Upper Limb Function in Spinal Cord Injury
Improvement in upper limb function is identified as a top priority for people with tetraplegia following spinal cord injury.  Management of the tetraplegic upper limb aims to maximize hand function to enable performance of daily tasks as independently as possible. In order to reach this goal it is important to prevent secondary complications of the upper limb occurring in the acute phase. Therefore interventions need to start early and involve all members of the rehabilitation team. Initial intervention aims to prevent secondary complications of restricted joint movement, pain, swelling and contracture. Following this, rehabilitation of the tetraplegic upper limb consists of strengthening remaining muscles and retraining skills using motor relearning, compensatory and adaptive techniques. Following neurological plateau of the injury, which is usually between 6 - 12 months in the complete spinal cord injury, there are a number of reconstructive surgery options available to further improve upper limb function. This module will provide a guideline for the management of the tetraplegic upper limb, describe rehabilitation principles to develop a functioning hand. Common surgical reconstruction and other interventions will also be reviewed.
Function and Management According to Neurological Level
The limitations experienced following spinal cord injury are dependent upon the severity and level of injury. While individuals with the same motor level of injury, assessed by the ICNSCI, will have similar muscles innervated, how they use these muscles is dependent on a number of factors such as age, body composition, completeness of spinal cord injury, other injuries and motor planning. This makes describing expected functional capacity of a specific level difficult, however publications there are clinical practice guidelines published at outline the expected skills and outcomes for each significant level of spinal cord injury.  It is therefore important that a thorough examination of the upper limb with regarding to muscle strength, sensation and function is performed.
- Anderson KD. Targeting Recovery: Priorities of the Spinal Cord-injured Population. Journal of Neurotrauma. 2004;21(10):1371 - 1383.
- Consortium for Spinal Cord Medicine. Outcomes following Traumatic Spinal Cord Injury: Clinical Practice Guidelines for Health-care Professionals. Consortium for Spinal Cord Medicine; 1999.