Upper extremity functioning in individuals with cervical or thoracic spinal cord injury - From body functions to participation

Abstract: Background: A spinal cord injury (SCI) can lead to a range of impairments in various body functions, including the function of upper extremity, with severity varying from mild to severe. Long-term consequences for functioning and disability are a dynamic result of the injury characteristics and various other factors, requiring further knowledge regarding upper extremity functioning. The overall aim was to enhance the knowledge of upper extremity functioning across various domains of the International Classification of Functioning, Disability, and Health (ICF) in individuals with SCI. The specific aims of the four studies were to determine the altered kinematic measures during a purposeful daily task and to identify the relationships across kinematics, clinical assessments, independence in everyday activities, and self-perceived autonomy in participation. Methods: For this thesis, 29 individuals with cervical or thoracic complete or incomplete SCI and 54 non-disabled controls recruited. Assessments used were: American Spinal Injury Association (ASIA), vi kinematics during the 'drinking task,' grip strength, Action Research Arm Test (ARAT), Sollerman Hand Function Test (SHFT), Box and Block Test (BBT), International SCI Upper Extremity Basic Data Set (ISCI-Hand, ISCI-Shoulder), Spinal Cord Independence Measure (SCIM), and Impact on Autonomy and Participation. Results: Several kinematic measures (e.g., movement time (MT), smoothness, wrist dorsiflexion) were altered in the upper extremities with limited functioning after SCI. Wrist angle, alongside MT or smoothness, explained 82% and 77% of the variance in ARAT and SHFT, respectively, and explained 91% of the variance in ARAT and SHFT with the addition of hand proprioception. Wrist angle alone explained 59% of ISCI-Hand. MT, smoothness (r≥0.6), and grip strength (r≥0.5) correlated with SCIM-self-care, feeding, and dressing, as well as with ARAT, BBT, and ISCI-Hand (r 0.52-0.76). SCIM-mobility items correlated similarly. Independence in respiration management correlated with MT (r -0.53), smoothness (r -0.50), BBT (r -0.56), and toilet use solely with MT (r -0.66). Most participants with SCI (68%–88%) reported restrictions in outdoor, family role, and indoor autonomy in participation. Indoor autonomy correlated (r 0.72) with SCIM-self-care and SCIM-mobility (r 0.60), while problematic work autonomy correlated (r 0.55) with SCIM-respiration/sphincter management. Conclusions: This thesis emphasises the critical importance of addressing upper extremity functioning within rehabilitation medical practises from various perspectives and highlights certain key aspects within 'functioning and disability' ICF section.