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Spinal Cord Injury Paralysis Resource Center

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Upper Extremity Care

Upper Limb FunctionGot arm, shoulder or wrist pain? If you're pushing a wheelchair, you are not alone. About half of those with spinal cord injury eventually experience upper extremity pain. It doesn't have to be so… with knowledge, the right equipment, exercise and care you can preserve arms and shoulders for the long-term, and avoid pain.

The following information is derived from the Clinical Practice Guidelines developed by the Consortium for Spinal Cord Injury, of which the Reeve Foundation is a steering committee member. The primary guidelines are targeted to health care professionals. A consumer guide, "Preservation of Upper Limb Function: What You Should Know" was recently released. The publications are available from the Paralyzed Veterans of America. Click here for information on downloading these and the entire catalog of authoritative guidelines.

Lots of folks push a manual wheelchair their whole life without pain but weight gain, aging or pain in the hands, fingers, wrists, elbows, or shoulders can force a switch from manual to power. There may be lots of good reasons to switch – power chairs are faster and they don't hurt when you move them, and they can be fitted with a tilt-in-space seat that provides the best pressure relief -- but it can be a tough decision; psychologically, some may feel more 'disabled' in a power chair. For some, the need for a van is a big and expensive factor since transfers from a power chair to a car seat are not practical.

Power-assist devices are available to make a manual chair into a sort of hybrid power unit; they are less expensive that a full power unit, too. These do add quite a bit of weight to a manual chair, making it more difficult to load into a car.

The key to the decision is maximizing independence. The choice of moving to a power chair cannot and should not be made alone. There are many factors involved in choosing the right chair and accessories to match your specific needs. Always work with a team of seating specialists; they're the ones who know that positioning is the key to preventing pain. Moreover, they can help with medical equipment reimbursement issues.

If you're sticking to your manual chair, here are a few tips to maximize efficiency and minimize upper limb problems.

Adjust rear axles as far forward as possible without feeling too tippy. You might add anti-tippers if you can't hold on to a wheelie; these will keep you from falling over backward.

For a smooth, low-impact push, hand motion should be around and around—not back and forth. It's best to drop your hands when you release the rims. Bring them back low, as if you are going to touch the axles. The path of your hands should be a little circle inside the big circle of the rim.

Transfers are tough on the shoulders. Don't transfer unnecessarily.

Seat height affects the efficiency of a rim push. You have to work harder if your wheel axles are too high or too low it makes for harder work. Sitting low is better than sitting high; set axle height so the fingertips extend just past the axles when you lean back with arms relaxed.

Tires that are not properly inflated are harder to push. Keep a gauge handy and keep the tires fully filled.

The current crop of lightweight chairs, especially those made of titanium, can make a huge difference in one's mobility. Lightweights require less force to propel, they are fully adjustable and cost less to operate than heavy hospital-type units.

Exercise and stretching are an important part of shoulder health. The shoulder is an amazing joint but since it's held together by a complex set of tendons and soft tissue, it needs to be moved through its range. It is advised you work with a physical therapist to best know what you should do to stretch the shoulder.

Maintaining shoulder strength and flexibility requires exercise. The Guidelines suggest ways of working out the muscle groups in the upper extremities. Strength is a matter of working against resistance. Many who use wheelchairs get good results using pair of light dumbbells or an elastic band. Again, get advice before you begin an exercise program; you can hurt yourself if you try to do too much too fast.

Remember to treat acute pain right away; try to maintain optimal range of motion. Consider modifications to the home environment to reduce stress on the upper extremities. This would include transfer equipment, lifts or hospital beds.

Craig Hospital: Aching ShouldersWith funding from the US Department of Education's National Institute on Disability & Rehabilitation Research, has developed educational materials to help people with spinal cord injuries live in the community maintain their health. Topics include skin care, exercise, heart disease, weight control, alcohol abuse and conditions related to the aging body.

Craig Hospital: Upper-Extremity PainWith funding from the US Department of Education's National Institute on Disability & Rehabilitation Research, has developed educational materials to help people with spinal cord injuries live in the community maintain their health. Topics include skin care, exercise, heart disease, weight control, alcohol abuse and conditions related to the aging body.

Preservation of Upper Limb Function: What You Should KnowClinical Practice Guidelines developed by the Consortium for Spinal Cord Injury, of which the Reeve Foundation is a steering committee member. The primary guidelines are targeted to health care professionals. A consumer guide, “Preservation of Upper Limb Function: What You Should Know” was recently released. The publications are available at no cost from the Paralyzed Veterans of America.

Quality of Life Grants DatabaseFind resources within the PRC Quality of Life Grants Database. Search by Zip Code, State or an Entire Category.

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The Reeve Foundation Paralysis Resource Center Information Specialists are reachable business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time. International callers use 973-467-8270. You may also schedule a call or send a message online.

The information provided in the Paralysis Resource Center was supported by Cooperative Agreement number 1U59DD000838-01 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the Reeve Foundation and do not necessarily represent the official views of the CDC.