Activity gains after upper limb surgery for spasticity in patients with spinal cord injury

Wangdell, Johanna; Reinholdt, Carina; Fridén, Jan

doi:10.1177/1753193418758852

Cited by 12 publications

(8 citation statements)

References 25 publications

(31 reference statements)

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“…A mean of 1.4 improvements in MAS and significant improvement in resting position, improvement of the wrist, finger, and thumb passive ROM and active were reported. Wangdell et al ( 5 ) reported the result of the procedure of tendon lengthening for wrist flexors and finger flexors combined with the additional procedure of pronator teres, thumb adductor, and intrinsic tendon release if necessary, in tetraplegic, SCI patients. The most common tendons lengthened were flexor digitorum superficialis (FDS).…”

Section: Resultsmentioning

confidence: 99%

“…These manifestations of hypertonicity are the main complication in many upper motor neuron disorders, such as cerebral palsy (CP), traumatic brain injury (TBI), stroke, multiple sclerosis (MS), and spinal cord injury (SCI), with about 40% prevalence in patients after stroke ( 3 ) and 65% in patients with SCI ( 4 ). Spasticity may lead to stiffness of the affected muscles, joints, and surrounding soft tissue and ultimately contracture ( 5 ). Restricted range of motion (ROM) due to spasticity or contracture may cause pain, skin breakdown, and have a significant influence on daily activities including mobility, feeding, hygiene, and dressing.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Hashemi

Sturbois-Nachef

Keenan

et al. 2021

Front. Rehabilit. Sci.

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Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Hashemi

Sturbois-Nachef

Keenan

et al. 2021

Front. Rehabilit. Sci.

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“…According to the standard procedure at our centre, early active rehabilitation was applied in patients assigned to the high and medium rehabilitation levels. This promotes early active mobilization of sutured tendons and surrounding tissues and thus maintenance of ADL (Friden et al., 2010; Wangdell et al., 2016, 2018). All patients received wrapping and a custom-made splint (plaster in the low intensity group) for day and night use to prevent swelling, to maintain the length of the operated tendons and to prevent contractures.…”

Section: Methodsmentioning

confidence: 99%

Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients

Bergfeldt

Strömberg

Ramström

et al. 2020

J Hand Surg Eur Vol

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The effects of spasticity-reducing surgery in the upper extremity were assessed in a prospective observational study of 30 consecutive patients with stroke ( n = 13), incomplete spinal cord injury ( n = 9), traumatic brain injury ( n = 5), cerebral palsy ( n = 2), and degenerative central nervous system disease ( n = 1). Surgery, which included lengthening of tendons and release of muscles, was followed by early rehabilitation at three intensity levels depending on the patients’ specific needs and conditions. At 12 months follow-up there were significant improvements in all outcome measures with the following mean values: spasticity decreased by 1.4 points (Modified Ashworth Scale, 0–5), visual analogue pain score by 1.3 points, and both Canadian Occupational Performance Measures increased (performance by 3.4 and satisfaction by 3.6), and most measures of joint position or mobility improved. Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients’ satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. Level of evidence: II

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“…To the best of our knowledge, this is the first study to report and classify POPG according to ICF in a cohort of patients stratified in groups based on diagnosis, gender, and severity of UL impairment. Previous reports exist on the same theme but involve patients with disabling spasticity who are receiving botulinum toxin treatment [24,25] or are limited to patients with SCI only [26]. COPM has previously been used to demonstrate positive POPG outcomes in a mixed population undergoing spasticity-correcting surgery [12] and with patients split into regimens [13].…”

Section: Discussionmentioning

confidence: 99%

Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health

Ramström

Wangdell

Reinholdt

et al. 2022

Occupational Therapy International

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Background. Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks. Objectives. The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength. Methods. In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation. Results. 60 patients with a history of spinal cord injury (SCI) ( n = 42 ; 59%), stroke ( n = 25 ; 34%), traumatic brain injury (TBI) ( n = 4 ; 6%), and reason unknown ( n = 1 ; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care ( n = 131 ; 41%), domestic life ( n = 68 ; 21%), and mobility ( n = 58 ; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown. Conclusion. Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.

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Activity gains after upper limb surgery for spasticity in patients with spinal cord injury

Abstract: IV.

Cited by 12 publications

References 25 publications

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients

Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health

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