Preservation of Upper Limb Function Following Spinal Cord Injury - v

Foreword

or individuals with spinal cord injury (SCI), paralysis of the lower limbs necessitates reliance on the upper limbs for mobility. This greater reliance on the arms can lead to pain and injury, which can have an impact not only on mobility, but also on the ability to complete activities of daily living. The high prevalence of upper limb pain and injury in SCI is well documented, as are the negative consequences on quality of life. Unfortunately, little research exists that clearly documents how to prevent upper limb pain and injury and thus preserve function. The purpose of this guideline is to provide health-care professionals with concise, practical information that will help them prevent and treat upper limb pain and injury in their patients. This guideline is unique in that we relied heavily on a field of specialists outside of SCI and traditional medicine for support of many of the recommendations. Ergonomics is a branch of engineering that studies the relationship between workers and their environment. The ergonomics literature was reviewed and is interspersed throughout the recommendations. A separate literature grade is provided to enable the reader to ascertain to what level the recommendation is supported by the ergonomics literature. And, with the guidance of our methodologist, we combined the ergonomic, epidemiologic, and health sciences research into a single grade of recommendation. The multidisciplinary panel responsible for this guideline extensively debated what to include and what not to include. To keep the document manageable in terms of both size and scope, we omitted topics that easily could have been included. For example, we did not include information on management of the upper limbs at the time of the acute SCI because a future guideline is likely to cover that topic. Another area we did not cover is procedures to improve upper limb function, such as tendon transfers or functional electrical stimulation. We are hopeful that this area, too, will be covered in a future practice guideline. Finally, we only briefly touched on the management of chronic musculoskeletal pain. The panelists are aware that this guideline is but a beginning step in the ongoing process of developing useful tools for preserving upper limb function in individuals with SCI. It is the panel’s hope that the guideline will stimulate research in this vital area and provide guidance in dealing with the complexities of upper limb pain and injury in SCI. Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals is the result of a collaborative effort among a group of professionals with extensive research and clinical experience. Their hard work and vision are reflected in the pages of this document.

Michael L. Boninger, MD Panel Chair

Preservation of Upper Limb Function Following Spinal Cord Injury

Table of Contents for the Digital Edition of Preservation of Upper Limb Function Following Spinal Cord Injury