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When talking to a wheelchair user try to sit across from them. Do not lean on the wheelchair. Wheelchair users consider the chair to be part of their body and personal space. Avoid crouching down like you would to a child.
Don’t move wheelchairs / mobility aids without asking permission first.
Speech impairment or a lack of speech does not necessarily indicate an inability to understand – allow the individual to speak at their own pace and finish what they are saying.
Ask about equipment, aids or techniques they may use to assist them in daily living – wheelchairs, crutches, and braces are visible but prostheses, ileostomy or colostomy devices and breathing assistance devices may not be.
Experience their world – try a sports chair, join in training.
By spinal root level of lesion - e.g. injury at first lumbar level is referred to as L1.
By type of cord lesion -
(a) complete - paralysis or loss of sensation in the muscles innervated below the level of the lesion.
(b) incomplete - paresis (partial paralysis) which leaves some spinal cord function intact and therefore allows some movements or sensations in muscles innervated below the level of the lesion. May not be equal on each side.
By body parts affected -
(a) paraplegia - at or below the level of upper abdominals (T1) – the person has full use of the upper extremities including hands but there is neurological impairment to the lower extremities and often part of the trunk.
(b) quadriplegia (tetraplegia) - at the cervical level, involving all four limbs and trunk although does not necessarily mean no use of arms.
Level C4 is the highest level lesion that a person can sustain and remain alive without breathing support.
Transfer ability – plinthe height, assistance needed or not? May need help to lift hips and legs through to achieve prone. If no abdominal control, need assistance to lower into supine.
May need to empty / adjust leg bag, tubing, slacken clothing to prevent blockages – see autonomic dysreflexia
Treatment position - ? treat in chair or on plinthe.
at comps athlete may prefer to be treated in chair between events
May need to adapt traditional treatment techniques to apply in chair e.g. mobilisations in sitting / forward lean sitting, nags and snags, acupuncture, soft tissue release. Use of theraband/tubing in chair.
SCI athletes only sweat above level of lesion so need to avoid overheating/dehydration during training / competition.
S+C – Be aware resting heart rate in quads much lower. MHR 100-125 bpm therefore target training heart rate much lower at 65-91bpm. T1-T6 also lower but not as much. Below T6 – comparative to able bodied.
Assess extent of sensation to assist in treatment awareness – may have odd pattern of sensation.
Disproportionate - commoner of the two. Results in average size torsos with shorter arms and legs – cause is from skeletal dysplasia, the failure to develop bone either inherited or due to gene mutation.
Proportionate - short in stature
Main cause due to pituitary gland dysfunction (growth hormone deficiency)