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.

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Upper extremity surgical reconstruction can play an important role In helping the spinal cord injured quadriplegic patient achieve maximum independence in a variety of activities of daily living. The transfer of the brachioradialis to the extensor carpi radialis brevis, the brachioradialis to the flexor pollicis longus, and the posterior deltoid to the triceps each provide opportunities for functional improvement in this patient group. The occupational therapist's understanding of functional potentials and problems unique to spinal cord injury provides a realistic perspective to the team on potential benefits of each surgery. The occupational therapist also plays a critical role in identifying appropriate surgical candidates, in establishing treatment goals with the patient, and in administering a carefully planned post-operative treatment program.

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