When you hear the phrase spinal cord injury, what’s the first thing that comes to mind? Most likely it’s the back, loss of mobility or paralysis.
Something that often doesn’t immediately rise to the surface is how a spinal cord injury affects the hands. It’s easy to correlate a damaged spinal cord with a loss of feeling or strength in the legs resulting in paralysis. The other end of the spectrum is when quadriplegic patients, who have suffered a higher cervical injury, have little to no feeling or movement beyond the neck.
The truth, however, is that the impacts of a spinal cord injury can vary greatly and leave patients managing symptoms ranging from having full use of their trunk, arms and hands, to having limited movement in the right arm and hand, but none in the left, or little movement below the shoulders.
It takes a team of physical and occupational therapists to help spinal cord injury patients maximize what movement and feeling they do have, so they can have the best quality of life possible.
Movement depends on the injury
Which part of the spinal cord is damaged in an injury matters when it comes to limb function – especially the hands and arms.
A Thoracic spine injury, which involves the upper and middle section of the spine, usually results in weakness or loss of sensation in the legs and perhaps the trunk, but arm, hand and shoulder function will remain intact. A cervical spine injury, which includes the spine from the base of the skull to the top of the shoulders, can result in a loss of movement in all limbs and the trunk.
But how catastrophic a cervical injury is depends on where exactly the injury occurred. Damage to the C1 or C2 vertebrae (at the base of the skull) will most likely leave a patient with no movement from the neck down and require the use of a ventilator. Just a little lower at C3 or C4, a patient may be able to shrug his or her shoulders and at C5 a patient could have the ability to lift his or her arm to the side or forward or even bend the elbow weakly.
The general rule of thumb is even at injuries between C7, C8 and T1 (the top of the thoracic spine), patients likely will not have control of their hands. Of course, as is the case in many injuries, rarely is anything that cut and dry.
A patient with injuries in that range may have the ability to move his or her right hand slightly, but have no movement beyond the shoulder on the left. Or a patient could have use of both shoulders but struggle with weakness in the wrist or elbow.
For physical and occupational therapists, the task is to offer therapy and support that gives patients as much independence as possible.
Making the most of movement
Due to the devastating nature of spinal cord injuries much of the therapy for patients is done in a hospital or inpatient rehabilitation setting.
For patients dealing with a loss of arm, shoulder and hand function, an occupational therapist can help them relearn things like eating or grabbing objects, either by making use of what movement they do have or through adaptive equipment. Patients who have wrist and hand movement but can’t grip with their fingers, for example, may use an angled utensil or a utensil that slides on the hand. If a patient has decent strength in their hands but remains weak in their shoulders, a sling maybe used to help support the arm so a patient can eat.
Physical therapy can help patients to maximize the strength of any remaining muscular movement. Exercise and therapies for cervical patients will depend on what function still exists, whether that’s the shoulders, arms, elbows, wrists or hands. One muscle group a cervical patient with some arm and shoulder movement may tackle is the triceps. Retaining the use of those muscles could allow patients to help lift themselves and assist in transferring to and from the bed and wheel chair.
Outpatient physical therapy may come into play down the road to make sure patients are maintaining proper form for home exercise programs. Physical therapists may also be able to make tweaks or suggestions for better technique of maneuvering in a wheel chair to avoid a painful shoulder or a painful wrist.
There’s no doubt that a spinal cord injury can be life altering. Having the right support is critical for making patients comfortable and confident.