Traumatic quadriplegia: follow-up study of self-care skills

In this study to assess the extent of use of the self-care skills learned during rehabilitation and of the orthotic devices provided to support function once community living was resumed, 35 persons with traumatic cervical cord injury were tested in the home environment 1 to 4 years after discharge from the hospital. Of this group, 20 had a functional spinal cord level of C6 or C7 and 15 of C4 or C5. The results indicated that the level of self-care achieved during rehabilitation was maintained by the majority of persons at follow-up. The areas most sensitive to change were toileting and bathing, desk skills, grooming, transfers and upper and lower extremity dressing for those with C6 or C7 functional spinal cord levels, and grooming, written communication and desk skills for those with C4 or C5 levels. The majority continued to use at least some of the prescribed upper extremity orthotics and assistive devices. Neither hand surgery nor equipment use was clearly related to functional status. The ratchet hand splint was well accepted by the C4-5 group. Changes in performance are discussed in terms of a restructuring of personal priorities, the availability of interpersonal support, and architectural and attitudinal barriers within the community.