Spinal Injuries have various causes leading to partial or complete compression of the spinal cord comprising of vascular and traumatic disturbances leading to the development of quadriplegia or paraplegia depending upon the level of the lesion.

        The Occupational Therapist mostly comes across teenagers or young adults who had acquired the disability due to war injuries, sports injuries or road accidents.
  Various levels of the lesion determine the functional capacity of the injured as follows :

                     Functional ability at different levels of the lesion :

C4-Level : The muscles of neck and upper fibers of trapezes are functional, so the patient will need specialized equipment like modified splints to enable the quadriplegic to perform limited hand activities such as self feeding, typing, turning pages and use object for the purpose of recreation on the work surface. Such cases are confined to home and require help in all the activities.

C5-Level : A moveable arm support with ball bearings can be given to help feeding and balance forearm. This supports the use of biceps, supinators and deltoid. The slings may also be used in addition. Special equipment may be used to hold the paralyzed parts. These cases may perform all the activities enumerated above but in addition some self-care activities like makeup, shaving, brushing teeth, washing the face, and combing the hair. The other activities as writing and using the telephone can also be performed. These patients are home bound and need an assistant for positioning and preparation of the objects. They may propel wheel chair for short distances using projection on the hand rims and splints to stabilize the wrists.

C6-Level : These cases have the additional use of clavicular portion of the pectoralis major and radial wrist extensors and hence the functional abilities are increased tremendously. Such cases can perform all the above activities efficiently using less equipment. He can sit up in the bed and can assist in wheel chair transfers. These can be made easy further using sliding boards. They can dress, propel wheel chair and can drive car with special steering cuff. These patients can take up vocational pursuits outside home, provided no fine hand movements are required.

C7-Level : In these the biceps, latissimus dorsi and radial wrist flexors afford additional use to the patients suffering from quadriplegia. They can perform all the activities described earlier with the less equipment. They can transfer themselves from wheel chair and can perform all above activities. They can stand in braces, if bracing is adequate and walking is not possible. All the hand activities can be performed except those involving finer finger co-ordination.

C8 Level : The wrist ulner flexors and extensors, long finger flexors and extensors are functional at this level. All activities can be performed independently and with ease.

T1 Level : Intrinsic muscles of hand are functional and allow addition of activities requiring finer finger dexterity. There is lack of stability of trunk. The Spinal bracing enables the patient to attempt ambulation with crutches.

T6 Level : The thoracic muscles are strong which give respiratory reserve to the patient combined with increased endurance. The bracing enables ambulation with crutches using swing through gait. These cases are independent in putting on and off the braces. They offer few vocational limitations.

T12 Level : These cases have full innervation of abdominal muscles hence can walk with full strength calipers and crutches, wheel chair advised for easy moving around house.

L4 Level : There is power in quadrates lumborum, quadriceps, and hip flexors. They may need short leg braces for stability around ankle and can be independent without canes and crutches. They may offer job limitation, cannot stand for long periods and limited climbing activities. Wheel Chair may be convenient at home.

                     The general O.T. aims are :

       1. To relieve spasticity
       2. To increase muscle power
       3. To increase/maintain R.O.M.
       4. To improve co-ordination
       5. To prevent development of contractures and deformities.
       6. To provide splints, calipers and self help devices.
       7. To prevent development of pressure sores.
       8. To allay the patient psychologically.
       9. To give A.D.L. training.
     10. To give pre-vocational training
     11. To give vocational training

        The main idea behind the treatment is to make them adapt themselves to wheel chair life and return to a normal and useful life as soon as possible. This is achieved by adjustment of the neuro muscular system, reeducation of bladder and bowel, psychological rehabilitation.

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