Possible restorations of the upper extremity motion in tetraplegic patients - 5-year clinical experience

Abstract

Aim:The aim of the work is to objectify the functional effectiveness of these operations and their influence on the quality of life of handicapped patients.Method: The authors evaluate the results of reconstructive surgery restoring hand grip in a group of 15 tetraplegic patients (3 women and 12 men) with complete spinal cord lesion of C5-C7 segments. The average age of patients in the group is 33 (22-50) years old. The reconstructions were performed using tendon transfer and tenodesis in the forearm and hand area. The effectiveness of the transfer was assessed objectively with regard to muscle strength by measuring the restored "thumb-index finger" grip and "into fist" grip. The range of motion achieved was also evaluated. Transfer effectiveness was evaluated on the basis of subjective patients' evaluation. An ADL (activities of daily living) questionnaire by Mohammed's (1992) took into account the effect of the surgery in a whole range of common daily activities.Results: An extended range of daily activities was evident mainly in the fields of: communication, eating and drinking and operations associated with increase in general selfcare of the patient. There was no deterioration of condition in any of the activities.Conclusions: Up to 80 % of tetraplegic patients are suitable candidates for transfers and, to a certain extent, it is possible to improve the upper limb function. In a partial function restoration of the upper limbs there is immense potential for improvement in the quality of life of these patients.

Biomechanical evaluation of wrist-driven flexor hinge orthosis in persons with spinal cord injury

“…Until now, other rehabilitative approaches also have been attempted to improve hand function in persons with tetraplegic SCI [18][19][20][21][22][23][24][25]. Functional electrical stimulation (FES) enables persons with tetraplegia to restore grasp function [18][19][20][21][22].…”

“…This system uses electrical current pulses to excite nerves going to paralyzed muscles and provokes contraction of the muscles required for grasp and release. In addition, reconstructive surgery can be performed to transfer active muscles or shorten tendons to enhance grasp force [23][24][25].…”

Toronto Rehabilitation Institute–Hand Function Test: Assessment of Gross Motor Function in Individuals With Spinal Cord Injury

“…The TRI-HFT has been designed to be used to assess the effectiveness of (a) hand therapies; (b) neuroprosthesis for grasping as an orthosis (ie, as a permanent assistive device) in ADLs; (c) FES therapy for restoring voluntary grasping function 1,2,8 ; and (d) surgical restoration options such as tendon transfer surgeries. 29 The purpose of this study was to establish the reliability, construct validity, and sensitivity of the TRI-HFT as an evaluation tool for use in patients with SCI and to assess the unilateral gross motor function of their hand to perform lateral pinch, pulp pinch, and palmar grasp.…”