To transfer from a wheelchair to a mat for a patient with C6 quadriplegia, which wrist/hand position is part of the functional transfer?

To transfer from a wheelchair to a mat for a patient with C6 quadriplegia, which wrist/hand position is part of the functional transfer?

• A. Fingers extended with the wrist in neutral
• B. Wrist neutral, fingers extended
• C. Wrist slightly extended, fingers flexed at MCP, PIP, DIP, thumb abducted
• D. Wrist flexed, fingers flexed

Answer: (C)

Tenodesis grasp is the mechanism at play here. With C6 quadriplegia, the wrist extensors are preserved, so extending the wrist causes the fingers to automatically flex through the intact flexor mechanisms. For a safe transfer from a wheelchair to a mat, you want that handshake-like grip to form without requiring active finger flexion. Positioning the wrist in slight extension (about 20 degrees) while the fingers are flexed at the MCP, PIP, and DIP and the thumb abducted creates a secure grip on the edge of the mat. This combination uses the functional pattern available at C6 to enable a stable transfer. If the wrist is neutral or flexed, or if the fingers are flexed but the wrist isn’t extended, you don’t engage the tenodesis mechanism, so a reliable grip isn’t produced, making a transfer harder or unsafe.

Tenodesis grasp is the mechanism at play here. With C6 quadriplegia, the wrist extensors are preserved, so extending the wrist causes the fingers to automatically flex through the intact flexor mechanisms. For a safe transfer from a wheelchair to a mat, you want that handshake-like grip to form without requiring active finger flexion. Positioning the wrist in slight extension (about 20 degrees) while the fingers are flexed at the MCP, PIP, and DIP and the thumb abducted creates a secure grip on the edge of the mat. This combination uses the functional pattern available at C6 to enable a stable transfer.

If the wrist is neutral or flexed, or if the fingers are flexed but the wrist isn’t extended, you don’t engage the tenodesis mechanism, so a reliable grip isn’t produced, making a transfer harder or unsafe.