The functional limitations of tetraplegic hands for intermittent clean self-catheterisation

Abstract

Si � c � the introduction of intermittent s � lf-catheterisation by Lapides et ai, 1 low pressure vOldmg methods have been adopted acttvely in our centre. A retrospective review of 47 p atien � s with cervic � l s l? inal cord inju � y (CSC!) who performed independent (self) clean mtermlttent cathetensatton (CIC) on dIscharge IS presented. Their functional abilities were evaluated by both the Frankel 2 and the Zancolli scales. 3 Fourteen out of the 47 patients could I? anage ind � pende !l t CIC, 17 � ssisted CIC, nine tapped or voided voluntarily, two were dIscharged WIth a dIaper, one WIth a suprapubic catheter, and four with an indwelling cath � ter. Accor . din � to Frankel's classification, four patients were in A category, four in B, one m � and flve m D among the group of complete CIC. C6A/C5B (right/left hand) by Za t;I colh's classification was the highest level of ability for all these 14 patients; and one pattent (a 30-year-old male, Frankel B classification) could manage independent CIC with the aid of our special device. However, the practical limit of functional hands for independent CIC appeared to be about C6Bl.

Intermittent self-catheterization in tetraplegic patients: a 6-year experience gained in the spinal cord unit in Prague

“…Apart from compliance and motivation, biceps and wrist extensor muscle strength is a crucial factor. 8 To illustrate the outcomes of the Spinal Cord Unit, patients with tetraplegia with a complete motor SCI were selected and stratified into four groups according to the motor level of injury. In group 2 (C5), particular focus was placed on the wrist muscle strength.…”

“…The most common reason for not including these patients in the group with a C6 level SCI is that, at least unilaterally, brachial biceps muscle strength is grade 4 or wrist extensor muscle strength is grade 2 on the worse side. 8 Six patients in this group preferred IC, whereas five patients continued to use an indwelling suprapubic catheter. Nevertheless, 8 months after injury, two patients performing IC still had to undergo cystostomy as a rescue option.…”

Self-catheterization acquisition after hand reanimation protocols in C5–C7 tetraplegic patients

“…The overall success for ISC ranges from 20 to 30% in the whole tetraplegic population. 8 In contrast, the majority of C8 level patients can perform ISC with active pinch and grasp holds. 9 Hand function can be improved by upper limb reanimation (ULR) protocols consisting of reconstructive surgery 10,11 (tendon transfers, tenodeses and arthrodeses) combined with specific rehabilitation procedures (tasked motor training, biofeedback and new muscle-function integration).…”

Improvement of urological-management abilities in individuals with tetraplegia by reconstructive hand surgery

“…However, there are a limited number of reports 7,8 which have examined in detail the ability of tetraplegic patients to manage CIC as a function of neurological level of injury (NLI). Unlike paraplegia, the residual hand function of people with tetraplegia very much depends on the spinal cord injury level, with dierences being particularly marked at the C6 level.…”

“…However, many tetraplegic patients with inadequate hand function depend on family members or care attendants for assisted catheterization. 7,13 At the Nagano Rehabilitation Center, reconstructive hand surgery has been performed since 1977 14 in suitable tetraplegic patients to increase their independence in terms of ADL and urological management.…”