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Life After Paralysis is a blog that represents a variety of paralysis community members. It is a place for open conversation about the issues and the interests of people living with paralysis, their family, friends, caregivers, and the professionals that serve them. Comments are welcome!
 
The opinions expressed in these blogs are the author's own and do not necessarily reflect the views of the Christopher & Dana Reeve Foundation.

Secrets To Save Our Shoulders


If we are lucky enough to live long enough, parts of our body are going to begin wearing out. Many people my age, and even younger, are moving around on replacement knees and hip joints. For those of us who are paralyzed at various levels, I would argue that two of the most important body parts are the shoulders. We need them for basic mobility (propulsion), dexterity and the strength required to perform the activities of daily living.

Taking good care of shoulders can be a challenge.
 
My shoulders are a source of constant pain, and have been during most of the 27 years since my cervical spinal cord injury. My own problems seem minor, as I recently heard from a friend who is 70 and has been paraplegic for nearly 50 years. She was complaining about the serious nature of her pain, and how it is impacting her ability to remain independent in her manual wheelchair. During the past few years the pain in her shoulder area has been getting increasingly worse, but she has been unsuccessful in attempts to learn what she can do to correct the situation.
 
I used her situation as a challenge, and began to ask other friends and a few of my medical resources about what could be done to help her. In the process I learned some things that might improve my own health.
 
Several of my friends are long-term "paras" and say their shoulders or arms have caused them problems at various times. All of them started out their "post-injury lives" using manual wheelchairs, but a couple of them have graduated to power wheelchairs due to deteriorating strength or other problems with their shoulders. Many of them have been involved in wheelchair sports, from basketball and tennis to marathon racing, but the thing they have in common with some of us who are more sedentary is that nagging shoulder pain.
 
Everyone is different, so it is important to get a proper diagnosis from a specialist before any significant changes take place. Be sure that the referral "team" includes a rehab physician, or physiatrist. A great resource for finding information from, and about, qualified specialists is the network of Regional Spinal Cord Injury Centers that includes some of the best rehabilitation hospitals in the country. I found a very informative video about shoulder injuries at the website of one of these centers, and there is even more information available by asking Nurse Linda at our own Reeve Foundation site.
 
One reason for seeking out specialists is that discovering the source of pain can be difficult. Upper body pain might be caused by a pinched nerve, misplaced vertebra, muscle tear, arthritis, osteoporosis, recent injury or none of these causes. "Misalignment" of the spine, as evidenced by scoliosis or kyphosis caused by postural changes associated with aging or being in a wheelchair, can also contribute to this situation.
 
For specific conditions such as rotator cuff tears and other localized problems, more minimally-invasive procedures become available all the time. Surgical repair can be successful in the right patients. A consultation with an orthopedist who specializes in the shoulder can be helpful if that is the source of the pain. The problem, of course, is that the recuperation period after surgery often requires a number of weeks, or even months, without using that arm for transfers. The individual with paraplegia often requires attendant care or inpatient rehab during this process.
 
Prevention and rehabilitation should be the first priority, but accommodation is often necessary. Paraplegics overwork their shoulders and upper bodies on a daily basis, thanks to the repetitive actions and strength needed to propel a manual wheelchair (estimates are that the average wheelchair user has to push 2000 to 3000 times per day). They also suffer from the effects of periodic transfers needed to get in and out of their wheelchairs, especially if they are driving.
 
There are some fairly simple actions that might alleviate some of the pain and also prevent further damage. The new ergonomic handrims may make it easier to push a manual wheelchair, keeping the hands in a more natural position. There are also add-on devices that provide a power assist or the advantage of leverage, like the Smart Drive or the Wijit. They take some of the work out of movement, especially if pushing up hills.
 
The next step "up" may be a power wheelchair or scooter, which would entail possible changes in accessibility of the home environment and the manner in which driving takes place. Powered mobility can be a hassle, but for those who have significant shoulder arthritis a power wheelchair can sometimes make the difference between maintaining employment and community involvement instead of heightened disability and isolation.
 
Switching to a powered mobility device may make it necessary to use a wheelchair van for transportation. If the van is set up for driving from a wheelchair no additional transfers would be needed. The use of a swiveling transfer seat in the driver's position makes it possible for the driver to use the van seat instead of sitting in a wheelchair. That transfer would be easier than getting into a driver's seat from sidewalk or street level.
 
In order to take some of the work out of transferring at home, it is possible to purchase a manual patient lift or even a ceiling-mounted lift with a track that will help with transfers in and out of wheelchairs from bed or even move the individual into positions within the bathroom or other parts of the home. That is a relatively expensive option, but some models can be operated without assistance from others. If prescribed by a physician, medical insurance may cover at least some of the costs of purchase and installation; check with your provider on that.
 
Don't overlook the value of frequent exercise, stretching, a healthy diet and plenty of hydration. The cumulative impact of all of this may be to make "rolling around" a bit easier as aging continues.

© 2015 Michael Collins | Like Mike on Facebook
Posted by Community Admin on Feb 19, 2015 1:02 PM America/New_York

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