Page 15 - Mobility Management, October 2018

ATP Series
S SE ET T T TI IN NG G U UP P FOR SUCCESS
SELF-PROPELLING FOR CLIENTS WITH QUADRIPLEGIA IS ALL IN THE DETAILS
PICTURE TWO SCUBA DIVERS. The first is a strong swimmer, naturally proficient and comfortable in the water. Mastering buoyancy and communicating via hand signals come easily.
The second diver is not as comfortable in the water and is not a natural swimmer. To compensate, this diver works hard to get the most from his equipment. He learns to manage his buoy- ancy control device well and becomes an expert on every bit of equipment used during diving. In this way, he becomes a skilled, efficient diver.
Permobil VP of Marketing Josh Anderson offered that analogy when asked the differences between spinal cord injury (SCI) clients with quadriplegia versus paraplegia. Anderson, who sustained an incomplete injury at the C5-6 level as a teenager, speaks from experience when he talks of optimal setups for ultra- lightweight manual chairs.
“There are functional limitations,” he acknowledges of clients with lower cervical injuries. “I think [for clients] in a manual chair and having a higher-level injury, the importance of custom- ization related to function becomes that much more pronounced. I think that’s such a big thing.”
Results of Cervical Injuries
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When working with clients with SCI in the C5-C8 region, your first thought might be functional limitations in clients’ hands and arms. But the exact nature of those limitations vary from client to client, even if their injuries are in the same range.
For example, Brad Ramage, a Sunrise Medical account manager, has an incomplete C7-8 injury. “I have [use of] my biceps and my triceps,” he said. “I happen to have full extensors, so I can open my hands.” Clients with injuries in the C5-6 area might be able to raise their arms and elbows and flex their wrists, but might not be able to open their hands to use their fingers — a crucial consider- ation for how an ultralightweight chair will be propelled.
“Higher quadriplegics, like a C6-7, might push with an open palm and put their hands the whole way over the tire and the handrim to get a good friction surface,” Ramage explained.
Compromised function of the upper extremities isn’t the only result of a lower-cervical injury, however. Seated balance can also be a challenge.
“With a higher spinal cord injury,” Ramage said, “you’re usually going to sit with a little bit of posterior pelvic tilt. [These
By Laurie WatanaBe
SCUBA DIVERS: ISTOCKPHOTO.COM/ORLA