The Consortium for Spinal Cord Medicine supported by the Paralyzed Veterans of America have developed Clinical Practice Guidelines for looking after upper limb function for people with a spinal cord injury. This advice on maintaining function and longevity is required as many SCI will use a wheelchair for their main form of mobility and will use their arms for most of the their day to day tasks including transferring. The guidelines were published in 2005 and users are advised to consider more recent research as well.
Why Does the Upper Limb need to be preserved?
Research has shown that 68% of SCI people will complain of upper limb pain and 46% of that pain will be related to shoulder pain. Injury to the upper limbs can have serious consequences to SCI, as it could prevent them from being able to transfer, propel their wheelchair or even make a cup of tea. Biomechanically the upper limb in humans was not designed to be performing repetitive weight bearing activities; this is why we don’t walk on all fours. The glenoid fossa in which the humerus (arm bone) sits is very shallow and the arm stays in place due to the extensive ligaments, tendons and muscles surrounding it. Repetitive use and / or use of the upper limb in a poor position will cause excessive strain on this surrounding soft tissue which can results in injury and pain. As a person with SCI will be reliant on their upper limbs for the rest of their life, it is essential to ensure longevity and preservation of their body.
What are some of the key components?
- Increased awareness of the risks of upper limb pain and injury
- Ensure that you are performing the correct strengthening exercises for the shoulders, incorporating scapular setting for all movements. This should be individualized and progressive
- Regular stretches need to be performed as well to maintain range of movement in the shoulders
- Transfer techniques
- To reduced strain try to only transfer at level heights, and use a sliding board even if you don’t need one, by performing 50% of your transfers with one you can dramatically reduce the pressures going through your arms.
- Wheelchair propulsion techniques
- Ensure you are using long, smooth strokes allowing the arm to drift down after releasing
- Gloves can also reduce strain by providing better grip and also protects the hands
- Be mindful to reduce the frequency of repetitive upper limb tasks
- Reduce how many tasks you are performing with your arms above shoulder level
- Avoid extreme positions of the wrist and shoulders and avoid positions of impingement when possible
- Using a power wheelchair more often than a manual chair – especially for community mobility
- Ensure your manual wheelchair is as light as possible and correctly fitted – this needs to be reviewed on a regular basis