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Thread: New C6/C7

  1. #1

    New C6/C7

    My brother's 21 and has a new C6/C7 SCI (happened 2 weeks ago). I'm not sure if he's complete or incomplete. I think his neurosurgeon (they replaced the shattered vertebrae and relieved pressure on the cord) said he was incomplete, but I don't think he has any control over bowels or anal sensation. He doesn't have any feeling/movement from his armpits down. He was a strong and big guy before the accident, so it's a bit of a shock to see how weak his arms are, but he does have pretty good movement. He's also able to bend his wrists pretty well. He can't control his grip using hand muscles, but the therapists did have him picking up pegs with rubberbands around them by using his wrist to relax/tighten his grip (he calls this cheating ). I have a trillion questions floating around in my head, but I'm still working on organizing them into actual words...

    For starters, I was wondering what he should maybe be doing with his hands. One nurse told him he should stretch them out a little bit each day so they don't get stiff. Another nurse said not to stretch them, because if he doesn't gain anything back in his hands, at least with his hands curled the way they currently are, he can use his wrist flexors to grip things. Can anyone tell me what they believe is the best thing for him to do? Is there anything else he can be working on with his hands right now that will either help him use them as they are or help bring his grip back? Thanks so much for any help/advice. I'm so glad I've found this website, I can't wait until my mind clears up a little bit more and I'm able to get even more use out of it.

  2. #2
    Definitely have him do as much as he can with his hands. I'm C6/C7 also. I had some clawing intially and every night in the hospital I would stick them under my legs when I was in bed for as long as I could to try and stretch them out. I think it helped. The grip strength just took a long time to get back, took months of working at it to finally be able to open up soft drinks, etc. Just make sure he doesn't quit trying and to keep at it. Where is he located?

  3. #3

    Life skills

    Give him a shirt and have him button all the buttons upfront and sleeves. Then have him fold a tie around his neck and fold the collar down. Get him a strap watch and have him put it on his wrist. Have him pull up a pair of jeans, pull up the zipper and button them. Put a belt on around his waist. Have him put on socks and then put a pair of shoes on and tie them. These are life skills to be successful.

    For fun, build a puzzle or a model. Count coins and paper bills. Start writing everyday to help build up his manual dexterity. Pick up paper clips and pins. Get him a set of dumb bells and start lifting them every morning. Increase the weight over time. Give him a hard cooked egg and have him peal the shell off. Do the same with an orange.



    Ti

  4. #4
    If he has tenodesis, that would be C6. C7 would also give him wrist flexion and triceps (elbow extension) and some finger extension. Does he have triceps??? Ask his actual ASIA level and classification of the physiatrist (not the neurosurgeon). This may be different from his fractures (which I am assuming are C6 and C7??).

    Learning to use a tenodesis grasp (as he is doing with his OT) is critical at his level. If range of motion and stretching of his hands is done incorrectly, he will not have a functional tenodesis. A slight contracture of the fingers in flexion will make tenodesis much stronger and more functional. Those nurses sound somewhat uninformed about tenodesis grasp. I have seen people ruin their hands for function by doing the wrong type of stretching and exercises. Talk to the OT. That is his expert on the hands. Follow their recommendations for stretching, resting night splints, and exercises.

    Ask if he has any grade 1 or 2 muscles below his C6-7 injury level. If so, electrical stimulation can be used to try to get them up to a grade 3 level where he can start to use some resistive types of exercises.

    He is still newly injured. It is common to get back 1 level for many. If he gets in some C8, he will have individual finger flexion (although the smaller hand muscles don't come in until T1).

    Where is he getting his rehab?

    (KLD)

  5. #5
    Thanks so much for everyone's responses. His OT is showing him things he can do to help/not hurt his hands. He was told not to stretch his fingers unless his wrist was bent all the way down. They also told him not to stretch out his thumbs at all (they're currently touching his index fingers) - even doing so twice might make them useless? No one has mentioned anything about night splints - so I've added that to my list of questions to ask.

    He's got wrist flexion and triceps. I'm not sure if he's being seen by a physiatrist. I'm not sure if we've heard anything from a doctor recently, but one of his therapists (physical I think) told us he was complete and didn't know why any doctor would call him incomplete.

    I will also ask about the grade 1/2 muscles below the injury, although I don't understand this too well so maybe having a little more background before asking might help me understand the answer. Could anyone give me a quick explanation of what this means? Why is strengthening muscles below the injury important if he can't use them?

    Yesterday he could wiggle (teeny tiny amount of movement) his middle finger and pinky finger on his right hand. Is this a possibility with C7 or are we moving into C8 realm? Is there still a chance of getting a level lower back even being complete? Is it possible to go from complete to incomplete?

    He's rehabbing at the Rehabilitation Hospital of Indiana. I wanted him to go to Chicago, but he really wanted to be close to friends/girlfriend as he's a very social guy, and ultimately it's his decision. Maybe after his initial rehab is over and he gets stronger we could do Chicago outpatient for a while.

    Again, thanks so much for everyone's help and advice. Sorry if I ask silly questions, but so far I've realized it's better to ask dumb questions than ask nothing at all!

  6. #6
    Rule #1: There are no dumb questions (although sometimes there are dumb answers!).

    The physician should be have done an ASIA exam at admission to rehab, and again before discharge, as well as additional exams during his stay as indicated. It is COMMON to start out looking complete and then change to incomplete, esp. during the first 3 months post injury. Does he have any sensation at his anus? This may allow him to be reclassified as incomplete at this time. If he has grade 3 or better strength in both triceps, and normal sensation in both middle fingers, he should be considered a C7, not a C6.

    Here is some additional information about level and completeness of injury, the ASIA, and manual muscle testing.

    http://sci.rutgers.edu/index.php?pag...nalLevels.html

    He should be seeing a physiatrist several times a week. Ask about this with his case manager.

    I would encourage you to look into RIC for an outpatient program if that is at all possible.

    Please come back often, ask questions, and let us know now he is doing. Is it on-line with a computer yet? Can you get him to join our Community as well?

    (KLD)

  7. #7
    I am still waiting to find out if they did an ASIA exam at rehab and what the results were. He has no sensation at his anus – I know “anything is possible”, but it’s not too likely that this will return – correct?

    I’m also waiting to find out if he is being seen by a physiatrist and how often. I live about 4 hours away and don’t have much vacation time at work, so I’m only there on the weekends when there aren’t too many experts around, but I will do my best to relay everything on to my parents and hopefully they can get some answers for me.

    I know that everyone stresses the importance of going to the best rehab hospital. I was just wondering if anyone could describe an excellent hospital (particularly RIC as it’s the closest model center), or compare the differences in an excellent rehab hospital from a “just okay” one. While he was in ICU, the nurses and doctors explained to us that we would need to start thinking about rehab. They told us RHI was a great one in the area. At first I thought there probably wasn’t much difference in rehab hospitals so RHI would be perfect since it’s so close to home. But as I’ve been reading these forums, everyone stresses the importance of choosing a rehab hospital and to not consider location as a major deciding factor. Now I worry that we made an uninformed decision as it was nearly impossible to read or think in the first week following the accident, especially since he was having breathing difficulties following the surgery (his trachea collapsed when they did the extubation) and rehab seemed so far away while he wasn’t breathing on his own.

    I’ve mentioned to him a few times that maybe we should consider a different/better rehab center or hinted that Chicago has a rehab hospital that’s been ranked on several top lists, especially for SCI’s. But my brother really, really wants to be close to his friends. And sometimes I wonder if that’s not the best thing for him – he certainly seems to be in a much better mood when friends are around. I think emotionally/mentally he is doing great so far, but there certainly is an extra-bright smile when he’s got a lot of visitors.

    Another thing is that many of the things that go wrong at rehab, my family rationalizes as things that happen everywhere. Is there truth to this rationalization? For example: is it normal that the wheelchair a patient is in for the first 2 weeks doesn’t fit properly/is a piece of junk (breaks don’t work very well – the back gets stuck when trying to raise him up/lower him into a laying position?) Or that they have to do transfers with 2 people when 3 people are really necessary over the weekends because there aren’t enough nurses/techs around? Or that the nurses give him a suppository, and even when he warns them that if they don’t come back in 30 min they will have a mess to clean up, they still show up 15 or more min late (regularly)? Or that of the 3 hoyers they have on his unit, none of them are working properly? Little to no therapy sessions on the weekends? Hired agency nurses (who work weekends) that come to work in dirty and stained clothing, have scrubs that don’t fit so dirty clothing shows, don’t seem to know how to properly cath someone? (I think we got that last one handled as my mom demanded he never have another agency nurse again).

    Sorry I’ve listed so many of my complaints, but I just don’t know what’s “normal” treatment and what’s not. And I do worry quite a bit about him, A) because I love him to death and B) because I’m a natural worrier. These “things that go wrong” probably bother me a whole lot more than they even do him. And it definitely seems that the weekend care is much worse – and that’s the only care that I’ve witnessed since I can’t be around during the week.

    I’m going to try to get him on here soon as well. He hasn’t been up to trying out the computer yet, and I’m sure his first tasks will be checking his email and facebook, so for now I will be the forum surfer. I’ll also try to get my parents on here as well – I think there’s a lot of great information to be found, and a lot of amazing stories that will help them realize that we (and he) can get through this.

    Oh – I’ve thought of another question as well. My brother is a heavy person. Around 5’6 and 250 lbs. A few months ago he was up to 300 lbs, so I think the fact that he’s recently lost those 50 lbs have already helped him a lot and will continue to help him. Because of his weight, he’s having trouble doing his own transfers. We’re hoping he will be able to continue to lose weight so that he will be able to maneuver himself better. Any words of advice/things we need to watch out for due to his weight or dieting?
    Last edited by GuleGule; 07-07-2009 at 07:35 AM.

  8. #8
    GuleGule, The complaints you have spoken about are legit and should be addressed. It sounds like lazy nursing. I would be all over them. My son is almost 2 years post and id not experience any of the things you are complaining about, so no, not all rehabs are the same. As far as the "complete, incomplete" thing...not to worry. My son was a C5 complete with very little happening below his injury at first. He was kind of a freak though because he had triceps and wrist working. After almost 2 years of working out at Project Walk, he has movement down into his legs and sensation to his feet. Your brother will continue to get better, but the chair is the enemy. Traditional rehab will keep him in the chair and say, 'This is your life...get used to it." It doesn't have to be that way. He can regain a lot of recovery if he works at it. I'm not saying it's a for sure thing about the walking, but he has a great chance of gaining lots of independence back. Check out projectwalk.org and find a center that promotes exercise recovery after his acute care is over. Good luck to you and your family.
    Luke 5:24

  9. #9
    Thanks tgoodwin and those who PM'ed me. I'm having a difficult time getting my brother to agree to a move to a Model SCI Center that's further away, so for now it may be that he finishes up his rehab here. Part of me is angry that he doesn't understand how important rehab is to recovery, part of me believes the rehab he is receiving now is great and I shouldn't worry so much (it's more the nursing that I have a problem with - the weekday therapists seem great so far), and part of me understands how important it seems when you're 21 to be close to your friends (plus add to that that he has always been 100 times more social than I am...) I have a feeling that dealing with a SCI brings about a crazy mix of emotions...

    I've read some more about Chicago's "Second Look" program - maybe some day he will be interested in that.

    Today the occupational therapist is going out to my parents house (my brother gets to come along too - so that's pretty exciting, it's his first trip outside of the hospitals) to check out what modifications are going to be made. Any recommendations on what we should be sure to check on that the OT may forget - or any questions we should be sure to ask?

    To all - thanks again for all your advice - reading through these threads (whether they were made yesterday or are much older) has really helped me get through this...

  10. #10
    Make sure he gets involve with the recreation therapy also. He's 21, same age as my son. He may not be able to participate with any sport yet but he can still go to the game, wheelchair events, museum, shopping and restaurant.

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