Combined motor and peripheral sensory insufficiency. III. Management of spinal cord injury.

For clarity in presenting the concepts of care, the patients have been divided into discrete neurological levels according to their dominant patterns of muscle strength. Individuals can vary considerably, however, and these differences must be accommodated by corresponding modification in the orthotic functional plan. The C6 level patient, with his effective wrist extensor as well as arm musculature, can recover a single mode of grasp and release through a wrist-driven, flexor-hinge-hand orthosis, or a natural tenodesis. Available arm function, despite the loss of all wrist and hand musculature, enables the C5 quadriplegic patient to regain prehension with a passive ratchet flexor-hinge or an electric flexor-hinge-hand orthosis. Both groups of patients also require various aids to accomplish wheelchair propulsion, ischial pressure relief, bed transfers, and, for the C6 level, driving.