SCI OT Intervention

OT Dude Academy’s Free NBCOT® Exam Prep Course Spinal Cord Injury (SCI) SCI OT Intervention

A goal of occupational therapy is to promote self-perceived quality of life for clients with SCI. OT can promote engagement in occupations that clients value no matter the amount of recovery of function. OT benefits clients with SCI by normalizing their lives and finding meaning in the participation of their daily life tasks.1 2  OT can also promote participation in community activities, which is an important aspect in maintaining one’s quality of life.3 4 5  Individuals who receive OT may show an increase in new roles that they assume after an SCI. Studies have shown the quality of life to be stable for 1-6 months post-SCI, but OT can influence a client’s perceived QoL during the early stages of SCI rehabilitation.6 2  OTs can also promote client-centered goal setting as goal-directed experiences have been found to have a powerful effect on clients.7 

Team Management8 

-Acute (<24 hours)
-Subacute (up to 18 months post-injury)
-Chronic (neuro recovery has plateaued)9 10 

  • Caregiver training and assistance recommendations
  • Preventing joint and muscle contractures (ROM)
  • Addressing spasticity
  • Preventing decubitus ulcers
  • Promoting bowel and bladder function
  • Promoting participation
  • Early mobilization11 
  • Positioning and turning (respiratory ability, skin breakdown, muscle shortening and contractures)
  • Positioning aids, e.g., pillows and wedges12 
  • Transfer training
  • Environmental modifications
  • Communication with staff, e.g., sip and puff, switches13 
  • ADL retraining: bed mobility, sitting, dangling, eating, grooming, dressing, bathing, and toileting.
  • Tenodesis grasp at C6 to allow for compensatory passive prehension.14 
  • Progressively raising the head of bed for increased upright tolerance for ADLs.
  • Promoting compression, e.g, stockings and abdominal binders for orthostatic hypotension.
  • Exercise
  • Adaptive equipment,e.g, universal cuff for ADLs, mobile arm support, tenodesis splint13  Other adaptive equipment that may help include a plate guard, cup holder, extended straw, nonskid mat, wash mitt, soap holder, soap-on-a-rope, slide board, DIL stick, suppository inserter, and handheld mirror.15 
  • DME: wheelchairs, seating, lifts, beds, bathing equipment, toileting, bed mobility
  • Wheelchair selection, adaptation, and training (manual vs powered)
  • Driving and community mobility
  • Establishing a mentor-mentee relationship
  • Peer support groups
  • Adaptive sports and recreation
  • Addressing psychosocial barriers

STOMPS

The strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury home exercise program (HEP) has shown to reduce shoulder pain to 1/3 of baseline levels after intervention in one study as measured by the Wheelchair User’s Shoulder Pain Index compared to a sham group.16 

Aging and SCI8 

  • Skin checks
  • Staying active
  • Eating and drinking responsibly
  • Breast and testicular self-exams
  • Physical check-ups (health management occupation) and eye exams
  • Assessment of adaptive equipment, posture, ROM, contractures, function
  • Skin checks
  • Blader and urethra exams
  • Other motor and sensory testing
  • Vaccines
  1. Boutin-Leister, P. & Gibson, R. W. (2002). Patients’ perceptions of home health occupational therapy. Australian Occupational Therapy Journal, 49, 146-154.[↩]
  2. Michelle E. Cohen & Ruth L. Schemm (2007) Client-Centered Occupational Therapy for Individuals with Spinal Cord Injury, Occupational Therapy In Health Care, 21:3, 1-15[↩][↩]
  3. Djiker, M. (1997). Quality of life after spinal cord injury: A meta analysis of effects of disablement. Spinal Cord, 35, 829-840.[↩]
  4. Kemp, B. & Ettelson, D. (2001). Quality of life while living and aging with a spinal cord injury and other impairments. Topics in Spinal Cord Injury Rehabilitation, 6, 116-127.[↩]
  5. Pierce, C. A., Richards, J. S., Gordon, W., & Tate, D. (1999). Life satisfaction following spinal cord injury and the WHO model of functioning and disability. SCI Psychosocial Process, 12, 124-127.[↩]
  6. Kennedy, P. & Rogers, B. (2000). Reported quality of life of people with spinal cord in- juries: A longitudinal analysis of the first 6 months post discharge. Spinal Cord, 38, 498-503.[↩]
  7. Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York, NY: Harper & Row.[↩]
  8. Model Systems Knowledge Transition Center. (2020). Spinal Cord Injury Fact Sheet Booklet. Retrieved from www.MSKTC.org/SCI[↩][↩]
  9. Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol.
    2012;109:47-62. doi:10.1016/B978-0-444-52137-8.00003-6.[↩]
  10. Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45:
    190-205. doi:10.1038/sj.sc.3102007.[↩]
  11. Hachem, L. D., Ahuja, C. S., & Fehlings, M. G. (2017). Assessment and management of acute spinal cord injury: from point of injury to rehabilitation. The journal of spinal cord medicine, 40(6), 665-675.[↩]
  12. Antcliff, P., & Turner, S. (2014). Minimizing secondary complications for clients with spinal cord injury: A guide for general occupational therapy practitioners. OT Practice, 19, CE-1–C-E7. https://doi.org/10.3109/09638 288.2012.721048[↩]
  13. Fries, J. M. (2005). Critical rehabilitation of the patient with spinal cord in- jury. Critical Care Nursing Quarterly, 28, 179–187. https://doi.org/10.1097 /00002727-200504000-00009[↩][↩]
  14. Mateo, S., Revol, P., Fourtassi, M., Rossetti, Y., Collet, C., & Rode, G. (2013). Kinematic characteristics of tenodesis grasp in C6 quadriplegia. Spinal cord, 51(2), 144-149.[↩]
  15. Adler C: Equipment considerations. In Whiteneck GG, Adler C, Carter E: The management of high quadriplegia, New York, 1989, Demos.[↩]
  16. Mulroy, S. J., Thompson, L., Kemp, B., Hatchett, P. P., Newsam, C. J., Lupold, D. G., … & Gordon, J. (2011). Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical therapy, 91(3), 305-324.[↩]
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