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Self-Catheterization Post-Cervical Spinal Cord Injury: Hand and Upper Extremity Rehabilitation

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Handbook of Neurourology

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Abstract

Bladder dysfunction caused by the development of a neurogenic bladder as a consequence of spinal cord injury (SCI) poses a significant threat to the wellbeing of patients. One of the most disabling aspects of tetraplegia following SCI is the loss of useful hand function. Clean self-intermittent catheterization (CSIC) is the preferred method of bladder emptying, but reduced hand dexterity challenges the independent management of this technique. Although there is no single, recommended management program that works for every patient, it is widely recognized that treatment directed to the hand and upper extremity (UE) should begin early in the acute phase of care. Evidence suggests that long-term rehabilitation also yields functional improvements.

Interdisciplinary team (IDT) collaboration and problem solving are required to learn CSIC techniques. Urologists, urology nurses, occupational therapists, and physiotherapists have complementary clinical knowledge, roles, and skills that can support patients with cervical SCI to achieve independence with CSIC. Urology reviews and follow-up may identify UE factors limiting a patient’s ability to perform CSIC warranting need for rehabilitation interventions that are tailored to optimize hand and UE function for this specific activity.

Rehabilitation of a tetraplegic hand can be thought of as the prudent application of non-operative and operative interventions, individualized to each patient, and designed to maximize function taking the patient’s psychosocial and medical status into account. This chapter discusses considerations for hand and UE assessment and intervention post-cervical SCI when considering CSIC. Non-operative approaches that focus on restorative interventions such as optimizing joint movement and grip strength, in addition to compensatory strategies such as splinting, adaptive equipment, modified techniques, and materials (e.g., catheter types), will be outlined. International consensus suggests that to maximize UE function, reanimation of the UE using tendon and/or nerve transfers should be considered for each patient. There is evidence to suggest that this intervention enhances ability to self-catheterize.

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Authors and Affiliations

  1. Clinical Specialist Occupational Therapist & Certified Hand Therapist, Beaumont Hospital, Dublin, Ireland

    Gillian Gavaghan

  2. Clinical Specialist Occupational Therapist, Spinal Cord System of Care Programme, National Rehabilitation Hospital, Dublin, Ireland

    Fiona Maye

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  1. Gillian Gavaghan
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  2. Fiona Maye
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Correspondence to Gillian Gavaghan .

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  1. Department of Urology Department of Neurourology, China Rehabiliation Research Center China Rehabilitation Science InstituteCapital Medical University, Beijing, China

    Limin Liao

  2. Department of Urology, Medical University Innsbruck, University Hospital, Innsbruck, Austria

    Helmut Madersbacher

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Gavaghan, G., Maye, F. (2023). Self-Catheterization Post-Cervical Spinal Cord Injury: Hand and Upper Extremity Rehabilitation. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1659-7_73

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