600 Section - Hand Rehabilitation in C6 Tetraplegia: A Case Report from a Low-Resource Setting

Case Diagnosis: A C6 cervical spinal cord injury with bowel bladder function impairment due to fall from tree. Admitted to  in CRP inpatient unit  for rehabilitation after  anterior cervical fixation at C7 skeletal level.

Case Description: A 13-year-old boy from  Bangladesh, sustained a complete C6 SCI. On Occupational therapy assessment revealed severe upper-limb weakness: shoulder flexors 3/5, elbow flexors 3/5, wrist extensors 2/5, elbow extensors 2/5, and finger flexors 0/5. Hand function assessment showed absent hook and cylindrical grasps (0/4) and minimal tenodesis grasp (1/4). Grip and pinch strength were 0 kg. Passive range of motion was full, with no edema or contracture. Functionally, he was highly dependent, with a SCIM score of 11/100. His primary rehabilitation goals included performing activities of daily living (ADLs) and returning to school.

Discussions: C6 complete tetraplegia significantly limits functional independence, particularly hand and upper-limb function, essential for self-care, education, and social participation. Individuals retain wrist extension but lack finger flexion and intrinsic hand function, making tenodesis grasp a key compensatory mechanism. In Atik’s case, severe wrist and finger weakness initially restricted ADLs and school participation. Rehabilitation focused on structured tenodesis training using a customized splint and belt with scheduled wearing, positioning, and task-specific exercises to optimize grasp and release for feeding, writing, handling objects, wheelchair propulsion, and transfers. Education emphasized avoiding overstretching and incorporating tenodesis in daily activities. Functional practice utilized locally available tools such as tenodesis writing splints and feeding aids. In low-resource settings, limited therapy tools and assistive devices require innovative, cost-effective strategies. This case demonstrates that structured, patient-centered tenodesis training and adaptive strategies can achieve meaningful functional improvements and enhance independence, even under resource constraints.

Conclusions:  

Hand rehabilitation for individuals with C6 tetraplegia can achieve meaningful functional gains even in low-resource settings where reconstructive surgery and advanced training equipment are unavailable. Level-specific training is essential.