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dc.contributor.authorHill, Bridget-
dc.contributor.othervan Zyl, Natasha-
dc.contributor.otherCooper, Catherine-
dc.contributor.otherHahn, Jodie-
dc.contributor.otherGalea, Mary-
dc.identifier.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.en_US
dc.descriptionSupplementary materials include, one supplementary appendix and three supplementary videos.en_US
dc.description.abstractIn 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.en_US
dc.subjectCervical Spinal Cord Injuryen_US
dc.subjectTendon-Based Techniquesen_US
dc.subjectNerve Transfersen_US
dc.subjectNerve Transfer Surgeryen_US
dc.subjectUpper Limben_US
dc.subjectUpper Limb Functionen_US
dc.subjectAction Research Arm Testen_US
dc.subjectGrasp Release Testen_US
dc.subjectSpinal Cord Independence Measureen_US
dc.subjectTraumatic Spinal Cord Injuryen_US
dc.subjectTendon Transfersen_US
dc.subjectUpper Limb Reanimationen_US
dc.subjectHand Functionen_US
dc.subjectUpper Extremity Functionen_US
dc.subjectCanadian Occupational Performance Measureen_US
dc.subjectEpworth Monash Rehabilitation Medicine Unit, Melbourne, VIC, Australiaen_US
dc.subjectRehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australiaen_US
dc.titleExpanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case seriesen_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleThe Lanceten_US
dc.description.affiliatesDepartment of Plastic and Reconstructive Surgery, Austin Health, Melbourne, VIC, Australiaen_US
dc.description.affiliatesDepartment of Occupational Therapy, Austin Health, Melbourne, VIC, Australiaen_US
dc.description.affiliatesVictorian Spinal Cord Service, Austin Health, Melbourne, VIC, Australiaen_US
dc.description.affiliatesDepartment of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australiaen_US
dc.type.studyortrialCase Series and Case Reportsen_US
Appears in Collections:Musculoskeletal

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