Background

In this section, we provide five videos that discuss treatments for people with spinal cord injury (SCI). The treatments that you the occupational therapy (OT) practitioner will learn will enable you to teach your client how to be as independent as possible, as well as to help them where they need it. First, you will learn about what spinal precautions to adhere to, as well as what your client will be physically and functionally experiencing at certain levels. The videos also explain the following skills: donning and doffing a thoracic lumbar sacral orthosis (TLSO) and clothing; learning bed mobility, wheelchair and bed-pressure relief strategies, range of motion (ROM) exercises to perform activities of daily living (ADLs) and to prevent contractures and injury; and slide-board transfers, upper-extremity pivot transfers, and wheelchair wheelies.

This spinal cord injury topic also relates to previously learned instruction about wheelchair accessibility, orthopedic precautions, and pressure ulcers. When you learned about wheelchair accessibility, you learned about how a door threshold height needs to be no more than one-half inch for accurate wheelchair accessibility. Regardless of this minimum height requirement, your wheelchair clients will need a way to get over it as well as other small obstacles in the way. Teaching your clients how to do a wheelie will provide them to gain more independence in their mobility and to overcome those small challenges.

In regard to pressure relief, you previously learned that long-term pressure will cause pressure ulcers. Pressure ulcers are localized damage to the skin and soft tissue, usually over a bony prominence, and occur as a result of pressure, shear forces, and moisture. These factors will, in turn, create sores and may cause infection. Thus, for any of your clients who will be lying or sitting much, they need to relieve pressure. The pressure-relieving strategies you learn will prevent these clients from getting pressure sores and aims to keep them healthy and safe.

Dressing and Donning a TLSO

This video describes how to assist your client to get dressed and to don a thoracic-lumbar-sacral orthosis (TLSO) while following back precautions.

Dressing and Donning a TLSO Video Transcript

Donning a Cervical Collar Tips

• Place the front half of the cervical collar on your client’s neck while they are lying down.
• Log roll the client.
  • Stabilize the neck.
• Place the back half of the cervical collar on your client’s neck.
• Log roll your client onto their back.
• Make sure that the collar is secure on both sides by adjusting the Velcro.

Donning a Thoracic Lumbar Sacral Orthosis (TLSO) Tips

• Log roll your client to their side while they are lying down.
• Position the back half of the TLSO under your client.
• Log roll your client onto their back.
• Place the front of the TLSO onto your client.
• Fasten and adjust the Velcro straps to the front of the TLSO.

Lower-Body Dressing Tips

• If your client is independent,
  • The client should do as much as they can.
  • The client will be in a long-sit position and do the figure-four position.
    • Your client’s left ankle will be placed above the right knee creating a figure-four with the legs.
  • Your client can now reach and dress their lower body one leg at a time.
    • The client will use their arms to straighten one leg out.
    • The client will toss one pant leg down, reach, bring the pants up.
    • Switch legs and repeat on the opposite side.
• If your client is dependent,
  • Your client is lying flat on the bed.
  • The OT practitioner will teach the caregiver to dress the client’s lower legs.
  • Bring the pants as high up on the thighs as possible.
  • Log roll the client to pull the pants up on one side.
  • Repeat on the opposite side.

Spinal Cord Injury Transfers

This video explains to the OT practitioner how to assist a client to transfer via a slide-board or an upper-extremity pivot.

Spinal Cord Injury Transfers Video Transcript

Slide-Board Transfer Tips

• Lock the wheelchair’s brakes
• Remove anything that might get in the way, such as arm rests or lateral supports.
• Position the wheelchair near where your client is transferring from.
• Place the slide board underneath your client.
  • Have your client lean to the opposite side.
  • Position the slide board under your clients IT’s.
• Have your client push up with their arms and move over.
  • Have your client use small, short movements to avoid shear forces.

Upper-Extremity Pivot Tips

• Lock the wheelchair’s breaks.
• Remove anything that might get in the way, such as arm rests or lateral supports.
• Independent Clients Upper-Extremity Pivot Transfer
  • Have your client slide to edge of the wheelchair.
  • Have your client lean down and away from the transfer location to take weight off the side nearest to the transfer location to make the transfer easier.
  • Have your client lift their body by pushing up on their hands and swinging their body over to the desired location.
• Dependent Client Upper-Extremity Pivot Transfer
  • Have your client lean down and away from the object they are transferring to.
  • Stand over the top of your client.
  • Reach around your client’s back.
  • Slide your hand under your client’s IT’s.
    • Lift your client toward your body and the desired location.
    • Pivot and lower your client to the object they are transferring to.

Range of Motion

This video discusses upper-extremity range of motion (ROM) to promote your client’s function and to prevent contractures.

Range of Motion for Individuals with SCI Video Transcript

Range of Motion Tips

• General Principles
  • Stretch until you feel mild resistance.
  • Hold each stretch for 60 seconds.
  • Respect pain. Back off the stretch’s intensity and, or, duration.
• Shoulder Range of Motion
  • Flexion, abduction, extension, internal and external rotation, and horizontal abduction.
• Elbow Range of Motion
  • Flexion and extension.
• Hand/Wrist Range of Motion
  • Tendonesis Grasp
    • Stretch the wrist into extension with finger flexion.
    • Stretch the wrist into flexion with finger extension.

Pressure Relief

This video describes how the OT practitioner can help to teach their client to shift their weight to relieve pressure while sitting in a wheelchair.

Pressure Relief Video Transcript

Pressure-Relief Tips

Tilt-in-Space Wheelchair Pressure Relief

• Teach your client to tilt all the way back for two minutes, every thirty minutes.

Manual Chair Pressure Relief

• Teach your client to lift their body.
  • Have your client place their hands on the arm rests.
  • Have your client push their body up off the chair using their arms.
  • Make sure that your client can hold their body weight.
  • If your client is unable to hold their body weight continuously for two minutes, have them hold for thirty seconds, rest, hold for thirty seconds, rest.
• Teach your client to lean forward.
  •  Have your client’s hands hanging toward the floor for two minutes with all their pressure and weight forward.
• Teach your client to lean to their side.
  • Have your client lean to one side.
  • Have your client rest an arm on a chair or table if possible, for one minute.
    • Repeat this position on their opposite side for another minute.

Wheelie

This video discusses how the OT practitioner can prepare their client for community mobility by teaching them how to do a wheelie in a wheelchair.

Performing a Wheelchair Wheelie Video Transcript

Wheelie Tips

• Practice safety before your client does a wheelie:
  • Remove the anti-tippers from your client’s wheelchair.
  • Keep your client safe by wrapping a gait belt around the wheelchair’s back handle.
• Have your client practice the wheelie by rolling forward with a hard pull back.
• Have your client use their hands to actively maintain balance while doing a wheelie.

Resources

These resources will guide you in learning more about spinal cord injury and its intervention techniques and equipment.

• Clinical Practice Guidelines by Paralyzed Veterans of America
• E Learn SCI Videos by the International Spinal Cord Society
• E Learn SCI Modules by the International Spinal Cord Society
• General Wear and Care Instructions for your TLSO by Cleveland Clinic
• Transferring Using a Transfer (Sliding) Board by FairView