ADAPTIVE DEVICES

FOR SPINAL CORD

02. ASSISTIVE AND ADAPTIVE

TABLE OF
CONTENT
01.

QUICK RECALL!
SPINAL CORD INJURY
Spinal cord injury (SCI) is a
relatively low-incidence, high-
cost injury that results in
tremendous change in an
individual’s life. Paralysis of the
muscles below the level of the
injury can lead to limited and
altered mobility, self-care, and
ability to participate in valued
social activities.
CLASSIFICATIONS
Spinal cord injuries typically are
divided into two broad functional
categories:
1. Tetraplegia refers to complete
paralysis of all four extremities
and trunk, including the
respiratory muscles, and results
from lesions of the cervical cord.
2. Paraplegia refers to complete
paralysis of all or part of the trunk
and both lower extremities (LEs),
resulting from lesions of the
thoracic or lumbar spinal cord or
cauda equina.
NEUROANATOMICAL ORGANIZATION AND STRUCTURE
The neurological level is defined
as the most caudal level of the
spinal cord with normal motor
and sensory function on both
the left and right sides of the
body. Motor level is referred to
as the most caudal segment of
the spinal cord with normal
motor function bilaterally.
Sensory level is defined in the
same way except in terms of
sensory function.
ASIA IMPAIRMENT
SCALE
Individuals with incomplete
injuries may have variable
clinical presentations in
terms of motor and/or
sensory function below the
neurological level.
02.
ASSISTIVE AND
ADAPTIVE DEVICES FOR
SCI PATIENTS
Cervical Level (C1-C4)
Limited movement of head and
neck. At C4 level, may shrug Rationale: Noted severe paralysis
shoulders. from the neck down. Users often
Powered Wheelchairs: lack functional arm and hand
Controlled by head movement movements, necessitating a
or breath. wheelchair controlled by head
Environmental Control Units movement or breath. Individuals
(ECUs): Allows control of might have limited to no
home devices using voice movement, relying on voice
commands or switches. commands or minimal head
Computer Accessibility movements to control devices.
Tools: Eye-tracking software,
sip-and-puff devices for
computer control.
 Powered Sip-and-Puff Environmental
Wheelchairs devices Control Units (ECUs)
Cervical Level (C5)
Electric-Powered Rationale: C5 lesions may require a
Wheelchair: Controlled by balanced forearm orthosis for
hand-operated controls. improved arm placement or a long
Universal Cuff: Assists in opponens orthosis for wrist stability
holding items like utensils, during activities like feeding, writing,
brushes, etc. and typing. C5 tetraplegics have
Mobile Arm Supports: Helps functional deltoid and/or biceps
with arm movement and musculature, allowing IR, abduction,
stabilization. and external rotation of the shoulder,
resulting in forearm pronation, wrist
flexion, supination, and extension.
However, elbow extension is only
produced by gravity or forceful
horizontal abduction or shoulder ER.
Hand Operated Mobile Arm
Universal Cuff Supports
Wheelchairs
Cervical Level (C6)
Manual Wheelchair: Aids in Rationale: C6 patients can perform
functional and community body dressing, transfers, and propel a
mobility manual wheelchair on level terrain.
Wrist Splints and Braces: Aid They can cook, perform light
in stabilizing wrist movements. housework, and live independently
Adaptive Utensils and Tools: with limited attendant care.
Designed for easier grip and
use with limited hand
dexterity.
Transfer Aids: Sliding boards,
transfer poles, or pivot discs
for easier movement between
surfaces.
 Wrist Splints and
Manual Wheelchair
Braces
Adaptive Utensils Transfer Aids
and Tools
Cervical Level (C7/C8)
Manual Wheelchairs: Can be Rationale: C7 Patients have functional
self-propelled with hand rims. triceps, they can bend and straighten
Orthoses: Braces for lower their elbows, they may also have
arm or hand to aid in stability enhanced finger extension and wrist
and grip. flexion. Therefore, they have
Adaptive Sports Equipment: enhanced grasp strength which
Such as hand cycles or permits enhanced transfer, mobility
adapted sports wheelchairs. and activity skills. C8 patients have
FDP function which permits all arm
movement but with some hand
weakness, they can propel a manual
wheelchair community distances.
 Manual Adaptive Sports
Orthoses Equipment
Wheelchairs
Thoracic Level (T1-T12)
Orthotic Devices: Braces for Rationale: T1-T6 (upper intercostals,
trunk stability. thoracic extensors) full function of
Standing Frames: Assist in upper limbs, therefore, physical
standing and weight-bearing independence for personal care and
exercises. ADLs. T7-T12 (abdominals, lumbar
Walking Aids: Canes, extensors, lower intercostals), as for
crutches, or walkers for T1-T6 greater preservation of trunk
limited mobility. functions, improving balance and
therefore able to complete more
challenging tasks like 180deg
transfers with greater ease.
Orthotic Devices Standing Frames Walking Aids
Lumbar Level (L1-L3)
Hip-Knee-Ankle-Foot Rationale: L1 patients may have
Orthoses (HKAFOs): Assist in affected pelvic movement and
lower limb stability and sensation with potential leg paralysis.
ambulation. L2 patients may have impacted upper
Wheelchairs with Standing thigh sensation and hip movement
Feature: Allows for standing but might limit lower leg sensation
when seated for prolonged and movement. L3 patients may have
periods. affected lower thigh sensation,
Standing frame: Aids in allowing more hip and knee
weight-bearing activities movement but potentially causing
ankle and lower leg sensation loss.
Hip-Knee-Ankle- Wheelchairs with Standing frame
Foot Orthoses Standing Feature
 Rationale: L4-S1 (ankle dorsiflexors,
long toe extensors, ankle plantar
Lumbar Level (L1-L3) flexors) independence in using
Ankle-Foot Orthoses (AFOs): manual wheelchair, with the potential
Supports lower limb control for future ambulation aided by lower
and stability. limb orthoses like callipers or AFOs
Custom Seating and (ankle-foot orthoses) and a walking
Positioning Devices: Ensure aid. Moreover, their capacity to drive
proper posture and prevent is facilitated by hand controls or
pressure sores in wheelchair adaptive driving controls, signifying a
users. level of independence in
Adaptive Driving Controls: transportation. L4 spinal cord injury
Hand controls or modified allows foot lifting and inner lower leg
vehicles for driving with sensation, L5 injury enables big toe
limited lower limb function. movement and outer lower leg
sensation, while S1 injury provides
sensation to the toes, heel, and calf
with ankle pointing down capability.
 Ankle-Foot Custom Seating and Adaptive Driving
Orthoses (AFOs) Positioning Devices Controls
REFERENCES:
Assistive devices for spinal cord injury. (n.d.). Physiopedia.
https://www.physio-
pedia.com/Assistive_Devices_for_Spinal_Cord_Injury

Braddom’s physical medicine & rehabilitation / edited by David X. Cifu;

Physical rehabilitation / [edited by] Susan B. O’Sullivan, homas J.

Schultz-krohn, W. (2017). Pedrettis occupational therapy - practice