The functional limitations of tetraplegic hands for intermittent clean self-catheterisation

Since the introduction of intermittent self-catheterisation by Lapides et al, low pressure voiding methods have been adopted actively in our centre. A retrospective review of 47 patients with cervical spinal cord injury (CSCI) who performed independent (self) clean intermittent catheterisation (CIC) on discharge is presented. Their functional abilities were evaluated by both the Frankel and the Zancolli scales. Fourteen out of the 47 patients could manage independent CIC, 17 assisted CIC, nine tapped or voided voluntarily, two were discharged with a diaper, one with a suprapubic catheter, and four with an indwelling catheter. According to Frankel's classification, four patients were in A category, four in B, one in C and five in D among the group of complete CIC. C6A/C5B (right/left hand) by Zancolli's classification was the highest level of ability for all these 14 patients; and one patient (a 30-year-old male, Frankel B classification) could manage independent CIC with the aid of our special device. However, the practical limit of functional hands for independent CIC appeared to be about C6B1.