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Mobility

  • Bed Mobility: some assistance
  • Transfers
  • Level: some assistance to independent
  • Uneven: some to total assistance
  • Pressure relief & positioning: independent w/proper equipment or adaptive techniques
  • Wheelchair and standing
  • Manual: Independent indoors and some to total assist outdoors
  • Power: Independent w/standard arm drive on all surfaces
  • Standing: total assistant
  • Transportation: independent driving from w/c (adapted controls)

Body Functions

-Can speak and use diaphragm (breathing may be weakened)

-Little to no voluntary bowel and bladder control

C6 Quadriplegic

By: Ben Kelly & Ashley Tietgen

ADLs & IADLs

Examinations:

  • Interview
  • PROM (available pain free ROM, contractures)
  • MMT
  • Sensation
  • Wrist/hand function (AE!)
  • Cognitive skills
  • Perceputal skills
  • ADLs
  • Tone
  • Transfers

Interventions

**Always test above and below lesion**

  • ADLs & IADLs
  • Universal Cuff
  • Transfers
  • Wheel Chair Management
  • Pressure Management
  • Catheter Management
  • Splinting
  • Autonomic Dysreflexia education

Type 1 Diabetes & C6 Quad

SCI patients with diabetes have extra ADLs to conquer and precautions to take into account. A high spinal cord lesion such as a C6 causes diabetic patients to lack early warning signs of hypoglycemia or make them unreliable sources of low blood sugar (e.g. palpitations, tachycardia, sweating). With the use of tenodesis, patients should be able to administer a test of blood glucose as well open and fill an insulin pump. However, if a strong tenodesis is not present a tenodesis split would allow patience to complete this. Also, SCI patients should inject insulin below the level of the spinal cord lesion. Research shows greatest problems seem to stem from infection from an overused injection site or bad technique administering the insulin (Barlascini, et. al., 1989).

  • Independent in upper body dressing
  • Low body dressing assistance varies
  • Independent shaving, brushing teeth, and brushing hair with use of palm straps
  • Independent feeding with use of adaptive equipment
  • Bathing assistance varies
  • Independent cooking with adaptive equipment and proper environmental set-up
  • IADL abilities vary

Movements:

Innervated Muscles:

  • Clavicle pectoralis
  • Supinator
  • Extensor carpi radialis longus/brevis
  • Serratus anterior
  • Lattisimus dorsi

Movements not possible:

-complete paralysis of legs

and trunk

-no direct finger movement

-decreased to no elbow extension

-decreased to no wrist flexion

Resources

Barlascini, C., Schmitt, J., & Adler, R. (1989). Insulin pump treatment of Type I diabetes mellitus in a

patient with C6 quadriplegia. Archives of Physical Medicine & Rehabilitation, 70(1), 58-60.

E Learn SCI (2012, February 26). OT Functional Expectations C6 upper body dressing in chair [Videofile]. Retrieved from http://vimeo.com/37479481

Harvey, L., & Crosbie, J. (1999). Weight bearing through flexed upper limbs in quadriplegics with

paralyzed triceps brachii muscles. School of Physiotherapy, 37(11), 780-785.

Levels of Injury. (2014, January 1). Retrieved September 17, 2014, from

http://www.spinalinjury101.org/details/levels-of-injury

Pedretti, L. (2013). Spinal Cord Injury. In OccupationalThreapy Practie Skills for Physcial

Dysfunction (7th ed., pp. 954-982). St. Louis: Mosby.

Quadriplegia. (2009, January 1). Retrieved September 17, 2014, from http://www.spinal-

injury.net/quadriplegia.htm

Radomski, M., & Trombly Latham, C. (2008). Spinal Cord Injury. In Occupational therapy for physcial

dysfunction (6th ed., pp. 1171-1211). Baltimore: Lippincott Williams & Wilkins.

Spinal Cord Injury Levels - Functionality of C6 Spinal Cord Injury. (2013, January 1). Retrieved

September 17, 2014, from http://www.apparelyzed.com/support/functionality/c6.html

Whiteneck, G., Adler, C., Blackburn, S., Hendricks, R., Johnson, K., & Thomas, H. (2002). A Guide

for People with C6 Spinal Cord Injury . In Expected outcomes: What You Should Know. Washington, DC (801 18th St. NW, Washington, DC 20006-3517): Paralyzed Veterans of America.

Movements possible:

-Full Head and Neck movement

w/normal strength

-Normal shoulder strength

-Wrist extension

-Elbow flexion

Research on elbow stability in C6 Quad

A study by Harvey and Crosbie (1999) shows that the paralysis of the triceps brachii muscles in C5 and C6 quadriplegics does not limit them from bearing weight on a flexed elbow. This is possible because of strong shoulder flexion movements as well as some wrist flexor movements. Results showed the anterior deltoid and upper pectoralis major to be the main contributors to this (Harvey & Crosbie, 1999).

**Developing good shoulder strength in C6 quads can benefit their ability to weight bear on a bent elbow which will carry over to occupation based tasks such as ability to perform transfers independently**

Spinal Cord Injury

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