SCI and Tenodesis Splint October 10, 2006 Dashia Harris Jenny Hasler Heidi Frohreich

Spinal Cord Injury Disruption in the motor & sensory pathways at site of lesion Affects approx. 10,000 people per year in the U.S. Male to Female=4:1 #1 cause is MVA Levels of Injury Above C4=ventilator to breathe C-5=shoulder and biceps control, but no control at the wrist or hand C-6=wrist control, but no hand function C-7 and T-1=straighten their arms but may have dexterity problems with the hand and fingers At T-1 to T-8=most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control T-9 to T-12 =good truck control and good abdominal muscle control Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.

Tenodesis Splint A tenodesis Splint is a device used to grasp objects by C6-C7 quadriplegics who lack finger movement but retain the ability to extend their wrist. The splint straps onto the user’s forearm, hand, and fingers.

Universal Cuff: Is a comfortable elastic band that can be added to the tenodesis splint Is designed to give people with limited grip or dexterity controlled use of items such as eating utensils and writing tools Can serve as a pencil holder, toothbrush holder, etc. Allows eating utensils to fit easily into it because it includes a utensil pocket to hold the item of choice, and a comfortable elastic strap to keep the unit secured on the hand or splint

Tenodesis Training Program Work with clients to strengthen the wrist Training for a tenodesis grasp done with a short opponens splint or possibly with a RIC tenodesis training splint May need a permanent tenodesis splint such as a wrist driven flexor hinge splint, which is fabricated by the orthotist Based off of rehab FOR

Problem Areas and OP Muscle weakness Available ROM may be limited Cognitive functioning Understanding use of splint Psychosocial issues depression Cant only focus on splint, but must be aware of all areas that coincide with SCI Muscle weakness- inability to use splint if not at 3+

Intervention Plan Patient education of splint Strengthening program Cognitive functioning Strengthening program Weakness Aids with IADL/ADLs PROM stretch followed by AROM strengthening Limited ROM Referral to Psychiatrist depression This is how his problem areas would be addressed: Patient education of splint - can write out instructions of how to don and doff splint Strengthening program -Heidi slides PROM -OT perform passive flexion and extension of wrist -teach caregiver how to stretch pts wrist to increase ROM function

Assessments P COPM MPT Observation E Environmental press O MMT PROM/AROM goniometry TONE ASIA Scale Sensation testing Pinch and Grip Strength

Muscle Strengthening Program Must have 3+ or higher MMT of wrist extensors to manipulate tenodesis function. (Trombly,2002) Begin with passive stretch of flexors and extensors to increase range. For 0 thru 2- muscle grades OT would manually stretch pt.’s wrist for 15 minutes In a gravity lessened plane do AROM through wrist flexion and extension For grades 2- thru 2 Patient will complete 2 sets of 10 AROM twice a day when not in therapy and increase intensity and frequency as tolerated. Each bullet is a step to treat based on muslce grade.

Muscle Strengthening Program In a gravity lessened plane do AROM with resistance For 2+ thru 3 muscle grade Resistance: wear 1lb. Weight on wrist thru motion for five minutes and increase duration as tolerated. Ex. Painting activity, wash off lunch table Alt: using gravity as the resistance Resistance against gravity For 3+ thru 5 muscle grade Resistance: brushing therapy dog’s hair with hair brush for fifteen minutes. I increased the brushing dogs hair due to enjoyment of act and not focusing on difficulty of act.

Evidence The study compared the methods for measuring three muscle tests in Spinal Cord injuries:the manual muscle test (MMT), the hand-held myometry and the isokinetic dynamometry. It was found that the MMT was found to be less effective in a grade 4 or higher injury and that the myometry technique seems to be highly valuable. Noreau,L. & Vachon,J. (1998). Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord. Vol. 36(10) 716-723.

Evidence Wrist Flexor hinge splint and tenodesis training were compared to tendon transfer surgery for pinch strength in tetraplegia adolescents. It was found that pinch strength was significantly better in those with tendon transfer surgery than tenodesis. Davis, S. (1999). Comparison of Interventions for Hand Function in Adolescents with Tetraplegia. Topics in Spinal Cord Injury Rehabilitation. Vol. 6S(1), 72-84

Evidence Hand splints are used in a number of spinal Cord injuries. In the United Kingdom these splints are rarely used. It is estimated that 30-60 of patients each year would benefit from them if fitted appropriately and started early in the diagnosis. Nichols, P.. Peach, S., Haworth, R., & Ennis, J. (1978). The value of flexor hinge hand splints. Prosthetics and orthotics international. Vol. 2(2), 86-94.

Rehabilitation (FOR) Concerned with compensation when remediation of underlying deficit is not possible Intended for use with anyone that can benefit form compensation methods in order to increase participation in daily occupations.

Resources Davis, S. (1999). Comparison of Interventions for Hand Function in Adolescents with Tetraplegia. Topics in Spinal Cord Injury Rehabilitation. Vol. 6S(1), 72-84 Nichols, P.. Peach, S., Haworth, R., & Ennis, J. (1978). The value of flexor hinge hand splints. Prosthetics and orthotics international. Vol. 2(2), 86-94. Pedretti L, & Early M., (2001). Occupational therapy; Practice skills for physical dysfunction, (5th ed.). St. Louis, MO: Mosby. Spinal cord injured male (n.d.). Retrieved October 6, 2006 from; www.SpinalCordInjuredMale.com Trombly, C.A., & Radomski, M.V. (2002). Occupational therapy for physical dysfunction, (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.