Surgical Rehabilitation of the Tetraplegic Upper Extremity

Keith, Michael W.; Lacey, Stephen H.

doi:10.1177/136140969100500108

Cited by 30 publications

(22 citation statements)

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“…The aim in the first two phases (together referred to as the initial phase) is to prevent complications, to achieve optimal functioning within the limits of the neurological deficit and to create optimal conditions for the reconstructive phase. [4][5][6][7] In the latter phase, various options for surgical and functional electrical stimulation (FES) are available to improve positioning and stabilisation of the arm as well as key and palmar grasp function. [8][9][10][11][12] Implanted FES devices are usually combined with augmentative and substitutional reconstructive surgery.…”

Section: Introductionmentioning

confidence: 99%

Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics

et al. 2004

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Objective: To investigate the impact of upper extremity deficit in subjects with tetraplegia. Setting: The United Kingdom and The Netherlands. Study design: Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations. Main outcome parameter: Indication of expected improvement in quality of life (QOL) on a 5-point scale in relation to improvement in hand function and seven other SCI-related impairments.Results: In all, 565 subjects with tetraplegia returned the questionnaire (overall response of 42%). Results in the Dutch and the UK group were comparable. A total of 77% of the tetraplegics expected an important or very important improvement in QOL if their hand function improved. This is comparable to their expectations with regard to improvement in bladder and bowel function. All other items were scored lower. Conclusion: This is the first study in which the impact of upper extremity impairment has been assessed in a large sample of tetraplegic subjects and compared to other SCI-related impairments that have a major impact on the life of subjects with SCI. The present study indicates a high impact as well as a high priority for improvement in hand function in tetraplegics.

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Section: Introductionmentioning

confidence: 99%

Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics

et al. 2004

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“…Owing to current limitations, users are only given one wrist position or a tenodesis grasp (i.e. the wrist joint is stabilised by anchoring its tendons to a bone, so that grasp force increases when the wrist is extended and decreases when the wrist is flexed) (KEITH and LACEY, 1991), which eliminates the possibility for independent wrist control.…”

Section: Functional Electrical Stimulation (Fes) Is a Neuroprostheticmentioning

confidence: 99%

Computer-based test-bed for clinical assessment of hand/wrist feed-forward neuroprosthetic controllers using artificial neural networks

Luján

Crago

2004

Med. Biol. Eng. Comput.

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Neuroprosthestic systems can be used to restore hand grasp and wrist control in individuals with C5/C6 spinal cord injury. A computer-based system was developed for the implementation, tuning and clinical assessment of neuroprosthetic controllers, using off-the-shelf hardware and software. The computer system turned a Pentium III PC running Windows NT into a non-dedicated, real-time system for the control of neuroprostheses. Software execution (written using the high-level programming languages LabVIEW and MATLAB) was divided into two phases: training and real-time control. During the training phase, the computer system collected input/output data by stimulating the muscles and measuring the muscle outputs in real-time, analysed the recorded data, generated a set of training data and trained an artificial neural network (ANN)-based controller. During real-time control, the computer system stimulated the muscles using stimulus pulsewidths predicted by the ANN controller in response to a sampled input from an external command source, to provide independent control of hand grasp and wrist posture. System timing was stable, reliable and capable of providing muscle stimulation at frequencies up to 24Hz. To demonstrate the application of the test-bed, an ANN-based controller was implemented with three inputs and two independent channels of stimulation. The ANN controller's ability to control hand grasp and wrist angle independently was assessed by quantitative comparison of the outputs of the stimulated muscles with a set of desired grasp or wrist postures determined by the command signal. Controller performance results were mixed, but the platform provided the tools to implement and assess future controller designs.

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“…Tendon transfer procedures are commonly used to improve upper extremity function by restoring movements such as elbow extension, wrist extension, and grasp/release. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In addition, there are procedures to reduce contractures such as the rotational radial osteotomy to correct a forearm supination contracture or a biceps tendon lengthening to reduce elbow flexion contractures. [16][17][18][19][20][21] Tendon transfer procedures have traditionally been most effective for individuals who have sustained injuries at the C5-C7 level, as persons at this level have strong but redundant donor muscles to be used for providing additional function.…”

Section: Introductionmentioning

confidence: 99%

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

et al. 2004

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A mailed survey eliciting responses with respect to: (1) utilization of upper extremity reconstructive procedures and (2) the clinicians' perceived outcomes of these procedures. Results: In all, 76% responded positively about the availability and appropriateness of upper extremity surgical reconstruction at their center. Of the respondents, 75% felt that surgery recipients were generally satisfied with their surgeries, 80% felt that the surgery made a positive impact on recipients' lives, 81% felt that recipients showed increased independence, and 70% reported a positive impact on recipients' occupation. In all, 93% felt insurance companies should pay for the procedures. Compared to the satisfaction of surgery recipients using a similar instrument, clinicians anticipated slightly greater improvements in all areas except occupation. Conclusions: There is a positive perception of the benefits of reconstructive surgery for tetraplegia; however, procedures are not routinely offered at all centers. The primary reasons reported for this include the misconception that insurance does not remit payment, that a surgeon is not available, and that surgical candidates are referred to another center.

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Surgical Rehabilitation of the Tetraplegic Upper Extremity

Cited by 30 publications

References 0 publications

Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics

Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics

Computer-based test-bed for clinical assessment of hand/wrist feed-forward neuroprosthetic controllers using artificial neural networks

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

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