Preservation of Upper Limb Function Following Spinal Cord Injury - 13

CLINICAL PRACTICE GUIDELINE

syndrome. Internal rotation and abduction are common positions during wheelchair propulsion (Newsam et al., 1999; Neer II, 1983). Maximum shoulder extension when combined with internal rotation and abduction should also be avoided. When performing such activities as transferring, adaptive equipment—a tub bench, for example—is needed to prevent awkward positions like those seen when transferring out of a tub.
(Clinical/epidemiologic evidence–4/5; Ergonomic evidence–1; Grade of recommendation–B; Strength of panel opinion–Strong)

limited to those who have a prior injury to the upper limb, are obese, are elderly, or live in a challenging environment, such as on a steep hill or very rough terrain. The advantages of power wheelchairs include: Reduced propulsion-related repetitive strain. Conserved energy and therefore reduced fatigue. Increased speed. Increased ease of traversing uneven terrain and inclines. The disadvantages include: Decreased transportability. Increased maintenance. Increased cost. Possible weight gain. Possible decreased fitness. Alternatives to manual mobility include scooters, power wheelchairs, and power-assist and addon devices. Scooters provide fewer seating and control options and are less maneuverable. In addition, three-wheeled scooters are less stable than power wheelchairs. Power-assist devices are a relatively new concept and generally consist of an add-on-powered motor(s) that supplements the force applied to the pushrim with additional rear-wheel torque. Powerassist devices have been shown to require considerably less energy expenditure to propel than a manual wheelchair (Cooper et al., 2001). Power add-on devices allow a joystick control power option on a manual wheelchair. Power add-on devices may be less expensive than other powered mobility options and are usually mounted directly onto a manual wheelchair. Power-assist and power add-on devices are lighter, less expensive, and easier to transport than the other powered options, and because these devices are often mounted directly onto a manual wheelchair, they can also be removed to allow normal manual wheelchair use. 7. Provide manual wheelchair users with SCI a high-strength, fully customizable manual wheelchair made of the lightest possible material.
(Clinical/epidemiologic evidence–2/5; Ergonomic evidence–1; Grade of recommendation–B; Strength of panel opinion–Strong)

For adequate stabilization and long-term health of the upper limb joints, proper positioning of the joint is imperative. The basis for this recommendation includes general biomechanical principles, ergonomic studies, and studies measuring the pressure in the carpal canal in various positions.

Equipment Selection, Training, and Environmental Adaptations
6. With high-risk patients, evaluate and discuss the pros and cons of changing to a power wheelchair system as a way to prevent repetitive injuries.
(Clinical/epidemiologic evidence–2/3; Ergonomic evidence–1; Grade of recommendation–B; Strength of panel opinion–Strong)

A powered form of mobility is often not considered until the individual begins to complain of upper limb pain or sustains a repetitive strain injury. Based on reviews by NRC, IOM, and NIOSH, powered mobility should help protect the upper limb by reducing repetitive forceful activity. However, use of powered mobility may lead to weight gain and upper limb deconditioning. Ultimately these factors could lead to an increased risk of injury during transfers due to the need to lift more weight by a less conditioned limb. A person with C6 level of SCI may need powered mobility to function with peers in the community environment (Newsam et al., 1996). The advantages and disadvantages of powered mobility should be discussed initially when deciding on a wheelchair and later when replacing a wheelchair. This discussion should focus on the high prevalence of upper limb pain and injury reported among individuals with SCI as well as on the association between manual wheelchair use and upper limb injury. High-risk patients include but are not

Manual wheelchairs are generally grouped into three primary classifications in accordance

Preservation of Upper Limb Function Following Spinal Cord Injury

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