Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1678
Title: Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series
Authors: Hill, Bridget
Other Authors: van Zyl, Natasha
Cooper, Catherine
Hahn, Jodie
Galea, Mary P
Keywords: Cervical Spinal Cord Injury
Tetraplegia
Tendon-Based Techniques
Nerve Transfers
Nerve Transfer Surgery
Upper Limb
Upper Limb Function
Action Research Arm Test
ARAT
Grasp Release Test
GRT
Spinal Cord Independence Measure
SCIM
Traumatic Spinal Cord Injury
Tendon Transfers
Upper Limb Reanimation
Hand Function
Upper Extremity Function
Canadian Occupational Performance Measure
COMP
Epworth Monash Rehabilitation Medicine Unit, Melbourne, VIC, Australia
Epworth HealthCare, Vic, Australia
Issue Date: Jul-2019
Publisher: Elservier
Citation: (2019). Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series. The Lancet.
Abstract: In this prospective case series, we consecutively recruited people of any age with early (<18 months post-injury) cervical spinal cord injury of motor level C5 and below, who had been referred to a single centre for upper extremity reanimation and were deemed suitable for nerve transfer. All participants underwent single or multiple nerve transfers in one or both upper limbs, sometimes combined with tendon transfers, for restoration of elbow extension, grasp, pinch, and hand opening. Participants were assessed at 12 months and 24 months post-surgery. Primary outcome measures were the action research arm test (ARAT), grasp release test (GRT), and spinal cord independence measure (SCIM). we recruited 16 participants (27 limbs) with traumatic spinal cord injury, among whom 59 nerve transfers were done. In ten participants (12 limbs), nerve transfers were combined with tendon transfers. 24-month follow-up data were unavailable for three patients (five limbs). At 24 months, significant improvements from baseline in median ARAT total score (34·0 [IQR 24·0-38·3] at 24 months vs 16·5 [12·0-22·0] at baseline, p<0·0001) and GRT total score (125·2 [65·1-154·4] vs 35·0 [21·0-52·3], p<0·0001) were observed. Mean total SCIM score and mobility in the room and toilet SCIM score improved by more than the minimal detectable change and the minimal clinically important difference, and the mean self-care SCIM score improved by more than the minimal detectable change between baseline and 24 months. Median Medical Research Council strength grades were 3 (IQR 2-3) for triceps and 4 (IQR 4-4) for digital extensor muscles after 24 months. Mean grasp strength at 24 months was 3·2 kg (SD 1·5) in participants who underwent distal nerve transfers (n=5), 2·8 kg (3·2) in those who had proximal nerve transfers (n=9), and 3·9 kg (2·4) in those who had tendon transfers (n=8). There were six adverse events related to the surgery, none of which had any ongoing functional consequences.
Description: Supplementary materials include, one supplementary appendix and three supplementary videos.
URI: http://hdl.handle.net/11434/1678
DOI: 10.1016/S0140-6736(19)31143-2
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/31280969
ISSN: 1474-547X
Journal Title: The Lancet
Type: Journal Article
Affiliated Organisations: Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, VIC, Australia
Department of Occupational Therapy, Austin Health, Melbourne, VIC, Australia
Victorian Spinal Cord Service, Austin Health, Melbourne, VIC, Australia
Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australia
Type of Clinical Study or Trial: Case Series and Case Reports
Appears in Collections:Musculoskeletal
Rehabilitation

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