SCI and Bone Density

[Kelsie Murek]

Hi! I’m no SCI expert, and quite literally am treating my first ever patient with this. My neuro background has been in more vestibular/concussion/brain injury and parkinsons.

In terms of bone density and the literature that doesn’t support standing frames, FES cycling being mixed, what functional treatment ideas do we utilize for these cervical tetraplegia patients? I am working with a gentlemen with a C5 ASIA B injury, he has 4/5 strength in L triceps but 1/5 on the right. We’ve worked trunk control, prone on elbows, supine propped on elbows, but looking for any other functional weight bearing ideas/treatments as this is not my area of expertise when the literature continues to seemingly focus more on ambulation. Appreciate any thoughts.

[Chrissy Durrough Lugge]

Hi Kelsie!

Personally, these are some of the most challenging patients for me. If someone has bothersome spasticity, I will do the standing frame occasionally to temporarily alleviate some of those symptoms and also help with autonomic functions. His 4/5 left triceps strength will be helpful, and you can work on press-ups and having him assist with transfers. Any kind of prop sitting and transitioning from anterior to/from posterior prop in short- and long-sitting would be good. You can do object manipulation while he is sitting to challenge trunk control (maybe propping on his RUE with full extension while placing objects in a basket with his LUE).

Again, it’s a challenging population and you’re doing all the right things!

[Kelsie Murek]

Thank you! I am finding this to be an injury of frustration, particularly adding in the social factors too (patient is a radiologist and knowledgeable but wants to be ambulatory and all I’m seeing is that his injury is too high to be a functional ambulator).

Thank you for the response Chrissy. Loving the content and organization of this! I had not thought of doing the one sided prop sitting and will add it today! We’ve been doing reaching activities and core training.

[Chrissy Durrough Lugge]

Heard that- everyone wants to walk! And, unfortunately, it’s just not in the cards in a lot of cases. At least not functionally. There are ways to make most people walk in clinical settings with enough personnel and equipment, but I have some issues with that from a false hope/slowing acceptance of the injury standpoint if functional ambulation isn’t a possibility.

In the grand scheme of things, walking isn’t the most important task for achieving independence, though I get that’s easy for me to say since I don’t know firsthand what it’s like to not be able to see the world from eye level.

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