Mobile Arm Supports: Evidence-Based Benefits and Criteria for Use

Abstract

Background/Objective: To collect data from therapists regarding criteria for use and activities that individuals with C4-C5 tetraplegia can perform using a mobile arm support (MAS) that they otherwise could not. Reasons for nonuse, equipment design limitations, and therapist training needs were also studied. Methods: A modified Delphi approach was used to conduct an e-mail survey for which the response to each question was analyzed and used to formulate the subsequent question. Setting: Rehabilitation centers. Participants: Eighteen occupational therapists (most affiliated with 1 of the federally designated Model Spinal Cord Injury Systems) with extensive experience in the treatment of individuals with spinal cord injury (SCI). Results: The key physical prerequisite for successful use of the MAS was at least minimal strength of the deltoid and biceps muscles; 92% of respondents indicated that they would fit an MAS for motivated patients having very weak (,2/5) biceps and deltoid muscles. According to the therapists, 100% (n ¼ 30) of their clients were able to perform at least 1 activity using a MAS that they were unable to perform without the device. These activities included (in descending frequency) eating, page turning, driving a power wheelchair, brushing teeth, keyboarding, writing, name signing, drawing, painting, scratching nose, playing board games, accessing electronic devices, drinking, and grooming. Equipment design limitations included increased wheelchair width and problems managing the arms while reclining. Conclusions: Mobile arm supports allow persons with C4-C5 tetraplegia to engage in activities that they otherwise cannot perform with their arms.

International Spinal Cord Injury Upper Extremity Basic Data Set

“…Suspension and arm support devices are used in individuals with C4-C5 tetraplegia and found to be beneficial; however, evidence about their efficacy is unavailable. 20 Standardisation of splinting protocols was found to be difficult, 21 but recommendations about usage of different types of splints are published in textbooks. 22,23 A number of adaptations of writing material, cutlery and ADL equipment (quite often individually made) can be used to enhance usage of impaired upper extremity function.…”

Use of powered mobile arm supports by people with neuromuscular conditions

“…However, even these latter aspects may reduce carer strain, which could have an indirect effect on care costs and health service utilization. The effects on various ADLs, such as eating, drinking, using a keyboard, and adjusting spectacles, have been noted in previous studies [4,6,[16][17][18]. The reported effects on posture and gastrointestinal symptoms are new observations that could have secondary implications for respiratory function and comfort.…”

Influence of gravity compensation on kinematics and muscle activation patterns during reach and retrieval in subjects with cervical spinal cord injury: An explorative study

“…Another type of arm support by subjects with a CSCI was studied by Atkins et al [7]. They reported about the effect of mobile arm support on ADLs.…”

“…We presume that during goal-directed movements, a large part of the preserved muscle force is required to hold the arm against gravity; consequently, less muscle force is available to perform the actual movements. To facilitate goal-directed arm movements during activities of daily living (ADLs) [7] or exercise therapy, therapeutic devices are often used to support the weight of the arm (e.g., with the Swedish Help Arm [Kinsman Enterprises, Inc; West Frankfort, Illinois]). In the last decade, several innovative therapeutic devices, including robotics, have been developed to support the affected upper limb during exercise therapy [8][9].…”