Spinal Cord Injury (SCI) is a life-changing condition that affects not only mobility but also independence, daily activities, and overall quality of life. It results from damage to the spinal neural elements, leading to varying degrees of motor and sensory impairment. While medical management focuses on stabilization and prevention of further injury, orthotic management and rehabilitation play an equally critical role in restoring function, preventing complications, and maximizing independence.
In this blog, we explore SCI, its assessment, and the vital role of orthotic interventions in upper limb management and rehabilitation.
Understanding Spinal Cord Injury (SCI)
SCI occurs when the spinal cord is damaged due to trauma or disease, thereby disrupting the communication between the brain and the body.
Who is affected?
About 80% of SCI cases occur in males, with young adults being most at risk.
Leading causes include:
- Vehicle crashes
- Falls
- Violence (such as gunshots)
- Sports-related injuries
Types of injury:
- Tetraplegia (59%) – paralysis affecting all four limbs and torso
- Paraplegia (41%) – paralysis of the lower half of the body
Rehabilitation Goals:
- Maximize independence in daily activities
- Prevent secondary complications such as contractures and pressure sores
- Improve efficiency and ease of movement
Neurological Assessment in SCI
An accurate assessment helps clinicians determine the level and extent of injury.
Dermatome
Each spinal nerve root supplies sensation to a specific skin area. There are:
- 8 cervical dermatomes (C1 has no dermatome)
- 12 thoracic
- 5 lumbar
- 5 sacral
Testing involves pinprick (sharp/blunt) and light touch (cotton wool) to compare sensations on both sides.
Myotome
Groups of muscles are innervated by a single spinal nerve root. Muscle testing helps identify preserved motor function.
This structured neurological evaluation helps clinicians define the level of lesion and plan appropriate orthotic intervention.
Orthotic Management in SCI
Orthotic devices are designed to support weak muscles, prevent deformities, and restore some degree of functional independence. Their role is especially crucial in upper limb management for individuals with tetraplegia.
Upper Extremity Management in Acute Tetraplegia
Rehabilitation begins early with splinting and positioning.
Goals of splinting:
- Immobilization and joint protection
- Prevention of contractures and deformities
- Pain relief and muscle support
- Improvement of function in daily tasks
Common Splints:
- Resting hand splint: Wrist at 20° extension, MCP joints slightly flexed
- Wrist extension splint
- Tenodesis splint: Uses natural tendon tension to enable grasp (wrist extension leads to passive finger flexion)
Additionally, a range of motion (ROM) exercises and proper positioning are critical during early rehabilitation.
High Tetraplegia (C1–C4): Orthotic & Assistive Support
Patients with high cervical injuries require specialized support.
Goals:
- Prevent deformities
- Protect insensate areas
- Reduce edema
- Maintain hand flexibility
Splints:
- Resting hand splints
- Opponens splints
- Wrist extension splints
Assistive Technology:
- Wilmington Robotic Exoskeleton (WREX): Wheelchair-mounted device using elastic elements and power assistance to enable arm movement against gravity
- Feeding aids:
- Winsford Feeder – chin-controlled mechanical feeding device
- Meal Buddy – robotic feeding system with programmable functions and portability
Robotic Arms & Neuroprosthetics
Modern rehabilitation combines orthotics with robotics to restore independence.
- JACO Arm (Kinova Robotics): A wheelchair-mounted robotic arm with a 2- or 3-fingered hand, joystick-controlled for intuitive use
- iARM (Exact Dynamics): Seven-joint robotic arm powered by the wheelchair battery, controlled by joystick or keypad
- MyoPro Orthosis: FDA-approved robotic arm orthosis that uses surface EMG signals to trigger powered assistance in partially paralyzed arms
These innovations empower individuals with tetraplegia to perform daily tasks more independently.
Low-Tech Aids for Mid-Cervical Tetraplegia
- Simple devices remain vital for daily function.
- Key considerations:
- Easy to don
- Lightweight and low-profile
- Cosmetically acceptable
- Common orthosis:
- Resting hand splints
- Dorsal wrist splints
- Long & short Opponens splints
- Universal Cuff (with/without wrist support) enables essential tasks.
- Other aids: Writing splints, cup holders, and button hooks to promote independence.
Functional Electrical Stimulation (FES) & Neuroprosthetics
Neuroprosthetics use electrical stimulation to restore hand and arm function.
- H200 Wireless (Bioness): Commercially available upper limb neuroprosthetics using surface stimulation for grasp and release
- Freehand System: FDA-approved 8-channel device that restores hand function through FES
- Bionic Glove: Stimulates finger flexors and extensors, enabling grasp
- Advanced Systems: ETHZ-Para Care and Stimulus Router Systems provide innovative, though not widely available, solutions for grasp restoration
Mobile Arm Supports (MAS)
MASs are mechanical devices that assist arm and forearm movement, particularly useful for feeding and table tasks.
Examples:
- Rancho MAS (Golden Arm): Early design for polio patients, later adapted for SCI
- Feeding aids like Stand Feeder and C-Clamp Feeder
By reducing reliance on shoulder and elbow strength, MASs promote independence in daily living.
Tenodesis Orthosis (C6–C7 SCI)
For patients with partial hand function.
- C6 Level: Elbow flexion and wrist extension preserved
- C7 Level: Adds elbow extension
Wrist-driven orthosis (tenodesis splint):
- Uses active wrist extension to create passive finger flexion
- Enables functional grasp (thumb, index, middle fingers)
- Critical for restoring independence in self-care activities
Dynamic Splints for Hypertonicity
In cases of increased muscle tone:
- Saebo Stretch: Adjustable splint that allows safe stretching during muscle spasms and maintains ROM
- Dynasplint System: Provides low-load, prolonged stretching at the end range of motion to gradually improve flexibility
Low Cervical SCI (C8–T1): Orthotic Goals
The main objective is to preserve natural hand function and prevent deformities caused by muscle imbalance.
- Functional Splints: Prevent intrinsic minus posture and wrist flexion
- Universal Cuff: Allows patients without grasp to hold utensils or grooming tools
The Road Ahead: Innovation in Orthotic Management
With advances in robotics, neuroprosthetics, and FES, the future of SCI management is increasingly focused on restoring function rather than merely compensating for loss. Orthotic devices are evolving from static supports into dynamic, intelligent systems that integrate with user intent.
The ultimate goal is not only physical rehabilitation but also social reintegration, independence, and improved quality of life.
Empowering Lives Through Orthotic Management in Spinal Cord Injury
Spinal Cord Injury is a challenging condition, but with the right blend of medical care, orthotic support, and assistive technologies, individuals can regain meaningful function and independence. From traditional splints to cutting-edge robotic arms and neuroprosthetics, orthotic management continues to transform lives by bridging the gap between disability and ability.
At Proactive Technical Orthopaedics Pvt. Ltd, we are committed to delivering innovative, affordable, and effective orthotic solutions tailored to each patient’s unique needs—empowering them to live with dignity, independence, and confidence.
References
- Upper limb Orthoses for Persons with Spinal Cord Injuries and Brachial plexus injuries, in Atlas of Orthoses and Assistive Devices. Philadelphia, PA: Elsevier, pp. 157-169
- https://scireproject.com/evidence/upper-limb/complementary-and-alternative-medicine/ethz-paracare-system/
- https://scireproject.com/evidence/upper-limb/complementary-and-alternative-medicine/stimulus-router-system/
- https://www.ncmedical.com/wp-content/uploads/2011/07/Winsford-Broch_web_0611.pdf
- https://www.physio-pedia.com/American_Spinal_Cord_Injury_Association_(ASIA)_Impairment_Scale
