Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
The Hand Therapist’s Role in Caring for Spinal Cord Injury Patients
212 Plays11 days ago
Hand Therapy Academy has Delaney on the show, where she shares her clinical pearls about treating patients with spinal cord injuries (SCI). She highlights practical strategies and considerations to optimize patient outcomes.
Recommended
Transcript
Introduction to Hand Therapy Academy
00:00:05
Miranda Materi
Hello, I'm Miranda. All
00:00:06
Delaney Wright
And I'm Delaney, and we are Hand Therapy Academy.
00:00:09
Miranda Materi
right, Delaney,
Role of Hand Therapists in Spinal Cord Injury Treatment
00:00:10
Miranda Materi
welcome. Today we are going to be talking about spinal cord injuries and the hand therapist's role treating spinal cord injury. And I think on our team, you're the person that sees the most neuro-related conditions, that including spinal cord injury, and how how you treat them in the tool, like from your perspective of a hand therapist.
Delaney's Experience with Neuro-related Conditions
00:00:30
Delaney Wright
Yeah. So I've been very fortunate over the past couple of years. I work inside of our, our office is inside of a clinic that they specialize in PT neuro, um, like rehab.
00:00:41
Delaney Wright
And so they see a lot of spinal cord injuries and, um, believe it or not, which seems kind of obvious, but it's often, you know, they're, they don't receive hand therapy, but they have a lot of like upper extremity needs that um go like under addressed or not addressed
Overlooked Upper Extremity Needs in Neuro Interventions
00:00:57
Delaney Wright
at all. um Because, you know, typical um or or typical neuro ah interventions from like an OT's perspective are usually to get like ADLs back and everything, which is very important, high priority. And we still work on that stuff here.
00:01:11
Delaney Wright
um But they do have a lot of like fine motor stuff that really needs to be addressed and like strengthening larger muscle groups or the small muscle groups. So I see like a lot of patients and they are always, they've either come from somewhere else to them, um to the PT clinic.
00:01:30
Delaney Wright
And they're always very thankful to actually have like the hand therapy emphasis, I guess.
00:01:35
Miranda Materi
All right. So why don't you share like a few of the pearls you've learned over the first you know a couple of years of treating these patients or what are some things you avoid or
Importance of Preserving Tenodesis in Therapy
00:01:44
Miranda Materi
watch for? Just kind of what gems that we can share with our audience if they do having a spinal cord injury patient.
00:01:48
Delaney Wright
Yes.
00:01:51
Delaney Wright
um Yes. So one of the biggest things that I always teach my like students who come in right off the bat is we want to avoid composite like extension stretching. So we don't want to stretch out those long flexors because one of the most important things, I guess it depends on the level of the spinal cord injury, but one of the most important things is to preserve tenodesis.
00:02:09
Delaney Wright
Um, so preserving that is like of high priority. And if you're stretching out those long, like flexors, then that can actually hinder their ability to use their teen odysus to pick up items functionally.
00:02:20
Delaney Wright
Um, so that is a big one. I will say though, like knowing that as like a baseline, there are patients that will like mostly with my like incomplete injuries, um, they will end up getting like, you know, their, their strength back in their hands and,
00:02:38
Delaney Wright
their flexors end up being really tight because they haven't had anybody stretch their like long flexors. And then their hand is almost like less functional. And so like I have a patient right now who initially we didn't like stretch her in a composite extension, but her wrist was like, she came in with poorly, it was like over the counter splints and we made her custom ones. but um her wrist was dropped a little bit and her fingers were really tight and with some stretching her wrist range of motion has improved she has wrist strength she can functionally manipulate things with her fingers now so that's kind of avoid stretching out te like the long flexors but there are times when you will need to do that um
00:03:16
Miranda Materi
Yeah, and that
Monitoring for Autonomic Dysreflexia
00:03:17
Miranda Materi
makes sense. that means That's a good point you bring up. For the most part, no, don't do it. But of course, there's always...
00:03:21
Delaney Wright
for the most part don't do it but there will be a few like select cases where you say okay well we can do composite extension stretching here Um, and then, ah definitely like being aware of like autonomic dysreflexia.
00:03:28
Miranda Materi
Right.
00:03:34
Delaney Wright
Um, if you're patient, most of the people that come to us, they've like had experience with like you know knowing when their blood pressure is spiking and rising and like what maybe is causing that. and um And so they kind of know how to like manage treatment. But make sure you know, like check for kinked lines, tubes, tight clothing.
00:03:53
Delaney Wright
and Those are kind of like the initial things you really need to be super aware of and like cautious of. And then if you're having a patient whose blood pressure is fluctuating a lot during their session, making sure you have like some kind of a blood pressure monitor, cuffs, manual cuffs, so that you can check their blood pressure intermittently throughout.
00:04:09
Miranda Materi
Yeah, that's a good point. and It could be that their bladder is full or their bowel
Unexpected Recovery in Spinal Cord Injuries
00:04:13
Miranda Materi
is full and you know, they don't have that same urinary or bowel control that um they had before. So i think sometimes they'll like, oh, I need to go self-calf and then improves.
00:04:23
Delaney Wright
Exactly, yeah. And yeah, like at at this point in the in the game, in their stage of treatment, they they kind of know how to like self-manage and they know what's going on. But if you're catching someone really early, like right out of inpatient rehab, they might not be as aware.
00:04:38
Delaney Wright
So good things to know.
00:04:38
Miranda Materi
Right. That's a point.
00:04:41
Delaney Wright
ah
00:04:41
Miranda Materi
Yeah, that's a very good point. And something that you don't think of as a hand therapist, right? Like in our ortho clinic, you're like, oh, what's that?
00:04:46
Delaney Wright
Yeah.
00:04:47
Miranda Materi
You know, haven't heard of that since OT school or peak school.
00:04:48
Delaney Wright
Yeah. Yeah. Right. um But yeah, I will say that speaking of like OT school, it. Some of the things like you learn in OT school, they don't always transfer over it with the spinal cord injury population. Like you might learn that like a C7 is only ever going to get tricep extension. Like that's going to be their like main muscle or or um like, but, and like they need to, in order to get some like long flexors, they need CA Um, but I've had a lot of people actually who were like a C6, C7, it's supposed to be a complete injury, not an incomplete.
00:05:23
Miranda Materi
but
00:05:24
Delaney Wright
And they, uh, they came to me and like, after like a year and a half, they started getting like flexors back. So kind of unique, kind of interesting, definitely non-traditional, but, um those are things also that i feel like to keep in mind when you're working with a spinal cord population, obviously like prioritize function and getting them strong in the areas that,
00:05:45
Delaney Wright
they will need to be more functional and complete like ADLs, but um don't like count anything out.
00:05:53
Miranda Materi
Yeah, that's, I think, a good point. And also, when you say that, like, I think sometimes when we think about spinal cord injury, we're thinking about like textbook, this is C6 complete, and this is what they'll get back and this is what they don't.
00:06:04
Miranda Materi
But knowing that sometimes people have anatomical differences as well.
00:06:08
Delaney Wright
Yeah. Yes.
00:06:09
Miranda Materi
So
00:06:10
Delaney Wright
So it's always definitely
Adapting Ortho Interventions for Spinal Patients
00:06:12
Delaney Wright
different and unique. And um yeah, a lot of the interventions I like give some of my spinal cord patients are actually like common interventions that we use in everyday orthopedic care.
00:06:22
Delaney Wright
um But you just have to grade them down or up just depending on the person to meet like they're where they're at in their recovery process. So, but yeah, I do focus a lot on like fine motor stuff because I feel like a lot of that has like kind of gone to the wayside for them.
00:06:40
Delaney Wright
If they have the ability to use fine motor, I guess.
Evaluating Outcomes for Spinal Injuries
00:06:43
Miranda Materi
And then what about like your evaluation? How is is your evaluation any different from, i mean, I'm sure it is, but how would you say you have focused your avowal differently than you would like a traditional distal radius fracture or something like that?
00:06:55
Delaney Wright
Oh yes, definitely. So initially when I started, i kind of like, wasn't really sure about a good outcome measure. And because the, we use the quick dash, like just kind of as one of our standard outcome measures, but not for every patient, but we were using that. And it was just like kind of getting depressing actually, because you know, they, you see change quickly with that one more so, or like every like four weeks, but with a spinal cord patient or a neuro patient, you, um,
00:07:20
Delaney Wright
you really don't see change with the quick dash as quickly most of the time. um So one of my students actually came up with, or she, for her capstone, she found a different, um better, it's more more reflective for spinal cord injuries. It's specific to spinal cord injury patients. It's called the capabilities of the upper extremities. um So that assessment is, has been a lot better and it shows like functional like change. So that's a really good outcome measure.
00:07:45
Delaney Wright
that I have adapted to use. um And then I do like more so like manual muscle testing ah just to kind of see where they're at in like the main muscle groups. um So like triceps, biceps, wrist extensors, the interossei, just kind of that correlate to the level of the spinal cord injury. So.
00:08:06
Miranda Materi
Okay, awesome. I think those are some awesome tips to share if you happen to have a patient or you treat spinal cord injuries. Thank you so much, Delaney, for sharing all of your insight, and we're so happy that you are here.
Engaging with Hand Therapy Academy
00:08:17
Miranda Materi
And if you have questions, please reach out to us at hamtherapyacademy or email us info at hamtherapyacademy.
00:08:25
Delaney Wright
Thank you.