X - UPPER LIMB
It is recommended that individuals with SCI be referred to community-based exercise programs with periodic reassessment by an SCI clinician to maintain their fitness and wellness and optimize and monitor their function. (PRAXIS 2020; Level B)
We recommend that neuromuscular-assisted arm cycle ergometry be offered as a means to increase muscle strength in individuals with tetraplegia. (PRAXIS 2020; Level B)
Consider offering individuals with chronic incomplete tetraplegia (more than one-year post-injury) massed practice (repetitive activity) of task-oriented skills. Somatosensory stimulation is an important adjuvant to massed practice to augment hand function. (PRAXIS 2020; Level A)
Transmagnetic brain stimulation for augmenting function in SCI is under investigation and requires further evidence. (PRAXIS 2020; Level C)
Auricular and electrical acupuncture therapy for augmenting function in SCI is under investigation and requires further evidence. (PRAXIS 2020; Level B)
Consider offering patients with tetraplegia an active tenodesis thumb opponens splint to enhance pinch and hand function. (PRAXIS 2020; Level B)
For individuals with thumb web space contractures, stretching is likely not effective in reducing the contracture and therefore not recommended as an independent modality. (PRAXIS 2020; Level A)
A shoulder exercise and stretching protocol including protractor stretches and shoulder retractor strengthening can be used reduce the intensity of shoulder pain. (PRAXIS 2020; Level A)
Consider referring patients with tetraplegia to a quarternary trans-professional upper extremity clinic for assessment of candidacy of peripheral nerve transfer or tendon transfer for restoration of upper extremity function. Referral with specific functional goals is recommended. (PRAXIS 2020; Level A)
For assessment of the natural history of SCI disease, we recommend International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), and self-care subscore of Spinal Cord Independence Measure (SCIM).
For interventions, if a reconstructive surgery, the ISHT and grasp and release test\TRI-HFT should be used at baseline and discharge. If stimulation therapies are being used to restore hand function, then use the TRI\HFT. (PRAXIS 2020; Level C)
Functional electrical stimulation therapy (FEST) should be prescribed at least 3 times per week for a total of 40 hours for individuals with an AIS A complete injury and incomplete injury. (PRAXIS 2020; Level C)