Chapter Fifteen: Upper Limb orthoses for the person with spinal cord injury Flashcards
Where do the majority of injuries to the spinal cord occur? Why
C5, C6, C7.
The spinal cord takes up more space in the canal and those vertebra have greater ROM
What is central cord syndrome?
Incomplete spinal cord injury (SCI), damage usually expands outwards, but as the degree of injury resorbs back more centrally, the function effected by the periphery becomes preserved. It usually is characterized by bowel, bladder, and lower extremity function, but loss of upper extremity function.
what upper extremity orthosis is the common device used for patients with midcervical tetraplegia?
The wrist-flexor hinged orthosis
Or Wrist-driven flexor hinged orthosis
MAS and suspension slings are designed for what patients?
Person’s with high tetraplegia (C4 and up)
For Acute tetraplegia, what is usually done?
Early protective splinting to prevent oversetretching the ligaments, maintain functional hand position, prevent deformity, and protect and stabilize flaccid joints.
ROM exercises and proper bed positioning should also be done.
If edema is present, then a resting hand splint may be the best option.
What are the upper limb intervention goals with high-level tetraplegia (C1-4)?
Prevent and control development of paralytic deformities, protect insensate area from injury, prevent and/or reduce edema, maintain a supple hand for human contact, protect the limb from irreversible changes and preserve it for future treatment paradigms.
During waking hours, what orthosis should be used for a high-level tetraplegia? Why?
Long opponens WHO. It will support the proximal and distal transverse arch and the longitudinal arch.
How should the long opponens WHo be positioned for a high-level tetraplegia?
30 degrees of extension and the thumb placed in full abduction (carpometacarpal joint) and extension (metacarpophalangeal joint).
What type of night time splint position should a brace be set for a high-level tetraplegia patient (C1-4)
Support all the arches, while holding the thumb in full abduction-extension but places the hand in an intrinsic plus posture.
What other devices may be used for high-level tetraplegia (C1-4)?
Automatic, mechanical, and powered feeders along with an MAS
What two groups can midcervical SCI (C5-6) be separated into?
Those with gravity-eliminated wrist extension strength and those with against-gravity wrist extension strength.
Person’s with C5 tetraplegia typically have adequate what? and poor what?
Elbow flexion, but poor or no wrist extension.
What orthosis is best for patient’s with C6 tetraplegia?
The flexor hinge orthosis
For Low-level SCI, which orthoses are most beneficial?
Functional splinting to promote hand opening by preventing an intrinsic minus posture and wrist flexion.
For patients without gasping abilities, the universal cuff is most beneficial. It can hold all the utensils in the hand and make ADLs easier.
What assistive devices can be used for high-level (C1-4) tetraplegia?
Environmental control
Mouth stick
Automatic and mechanical feeders
