Need help with a quadriplegic client

[hil30]

Just got a call from a buddy of mine who I work on regularly. But this is a new one for me, so any help would be appreciated by both of us!

He has a spinal cord injury from 27 years ago, received while he was in the military. He caught the top of his head while diving underneath something in an obstacle course and shattered C5 and cracked C4 and C6. He has RMDD in his shoulders and rhomboids from using his wheelchair, but he has enough upper body strength to lift himself into his truck, onto my table, etc. Sometimes he has muscle spasms in his legs, but they usually go away if he just relaxes and lets them go. He has started working out at the VA per doctor's orders and has been on a regimen for about a month now. He also has a pool and usually works himself in there about once a week. His leg strength is minimal, other than being able to pivot himself around while in a standing position. But while in the pool, he can stretch and move around without the pull of gravity. The pool depth is 5' and he's easily 6'+ tall.

As I said, he's a buddy of mine. We had a big BBQ and pool party for the 4th on Wednesday and he spent more time than usual in the pool. He had a hard time getting out of it, and needed assistance getting back up and into his chair. I thought it was probably because the water was warm (easily 85 degrees) and he was just so loosened up. But, he called today and his low back is causing problems. When he sits upright in his chair, the spasms in his legs and back come on full force. He's been sitting forward most of the morning, but he's unable to do more than watch TV (and even that is uncomfortable). He said his low back feels hot and is warm to the touch.

I know a lot about referred pain and trigger points, but this is in an area that he doesn't feel, so he can't tell me if it's painful or the intensity of the pain. I won't know more until I can get my hands on him in about 4 hours, but I'm wondering if there's anything in particular that I should be looking for or checking out? Low back pain would normally lead me to pelvic girdle issues and warmth is normally inflammation, but is there something I'm missing or not seeing?

 

[Kewtenuekat]

Just curious, you mentioned he is quad, but with use of his arms to lift himself into his truck. Does he sometimes loose ability to use the arms and that is why he is a quad or is he actually considered a parplegic?

I have worked on paraplegics before, but never a quadraplegic.

I'll try to give some insight in a day or so, but if you wouldn't mind expanding on this, I'd be interested for my knowledge bank.

Thanks in advance.

 

[Vortex]

His is a quad. He has limited use of his arms and very limited use of his hands. He can move his index finger and by moving his wrist he can use his thumb, but the other three fingers don't work unless he pries them open. His joints in his legs work somewhat, but again, limited function.

I probably should have been more clear about getting himself into his truck. He pulls himself to a standing position using the open door, pivots on his feet to face the chair and slings one arm underneath to lift it into the truck. Then he pivots back around on his feet, slides himself over to the cab and flops down on the seat. He lifts his legs into the truck and drives with hand controls using his index fingers.

He has been a friend of my husband and I for more than 3 years, and he never fails to impress me with how well he gets along. There's nothing he can't do. Many things he doesn't do the same way we do, but he still gets the same results.

 

[supersetter1989]

Thanks for clarifying.

So, since we're throwing out things to be looking at:

You mentioned he's been working out with the VA now for a little while (month) - I am wondering if the work-out regimen has increased strength in any areas or loosened any areas which could be causing him to now function differently than he used to.

Possibly he is lifting/turning/pushing/pulling/flopping more than he used to.

I guess it is possible that he could even have a disc problem (even though he is quadraplegic). Just a thought that comes to mind - since the feeling to him is different than normal.

I'd definitely want to look at the psoas muscles, even though they may be weak, maybe there is something going on in this area?

Also, is there a possibilty of a referral pattern coming from the abdominal organs to be aware of?

I'm quite interested to hear what you found and how he is doing, if you are willing to share.

I hope this serves as a jumping off point of thoughts.


07/11/07 - Edited for typos.

 

[Honey Bees]

I was looking for so much more than what was actually causing the problem. :

Turned out, trigger points in glute max just under the pelvic crest and along sacrum were causing all the issues. I guess the not-being-able-to-pull-himself-out-of-the-pool was more of an issue than either of us realized. Got him on the table for our usual session, but I spent some time in his glutes. Then I fixed up an ice pack and let him lean back on it. Saw him the next morning and he was quite a happy camper.

The new work-out regimen causes the expected soreness in his arms. He's pretty sure his legs would feel sore, if he had much feeling in them. It's interesting to me - some areas he feels pain, some he feels no pain, and some areas are only sensitive to hot/cold.

Usually, our sessions consist of 75 minutes spent on his back and shoulders, specifically the rhomboids, SITS, traps, lats and lev. scap. We've tried to do some work on the neck muscles, but the day after a treatment he is in excruciating pain. So, I let him work those as his ROM will allow. After the 75 mins, I spend another 15-20 doing some positional release on his psoas, abs and shoulder muscles. I can usually tell when he needs a massage because his shoulders will be rolled so far forward that it's more comfortable for his elbows to be inside his thighs.

Thanks for your input, Pueppi. When working with differently-abled folks, there aren't any standard treatments. Five different quads with the same SCI are all going to have different levels of mobility, ROM, sensitivity, etc. Even the simplest things can be overlooked.

Oh, and my friend has given me permission to discuss his treatment, injury, functionality, etc. in great detail here. So, if anyone has any questions, feel free to ask.