  3. No active movements of fingers or thumbs
  4. Functional impact
    • Unable to raise arms above shoulder level without external rotation
    • Potential for tenodesis grip
    • Able to extend wrist, rotate and adduct the shoulder[2]
    • Improved weight bearing through the upper limbs due to the function of latissimus dorsi and pectoralis

Goals for upper limb(UL) management:

  • To prevent upper limb secondary complications, including development of contractures and deformities. [3]
  • To optimise independence with activities of daily living (ADLs), including eating, dressing, meal prep, grooming, bladder and bowel programme.[4]
  • To gain community integration through learning transfers with assistance and independent wheelchair propulsion[3]

Such factors as motivation, physique, psychosocial status, and complications of spinal cord injury, play a major role in determining actual functional outcomes of patients. Although not addressed specifically, these factors may explain the varied outcomes of many of these patients.

Prevention of Development of UL Deformities[edit | edit source]

Activities of Daily Living[edit | edit source]

Wheelchair Mobility[edit | edit source]

C7 Tetraplegia[edit | edit source]

  1. Innervated upper limb muscles
    1. All muscles at C6 level
    2. Pectoralis (sternal head)
    3. Triceps
    4. Pronator teres
    5. Flexor carpi radialis (wrist flexor)
    6. Extensor digitorum communis (finger extensor)
  2. Weak fingers and/or thumb extension may be present
  3. No fingers and thumb flexion
  4. Functional impact
    1. Able to lift arms above shoulder level
    2. Potential for tenodesis grip

C8 Tetraplegia[edit | edit source]

Central Cord Syndrome[edit | edit source]

Upper Limb Splinting[edit | edit source]

Short opponens

  • Almost exclusively custom-made
  • Facilitates tenodesis by opposing the thumb and preventing thumb overstretching during functional tasks.
  • Worn as needed to increase function
  • Facilitates tenodesis for individuals with wrist extension 3-5/5 and digitise 0-2/5
  • Recommended for individuals with C6, C7-8 SCI

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 Bersch I, Krebs J, Fridén J. A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia. Front Rehabil Sci. 2022 Jun 30;3:889577.
  2. ↑ Oelofse W. Upper Limb Management in Lower Tetraplegia  - Occupational Therapy Course. Plus 2022
  3. ↑ 3.0 3.1 Arsh A, Anwar Z, Zeb A, Ilyas SM. Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study. Pak J Med Sci. 2020 Jan-Feb;36(2):96-99.
  4. ↑ Yarkony GM, Roth EJ, Heinemann AW, Lovell L. Rehabilitation outcomes in C6 tetraplegia. Paraplegia. 1988 Jun;26(3):177-85.
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