Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia

Abstract Background Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL. Methods In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ). Results A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 “physical component score” and “role limitations due to physical health” scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36. Conclusion Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.

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Re: Predictors of Long-term Bladder Management in Spinal Cord Injury Patients—Upper Extremity Function May Matter Most

European Urology ◽

10.1016/j.eururo.2019.03.030 ◽

2019 ◽

Vol 76 (2) ◽

pp. 255-256

Author(s):

Sean P. Elliott

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Upper Extremity ◽

Extremity Function ◽

Cord Injury ◽

Bladder Management ◽

Upper Extremity Function

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Comparison of Upper Extremity Function in Women With and Women Without a History of Breast Cancer

Physical Therapy ◽

10.1093/ptj/pzaa015 ◽

2020 ◽

Vol 100 (3) ◽

pp. 500-508 ◽

Cited By ~ 1

Author(s):

Mary Insana Fisher ◽

Gilson Capilouto ◽

Terry Malone ◽

Heather Bush ◽

Timothy L Uhl

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

Range Of Motion ◽

Upper Extremity ◽

Current Evidence ◽

Muscular Endurance ◽

Ctrl Group ◽

Extremity Function ◽

Upper Extremity Function

Abstract Background Breast cancer treatments often result in upper extremity functional limitations in both the short and long term. Current evidence makes comparisons against a baseline or contralateral limb, but does not consider changes in function associated with aging. Objective The objective of this study was to compare upper extremity function between women treated for breast cancer more than 12 months in the past and women without cancer. Design This was an observational cross-sectional study. Methods Women who were diagnosed with breast cancer and had a mean post–surgical treatment time of 51 months (range = 12–336 months) were compared with women who did not have breast cancer (CTRL group). Self-reported upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and shoulder range of motion, strength, and muscular endurance were measured. Participants were divided into 3 groups: breast cancer involving the nondominant limb (BC-ND), breast cancer involving the dominant limb (BC-DOM), and CTRL. Results A total of 59 women in the CTRL group, 23 women in the BC-ND group, and 28 women in the BC-DOM group completed measures. Mean DASH scores in women with breast cancer were higher than those of women in the CTRL group, regardless of the limb on which cancer occurred (Cohen d = 1.13; 95% CI = 2.20 to 16.21) Range of motion for the BC-ND group was significantly less for flexion (Cohen d = 1.19, 95% CI = −13.08 to −0.11) and external rotation (Cohen d = 1.11, 95% CI = −18.62 to −1.98) compared with the CTRL group. Strength in the BC-ND group was 23% to 25% lower in the CTRL group for external (Cohen’s d = 0.89, 95% CI = 0.09 to 0.12) and internal rotation (Cohen d = 0.92, 95% CI = 0.10 to 0.13). Endurance was not significantly different in the 3 groups. Limitations Some participants had rehabilitation, which may have skewed results. The range of post–surgical treatment times was broad, making it difficult to determine when function returned. Muscular endurance measures demonstrated a ceiling effect and large variance, limiting the ability to distinguish differences among participants. These results may not be generalizable to the subset of women who were treated with lumpectomy, sentinel node biopsy, or chest wall radiation alone or who underwent a contralateral prophylactic mastectomy. Conclusion In the long term, women with breast cancer have lower self-reported shoulder function than women without breast cancer. Motion and strength are lower among women who have experienced cancer on the nondominant limb.

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