Can a C-7 quad generally transfer independently? Also morning/bedtime routines?

[ConcernedSon]

Firstly, I realise entirely that no two spinal injuries have the same results, regardless of level, so I'm just looking for a ballpark here.

My dad is an ASIA B C7 since June 2016, with some C8 function (he can bend his fingers, far more on the left than on the right, to the extent that he is able to do many day-to-day things - texting, eating, holding a drink, operating a television remote control, etc. He has absolutely no motor control below the C8 level. Some of you might remember me from Apparelyzed, which I joined mere days after his injury, and what a long way he's come since the day I posted a thread wondering if he'd ever breathe without a ventilator again!

One of the things which has massively frustrated me during his rehabilitation period is the attitude of his medical team to his potential recovery. It seems to me that they took every opportunity to tell him to give up on certain things altogether and not to even fight for them. Because of this, he has come to believe that transferring independently will always be impossible, self-washing and dressing will always be impossible (or so time consuming and exhausting as not to be worth it), that essentially getting up in the morning and going to bed at night are things which will always require external help. He also believes that transferring to and from a couch or other seat without assistance will be impossible, such that from the moment he wakes up in the morning to the moment he goes to bed at night, he will always be in the same wheelchair for the entire day, at least unless he gets help in moving from one to the other.

This does not seem to match up at all to what I've read of C7 injuries, and indeed what I've seen from C7 quad on sites like this and on YouTube - and many of those are *complete* C7s, with no finger function at all. Even one of the government documents I've read on SCI (I believe from the Australian government) suggests that a C7 injury can learn to live independently if they put a hell of a lot of work in to that. The experiences I've read from C7 quads coupled with these other sources lead me to the suspicion that my dad's rehab team were erroneously pessimistic regarding his chances for future independence.

The issue I have is that they've discouraged him from working towards these goals as he now believes them to be impossible. At one stage, for example, he was intending to join an accessible gym so that he could perform weight lifting and therefore regain some of the upper body muscle mass he has lost since his injury - he appears to have been talked out of doing this. He has entirely resigned himself to having to get up and go to bed every day based on somebody else's timetable rather than his own, as he fully believes that independent transfers etc are permanently out of his reach - that, to quote his own words, he'll never be able to set his own alarm in the morning and will instead be dictated by when the doorbell rings for his carers to arrive and/or when myself or my mum happen to be around.

Does this sound accurate to the people on this forum, particularly those with, or those who know somebody with, a complete - or almost complete - motor C7 injury? Is he right to assume that independent transfers and general independent living are entirely beyond reach and therefore to be given up on? It's incredible to hear him say for instance that he'll never sit on any chair other than his wheelchair again even though I've seen so many videos of C7 quads transferring from one to the other, some even without a sliding board due to good back and tricep muscle strength - is this the exception or the rule? Should he indeed resign himself to his life schedule and daily routine being entirely dictated by others, or is this, as I have come to suspect, an unreasonably morose prognosis?

EDIT: Just to be clear, since I haven't posted about this online since before Apparelyzed was taken down, he is now out of rehab and living at home again after some extensive renovations to our house.

[SCI-Nurse]

While many people with C7 injuries are totally independent in their own care, and do not require any attendant care, this is not always going to be the case, especially for those who are older (how old is your dad??), had other injuries (brain injury, shoulder or chest wall injuries, etc.) at the time of their SCI, had pre-existing problems such as cardiac or pulmonary disease or bad arthritis, and for those who are very obese. Does any of this apply to your dad??

Did he go to a specialty SCI rehabilitation center for a comprehensive acute rehabilitation program? If so, I am very surprised that the rehab professionals there would have told him what you say he was told.

While many people do transfer out of their chair onto a couch or easy chair, many do not, and yes, they are either in bed or in their wheelchair (or on a commode or shower chair) all the time. Skin wise, it is actually better to be on a specialty cushion designed to reduce pressure than it is to be sitting on a standard couch or easy chair, and of course the work of doing the transfers to/from the chair are an issue, much less the decreased function the person may find they have when not in their wheelchair. Not sure why this is such an issue for you if it is not for him.

If he does need help with his care, he needs to be the "boss" of the caregivers, and should be setting the times for when he needs services and not being so passive about being their employer (regardless of who actually pays them). Can you get your dad to join our community?

(KLD)

[ConcernedSon]

While many people with C7 injuries are totally independent in their own care, and do not require any attendant care, this is not always going to be the case, especially for those who are older (how old is your dad??), had other injuries (brain injury, shoulder or chest wall injuries, etc.) at the time of their SCI, had pre-existing problems such as cardiac or pulmonary disease or bad arthritis, and for those who are very obese. Does any of this apply to your dad??

Did he go to a specialty SCI rehabilitation center for a comprehensive acute rehabilitation program? If so, I am very surprised that the rehab professionals there would have told him what you say he was told.

While many people do transfer out of their chair onto a couch or easy chair, many do not, and yes, they are either in bed or in their wheelchair (or on a commode or shower chair) all the time. Skin wise, it is actually better to be on a specialty cushion designed to reduce pressure than it is to be sitting on a standard couch or easy chair, and of course the work of doing the transfers to/from the chair are an issue, much less the decreased function the person may find they have when not in their wheelchair. Not sure why this is such an issue for you if it is not for him.

If he does need help with his care, he needs to be the "boss" of the caregivers, and should be setting the times for when he needs services and not being so passive about being their employer (regardless of who actually pays them). Can you get your dad to join our community?

(KLD)

The only thing he checks on that list is that he's in his early fifties. In fact, one of the things the doctors in the first hospital where he was initially treated (whose attitudes were so, so different to what we encountered later) kept commenting on was how fit and healthy he was compared with a lot of their patients. He was actually injured in the middle of a multi-country, two week long hill walk, during which he sat on a stone bench at one point and toppled backwards off it, forcing his neck forwards because of the angle he hit the ground at and breaking several vertebrae. Apparently many people of his age who get spinal injuries, are injured more severely because they're already unfit or in bad health - conversely, his was simply a freak accident during an otherwise extremely active period of his life. He had been training every day for a year before this pilgrimage so it's safe to say he was probably as fit as one can be at his age. The only stumbling block is that he was in a coma for almost a month (he contracted a severe bacterial pneumonia from the ventilator, this rapidly progressed into full blown septic shock and as it was described to us, he was very lucky to make it through that at all) and as such he has lost considerable muscle mass even on the muscles which still work. That was one of the first things he noticed about himself when he woke from the coma, how much thinner he was than before. So I reckon some pretty intense weight lifting would be needed for him to regain his original strength. Having said that, the guy is genetically gifted - he's a former rugby player and was stronger and bulkier having never lifted weights a day in his life than many of his peers who would do huge gym sessions several times a week. I mean I'm in my mid twenties and even I've found myself slightly envious of his ability to build muscle easily while I'm your classic hard-gainer, working out non-stop only for very, very slow progress.

The chair-transfer thing is more of an issue for him than for me, to be honest - it was one of his first questions upon learning of the permanence of his injury and he has come back to it several times during meetings with his rehab, only to be given a very clear "forget it" with regard to transferring to different seats.

I agree regarding the care people. 7PM bedtime every day, especially when he returns to his 9-5 job which he is delighted to be able to resume and looking forward to, is completely crazy. We have a hoist which myself and my mum are learning to use so that's been handy on some occasions when he's had to be out late at meetings or anything like that, but the holy grail for him (which he has very reluctantly put out of his mind altogether) would be being able to get himself into bed without even needing one of us to help.

I've asked him about the possibility of joining one of these forums, I tried several times to get him to read Apparelyzed just to contradict some of the supreme negativity he was receiving in rehab, but he says he's not ready for that yet and I totally respect that, obviously in a situation like this everybody is going to react differently and I can completely understand why he may not feel ready to immerse himself in a community like this one, particularly since forums and social media in general are pretty alien to him, he's never really used them before apart from group emails and such.

[SCI-Nurse]

At C7, there are ceiling track lifts that he could use independently, even if he cannot do an independent slide board transfer in/out of bed. He should also be able to don/doff his clothing, although shoes and socks and slacks can take a lot of time and effort. He definitely should be able to dress his upper body totally independently once seated in his wheelchair. With adaptive equipment, he should be totally independent in bathing too, once he has transferred to a shower bench or commode (what is his bathing set up??), and he should be able to do all his own grooming (shaving, comb hair, etc.) and oral care. Most people at C7 also cook, was this something he did before his injury?

Has he expressed any interest in any wheelchair sports? With his athletic background he should be able to participate in swimming, hand cycling, quad rugby, sailing, etc. etc. These are also great ways to rebuild the muscle mass he has lost. Is he only able to go to the gym if it is ordered by his rehab physician? Can't he go on his own? I think the biggest obstacle you have is him not listening to himself and sticking up for himself and passively allowing these misinformed "rehab professionals" discourage him from maximizing his function and strength. Shame on them, if this is actually the case.

(KLD)

[gjnl]

One caution I would add, is don't let what you see on YouTube videos and other medical professional opinions color your expectations for your father's abilities. Each and every spinal cord injury and recovery is different and what one C7 can do, other C7s may not be able to do, and it isn't a matter of not trying or having the motivation or being discouraged by a rehab team of doctors, nurses and therapist.

Give you father a break and let him find his comfort zone for his care needs and then help him find the best balance of care and his abilities.

[jdellovade]

ConcernedSon, I'm a 46 year old C7 complete 23 years post injury. As was stated by others here, every injury is different so its not practical to try to make generalizations about how much recovery he will see. I can only offer you my experiences. The doctors and rehab specialists typically try to be conservative in their expectations, I'm assuming to try to not set the expectations too high which is a setup for disappointment. Try not to let any of the opinions set a ceiling for him.

It's good that he's back to work and keeping his mind active. That's a big step to staying positive and feeling productive. I'm a structural engineer and went back to work as soon as I could and I think that helped keeping the ball rolling after rehab to regain my independence. I was injured much earlier than your father so that will all play into this as well but it's good that he is fit and healthy that is a great asset. Even being fit, it will take some time to be able to perform the functions that you are concerned about. I had a very hard time transferring originally, even with the use of a sliding board but eventually you get stronger and learn how to use your balance and weight to work with you and not against you. You're using muscle groups that have never had to work that hard before and it will take some time to strengthen them. The best advice I can offer is to exercise and keep working at it. Find a physical activity he likes to build up his strength and endurance. In my younger days I was into road racing and regularly competed in marathons. These days I like handcycling but everyone has their own preferences. Your rehab facility should be able to direct you to a local group that he could get involved with to try some different things out. Also, being around others in similar situations could help him seeing what is possible and having the ability to ask questions from others that have been through the same thing. Eventually it will get better. If I had to guess, I'd say it took me almost two years post injury to become proficient in a lot of things and even after that it still gets better with time. It can be frustrating at times but you have to try not to get down and stay as positive as possible.

Hopefully he can work through all of these issues and realize that there is still so much he can do. Try to keep positive. If you have any other specific questions, feel free to ask either on the forum or send me a private message and I'll do what I can to help.

[vjls]

hello I was injured at 50 I am c6c7 and have fingers pretty good dexterity live indepent except care giver 1 hr in am I bathe my self but have yet to get my bare butt in shower chair by myself lol I can dress myself totally except socks

shoes are zipp up I cook I can mop floors fold laundry and throw clothes in dryer I drive and have been 8 months after injured

I am going to learn how to do a wheelie transferring just takes some time I get up at 7am bed at 1030pm I have a rope with loops that I use to get in bed otherwise it would not happen I transfer fall sides way thrpw my arm in loop and pull I am in bed

don/t get discourage it takes time

[JacksonsGirl]

My hubby is C6/7 (with zero movement below injury level) , he transfers independently. I do stand there a lot of the time, but... he does it alone a lot. I help him with difficult transfers (like getting into a vehicle that's higher up (truck or van). But, there's no reason to believe that your dad couldn't work toward this. It seems strange that a therapist would be discouraging it really- they are usually the motivators. Spasms play a part - if he's having horrible spasms every morning (chris does), it's difficult to transfer. But still possible. Chris can get himself up if he wants to (if I'm out for groceries or what have you). I'm usually there, but it isn't carved in stone that I have to be. I'm usually in the other room getting his breakfast ready, and he just gets up. Chris can transfer onto and off from the couch, chairs, into and out of bed, to different wheel chairs, etc. It's very rare that he falls or screws it up so badly that he needs me to bail him out. If it was me, I'd probably want a different therapist.

[DeadEye]

I'm C5-6, no triceps, and transfer independently. Maybe I missed it, but what's the reason he has difficulty transferring? Balance? Muscle strength? Technique?

[Cris]

It is much more difficult to learn how to adapt to such a significant life change in your 50s then it is in your 20s.

Luckily I'm still able to live by myself but I've had 35 years of practice that I started at 21. I have longer arms and still don't way very much and this is a great asset for transfers.

Every injury is different, every person is different, give the man time to see what he can do when he gets his head on straight because this is a hell of a life changr and we all know it.