颈椎C-6损伤的康复目标

C-6 Quadriplegia: C-6 patients have musculature that permits most shoulder motion, elbow bending, but not straightening, and active wrist extension which permits tenodesis, opposition of thumb to index finger, and finger flexion. Wrist extensor recovery is common in C-6 patients, but its return can be delayed. Tenodesis orthoses support tenodesis training early in recovery. Wrist-driven flexor hinge splints permit pinching strength, needed for catheterization and work skills. Short opponens orthoses with utensil slots, writing splints, Velcro handles, and cuffs permit feeding, writing, and oral facial hygiene. C-6 patients can perform upper body dressing without assistance and may also perform lower body dressing without assistance. They can catheterize themselves and perform their bowel program with assistive devices. They can perform some transfers independently with a transfer board, turn independently with the use of side rails, and relieve pressure by leaning forward, alternating sides, or possibly by push-ups. Water mattresses can lower pressure sufficiently to eliminate the need for turning during the night. They can propel a manual wheelchair short distances on level terrain, operate power wheelchairs, and may drive with a van and special equipment. They can cook, perform light housework, and live independently with limited attendant care. Upper extremity reconstructive surgery, or functional neuromuscular stimulation of the upper extremity, or surgery and stimulation in the same patient can improve function in C-6 patients. Surgery is recommended only for patients who are neurologically stable and without spasticity. Stimulation can be provided by external, percutaneous, or implanted electrodes, by shoulder motion utilizing an external system, or by key and palmar grip and release, or by a bionic glove, an electrical stimulator garment that provides controlled grasp and hand opening.   After a Spinal Cord Injury The bladder, along with the rest of the body, undergoes dramatic changes. Since messages between the bladder and the brain cannot travel up and down the spinal cord, the voiding pattern described above is not possible. Depending on your type of spinal cord injury, your bladder may become either "floppy" (flaccid) or "hyperactive" (spastic or reflex). The Flaccid Bladder: A floppy bladder loses detrusor muscle tone (strength) and does not contract for emptying. This type of bladder can be easily overstretched with too much urine, which can damage the bladder wall and increase the risk of infection. Emptying the flaccid bladder can be done with techniques such as Crede, Valsalva, or intermittent catheterization. It is very important that you do not let your bladder get overfull, even if it means waking up at night to catheterize yourself more frequently. The Reflex Bladder: The detrusor muscles in a hyperactive bladder may have increased tone, and may contract automatically, causing incontinence (accidental voiding). Sometimes the bladder sphincters do not coordinate properly with the detrusor muscles, and medication or surgery may be helpful.