Friday, May 7, 2010

Preparation for upper limb reconstruction by occupational therapist Johanna Wangdell

The final decision to undergo surgical reconstruction of upper extremity function is made after thorough considerations of pros and cons. Persons living with tetraplegia hesitate to become more dependent even though it is temporary. Therefore it is essential to reduce the extent of postoperative dependency as much as possible. Restrictions no doubt exist after surgery to protect the newly reconstructed functions but nevertheless much can be done to prevent tissue swelling by using muscle pump and to retain a generally good physical shape. Most patients have struggled quite a lot to reach a “normal” level of physical and psychological status and maintaining this accomplishment as far as possible is critical also during the surgical rehabilitation. Preparations prior to surgery must include detailed information and discussion about restrictions and what consequences these limitations will have for the individual in daily life. The ability to transfer both to the wheelchair and in the wheelchair, intimate self-care and the ability to work are common matters brought up before surgery. Specific transfer training and different parts of ADL training with new techniques and aids are necessary in order to maintain independence. Ability to maintain pressure relief might be limited and needs to be addressed. Analysis and, if necessary, modification of sitting position in the wheelchair is another important aspect of preparation to prevent pressure sore.