Module 3 - Hands-on assessment
Level of spinal cord injury, sitting balance and seating
After a spinal cord injury, external seating support may be required due to reduced or absent nerve innervation to the abdominal-thoracic muscles that provide intrinsic postural support for independent sitting. Other factors such as "completeness/ incompleteness" of the SCI, upper extremity injury, co-morbidities and orthopaedic complications can also influence balancing tasks.
The following is a general guide for clients with a complete spinal cord injury:
High cervical-level C1-C4 injuries
Propped sitters are unable to support themselves in sitting using the trunk muscles and upper extremities.
- External supports are required for total body support including upper thoracic, armrests and headrests to maintain an upright sitting posture
- Most propped sitters use power seating and wheeled mobility systems for independent mobility, postural and pressure care management.
Lower cervical-level C5-C8 and high thoracic-level T1-T8 injuries
Hands-dependent sitters need at least one upper extremity for support or otherwise adopt a "C sitting" posture to compensate for balance (both arms are lifted simultaneously).
- Seating system may include posterior and lateral postural support while maintaining neutral lordosis and kyphosis position
- The assessment of static posture and dynamic balance varies greatly with the level of spinal cord injury. Physiotherapist assessment/reports, activity level, time since injury and appropriate functional task such as feeding (hand to mouth movement), emptying catheters, reaching task, transfer and wheeled propulsion should be considered as obtained in the initial interview (Module 2). An improvement in the ability to use upper limbs for functional tasks and improved comfort level indicates a positive outcome of the seating intervention.
Low thoracic-level T9-T12 and lumbar/sacral-level injuries
Hands-free sitters can sit without using their hands for support and can change their sitting posture.
- Seating system may include a low backrest/posterior support to provide pelvic stability and skeletal alignment for manual wheelchair prolusion, efficiency and comfort
- A balance skill assessment, including during manual wheelchair propulsion and standing transfers, is important.