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Options for Improving Upper Extremity Function Following Cervical Spinal Cord Injury

Options for Improving Upper Extremity Function Following Cervical Spinal Cord Injury
Anne Bryden, OTR/L
August 2, 2013

This text based course is a transcript of the live webinar tiltled "Options for Improving Upper Extremity Function Following Spinal Cord Injury" presented by Anne M. Bryden, OTR/L.

>> Anne Bryden:  I am glad to see such interest in this topic.  I know that spinal cord injury is generally a smaller population compared to a lot of the types of disabilities that we as occupational therapists can be treating.  What I thought I would start with, not knowing how many of you are familiar with spinal cord injury, is to set the stage and go through some of the spinal cord injury statistics.  

Spinal Cord Injury Statistics


In general, currently there is about 265,000 people living in the United States with spinal cord injury that means that basically every year there is approximately 12,000 new cases in the U.S.  Compared to the stroke population, that is a relatively low number.  There are about 795,000 new stroke cases per year.  Actually 600,000 are new, and the remaining would be recurring strokes.  My point with that is we are dealing with a relatively small number of people with spinal cord injury.  The average age at injury is 40.  That is a little bit older these days.  Back in the late 70’s-early 80’s, the average age was about 28 to 30; somewhere around those years.  Eighty percent of spinal cord injury occurs among males.  More than half of all injuries result in complete or incomplete tetraplegia.  More than half of all of the injuries are the population that we might see when they are seeking better arm and hand function.

The main cause of spinal cord injury happens to be motor vehicle accidents with falls being a close second.  These are followed by violence, sports, and then there is the other/unknown category.  These statistics are from the National Spinal Cord Injury Statistical Center, and this is a service that operates out of the University of Alabama at Birmingham.  They have a grant from the National Institute on Disability and Rehabilitation Research.  They monitor the data from 14 model spinal cord injury centers plus about a handful of other spinal cord injury centers that are large, nationally known centers.

SCI Classification

There are two classifications that we will be talking about today related spinal cord injury.  The first one, the one you are probably most familiar with, is the American Spinal Injury Association (ASIA) and the second is the International Classification for Surgery of the Hand in Tetraplegia (ICSHT).  This is a more specific classification that was developed to help determine what the best options are for people with tetraplegia to have better arm and hand function.

ASIA Levels

The ASIA classification consists of a motor portion, as well as the sensory portion.  For the motor portion, there are key muscles that are associated with each cervical level. 


To do the testing for the motor portion, each of those key muscles would have to be a grade 3 on the manual muscle test scale or higher.  As an example, to be classified as a motor C5 injury, the person would have at least grade 3 elbow flexion and that also assumes that shoulder abduction is relatively strong as well.  To be classified as a C6 level injury, that would mean that you have wrist extension that is at least a grade 3 or stronger, and again that would assume that that is in addition to grade 3 or better elbow flexion (the segment just above it). 

anne bryden

Anne Bryden, OTR/L


Anne Bryden, OTR/L is an Occupational Therapist and Research Manager at Case Western Reserve University/The Cleveland FES Center. She graduated in 1991 with a Bachelors of Science in Occupational Therapy from Cleveland State University. Her responsibilities include developing and implementing assessment procedures to determine the efficacy of reconstructive procedures in people with tetraplegia, including tendon transfers and neuroprostheses.  She is in collaboration with therapists internationally to develop a multi-center study to measure the impact of UE reconstructive surgery.  Additionally, she has authored and co-authored journal articles related to spinal cord injury and rehabilitation.

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