C6 complete
Key muscles:
- Wrist Extensors (bend your wrist back)
- Serratus Anterior (hold shoulder blade in position)
- Latissimus Dorsi (helps to lift pelvis towards shoulders when weight bearing on your arms)
With several muscles working around the shoulders you will be able to learn to balance and move independently.
You are likely to require assistance for some movement tasks, particularly in the initial stages after your injury. You will be able to lean on your hands or elbows and push with your shoulders with some force. You will be able to lift and move your body by leaning on your arms with your elbows locked. You will also be able to use your arms to push a manual wheelchair as well as perform many other daily tasks independently.
You will be able to lift your hands to your face for eating and grooming, use your arms to help with dressing, rolling and transferring and you will be able to use your wrist extensors to form a tenodesis grasp. This compensatory movement will allow you to pick up and hold items in your hand even though the muscles that move your fingers are not working. You can learn to push a manual wheelchair using your biceps to ‘pull’ on the wheels.
Balance strategies:
You will have some ability to maintain your body position when you are in a sitting position by moving your head and arms. When you are sitting without support for your trunk, you will need to use a series of movements back and forth to keep your balance unless you put your hands down to lean on. You can learn to throw your head and arms backwards and catch yourself to lean on your hands. This is called propping. You need to get your elbows into a locked position and learn how to move your hands around to change your arm position without letting your elbows bend.
When you are sitting in your wheelchair, with your trunk supported you will have more balance. Performing two handed tasks can be a challenge but learning how to counter balance the weight of your arms by leaning your head back can help. Practice in your wheelchair by loosening your chest strap. Explore how changes in your head and arm position can shift your weight. Make sure you have someone spotting you.
You will be able to balance for safety and function but you may need some equipment to assist you. You can learn to hook your elbow on your wheelchair to stabilise yourself and to lean forward or to the side without falling. Wearing a chest strap can stop you from falling forward while sitting in your wheelchair. Many people with a C6 injury eventually stop needing to wear a chest strap but most of them have learned the skill of getting up from being bent forward before they do this (just in case they fall forward).
If using a power wheelchair, make use of the tilt in space function in your wheelchair to rest back from upright. This allows gravity to push you back into your backrest rather than falling forward.
Moving on the bed:
You will have some ability to move on the bed although you may require equipment and sometimes assistance to change positions.
You can learn how to sit in a bent forward position called long sitting (with your legs out in front of you on the bed). Then you can learn to move from this bent forward position to a leaning back position, by throwing your head and arms back and landing in the prop position.
Once you have learned to prop, then you can learn to move forward from the prop position and use your arms to push down on the bed to lift your bottom. A special lifting and twisting technique means you can move your bottom across the bed. Maintaining balance on one arm and moving your legs with the other is another important part of moving across the bed. You can learn how to balance on one arm and how to lean down on to your elbow and move around and how to get back up. If you combine this skill with rolling, then you are able to get from lying on your back to sitting up on the bed independently.
You may be able to learn how to roll over on to your side using a pulling technique (hooking your hand onto the edge of the bed or your wheelchair and pulling your body over). Some people also use a bed ladder to assist with this move. You may still require assistance to get in a comfortable position for sleeping.
You can also learn to use mechanical features of your bed and a bed ladder to get yourself into an upright sitting position (with your legs out in front of you on the bed).
Transferring:
Some people with a C6 injury use a hoist for their daily transfers on and off the bed. This can reduce strain for people helping and can also be quicker and safer than trying to perform multiple repetitions of the other transfers discussed here.
If you are able to balance and prop in a short sitting position (with your legs down over the edge of the bed) and you are able to lift and move your bottom across the bed, then you can learn to perform a slide board transfer with assistance. You will need to be able to keep your elbows in a locked position and push down on your arms to get some lift of your bottom. Moving across the slide board requires a specific technique of lift and twist and is difficult to master in the short sitting position. Balance and timing are the key features of this skill, not just strength!
Some people with a C6 injury are able to learn to perform this transfer without a slide board. This lift transfer requires very good balance and an ability to lift your bottom in the short sitting position. Some people with a C6 injury are able to transfer on and off the bed independently using a legs up technique. This helps with balance but can place additional strain on your shoulders and may put you at risk of damaging your skin from friction.
Once you have mastered the basic lift transfer then getting on and off a variety of things becomes possible: couch, hand cycle, car, shower bench, toilet to name a few. Transferring up or down a height difference can be difficult without triceps function, (the muscle that straightens the elbow and holds it steady in a bent position), but there are people with a C6 injury that can transfer between two different heights without physical assistance.
Many people with C6 injury are able to learn how to transfer into a car; some people are able to get themselves and their wheelchair in the car independently although many people need assistance. Most people also need to use a slide board.
Equipment to get around:
Many people with a C6 injury are able to use a manual wheelchair for some mobility. Limited function of your arm muscles can mean this is very tiring, takes a long time and might cause shoulder pain. You might need to wear special gloves (push mitts) with grip to help you get traction on the push rim. You will need help to negotiate slopes, gutters and soft terrain like grass.
Some people with a C6 injury use motorised wheels on their manual chair to be able to push their chair independently in more situations. The wheels magnify the force of pushing, making it easier to push with weak muscles. These wheels are called power assist technology.
Many people with a C6 injury use both a manual and power wheelchair. You can learn to drive a power wheelchair with your arm and hand. You will need a special joystick knob to be able to steer the chair and you might need a splint or brace to support your wrist and hand. You might also need special buttons (spec switches) to be able to use the functions of the chair.
Power wheelchairs can cover up to 25 kms per day but they will not get you everywhere you need to go. People who use power chairs travel in a modified vehicle that transports them sitting in their wheelchair. Some vehicles have lowered floors to drive the chair straight in, others have ramps and some have hydraulic hoists that can lift you and the chair up into the vehicle.
Some people with a C6 injury are able to drive. They use hand controls to allow them to operate the vehicle. Many people who drive are able to transfer into their car and also get their wheelchair into the car as well. Some people who drive remain in their wheelchair and drive a customised vehicle that allows them to wheel up to the driving position where they dock their wheelchair into place.
In the video & images below Naz shows how he gets into his car. Naz has C6 quadriplegia.
Equipment to exercise:
You can learn to use straps, foam blocks and your wheelchair to be positioned using your body weight for stretch. You may need assistance to move into some of the positions but should be able to remain in the stretch without someone helping. This will help you maintain flexibility in your body which can help reduce pain and spasm.
You can use rubber tubing (Theraband) to perform strengthening exercises for your arms. Take care not to use a band that is too strong as this can cause shoulder blade winging and can lead to shoulder pain. Ask for an assessment from a physiotherapist or exercise physiologist to make sure you are using the correct technique and that you are performing the best exercises for you.
You have limited options for fitness training available because of the small number of muscles you have working. Many people do not undertake regular exercise for fitness and face the future problems of a sedentary life. You can use an arm crank machine to perform fitness training. FES cycling is another option that is effective for providing cardio-vascular exercise. The cycling equipment requires expert knowledge to set up and trial, it is also very expensive.
