SCI Motor/Sensory Deficits

Influencing factors on SCI intervention: Client’s Level & Severity of SCI

Influencing factors on SCI intervention: Support available

Social/caregiver support 

Influencing factors on SCI intervention (Phase of Care): Acute

• Focus: Medical stabilization, positioning/skin protection, basic ADLs, Early AT, education 

• Short duration  

• Prepares for rehabilitation process

Influencing factors on SCI intervention (Phase of Care): Impaitent

• Focus: ADLs, IADLs, Transfers, UE function, Wheelchair skills, AT, caregiver training

• Discharge Planning

Influencing factors on SCI intervention (Phase of Care): Outpatient/Community

Focus: ADLs, IADLs, Accessibility, Environmental adaptations, strengthening, community mobility, work/school, leisure, health maintenance

Influencing factors on SCI intervention (Phase of Lifespan):

Adolescence → 30s → Older adult.

Intervention strategies: Health Promotion

Support health, wellness, participation, & QOL

Intervention strategies: Remediation & Restoration

 Improve or restore impaired function  

Intervention strategies: Maintenance

Preserve existing abilities & prevent loss of function

Intervention strategies: Compensation & Adaptation

Change the task, environment, technique, or equipment.   

Intervention strategies: Prevention

Prevent secondary complications

Presentation & Intervention For (Presentation): C1-C3

• Neck flexion/extension/rotation 

• Significant respiratory impairment

• May require ventilatory support

Presentation & Intervention For (Presentation): C4

• Scapular evaluation 

• Diaphragmatic functions

• May eventually wean from ventilation

Presentation & Intervention For (Intervention): C1-C4

• Direct-care education 

• Patient/family education

• Equipment decision-making 

• Assistive technology

• Environmental control 

• Mouth-stick training 

• Power wheelchair positioning 

Presentation & Intervention For (Presentation): C5

• Preserved: Deltoid, biceps, brachialis, branchioradialis, rhomboids, part of serratus anterior 

• Movement: Shoulder flexion, shoulder extension, shoulder abduction, elbow flexion, supination, Scapular movement

• Absent/limited: Elbow extension, pronation, wrist/hand movement, trunk movement, LE movement.

Presentation & Intervention For (Presentation): C6

• Client Gains: Scapular protraction, some horizontal adduction, forearm supination, radial wrist extension. 

• Still Absent: Wrist flexion, elbow extension

Presentation & Intervention For (Presentation): C7

Elbow extension, increased wrist/hand function

Presentation & Intervention For (Presentation): C8

Wrist flexion, finger flexion/extension, thumb abduction, greater grasp/release potential

Presentation & Intervention For (Intervention): C5-C8

• Positioning 

• Splinting 

• ROM 

• Proximal strengthening 

• Mobile arm support 

• Adaptive Equipment (AE)

• Compensatory strategies 

• Feeding 

• Grooming 

• Phone use 

• writing/typing adaptations 

• Clothing management

Presentation & Intervention For (Presentation): C5 Tetraplegia

• Shoulder Movement 

• Elbow Flexion 

• No functional wrist/hand movement.

Presentation & Intervention For (Intervention): C5 Tetraplegia

• Strengthen available UE muscles 

• Mobile arm support 

• Wrist stabilization 

• Universal cuff

• Adapted feeding/grooming equipment 

• ADLs

Presentation & Intervention For (Presentation): C6 Tetraplegia

Major gain: wrist extension, wrist extension allows tendesis grasp

Presentation & Intervention For (Intervention): C6 Tetraplegia

• Preserve tenodesis 

• Strengthen wrist extension 

• Grasp/release 

• Tenodesis splint if appropriate 

• Adaptive utensils 

• dressing/grooming adaptations 

• phone/computer adaptations

Presentation & Intervention For: C6 Tetraplegia - Tenodesis Grasp

A passive hand movement by moving the wrist backwards (wrist extension), the tendon pulls tight and automatically curls your fingers and thumbs into a grip. To release, mend your wrist forward (wrist flexion), the tendons loosen and fingers straighten to drop or release the items.

Presentation & Intervention For (Presentation): C7 Tetraplegia

• Major Gains: Triceps → elbow extension

• Improves: Reaching, pushing, transfers, manual wheelchair propulsion, ADL performance.

Presentation & Intervention For (Intervention): C7 Tetraplegia

• Hand strengthening 

• Dexterity 

• Grasp/release 

• Fine motor 

• ADL/IADL training 

• Functional hand use

Surgical Options for UE: Tendon Transfer

Functioning muscle/tendon is redirected to replace a lost hand function

• May improve: Grasp, pinch, and release 

• Considered after neurological recovery and strength have stabilized