Upper Extremity Surgery in Tetraplegia and the Online Information Void

Hand ◽  
2019 ◽  
pp. 155894471987883
Author(s):  
Shuting Zhong ◽  
Gabriella E. Reed ◽  
Loree K. Kalliainen
Keyword(s):  
Upper Extremity ◽  
Health Care Providers ◽  
Key Words And Phrases ◽  
Online Information ◽  
Care Providers ◽  
Online Content ◽  
Nerve Transfers ◽  
Extremity Function ◽  
Surgical Options ◽  
Upper Extremity Function

Background: People with tetraplegia lack awareness of, and subsequently underutilize, reconstructive surgery to improve upper extremity function. This is a topic of international discussion. To bridge the information gap, proposed mandates encourage providers to discuss surgical options with all tetraplegic patients. Outside of the clinical setting, little is known about information available to patients and caregivers—particularly online. The purpose of this study is to evaluate online content for surgical options for improved upper extremity function for people with tetraplegia. Methods: A sample of online content was generated using common search engines and 2 categories of key words and phrases, general and specific. Articles on the first 2 search pages were evaluated for content and audience. Results: A total of 76 different search results appeared on the first 2 pages using 8 unique search phrases. Of articles generated from general phrases, only 5% mentioned tendon or nerve transfers in tetraplegia. When more specific key search phrases were used, the number of lay articles increased to 71%. Conclusions: Based on initial results, general online information on the management of tetraplegia largely excludes discussions of upper limb reconstruction and the well-known benefits. Unless patients, their caregivers, and nonsurgical health care providers have baseline knowledge of tendon and/or nerve transfers, they are unlikely to obtain de novo awareness of surgical options with self-initiated searches. Thus, the challenge and opportunity is to revise the online dialogue to include upper extremity surgery as a fundamental tenet of tetraplegia care.

Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

2015 ◽  
Vol 136 (4) ◽  
pp. 780-792 ◽  
Author(s):  
Ida K. Fox ◽  
Kristen M. Davidge ◽  
Christine B. Novak ◽  
Gwendolyn Hoben ◽  
Lorna C. Kahn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Nerve Transfers ◽  
Extremity Function ◽  
Cord Injury ◽  
Upper Extremity Function

The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

PM&R ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1173-1184.e2 ◽  
Author(s):  
Ida K. Fox ◽  
Christine B. Novak ◽  
Emily M. Krauss ◽  
Gwendolyn M. Hoben ◽  
Craig M. Zaidman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Nerve Transfers ◽  
Extremity Function ◽  
Cord Injury ◽  
Upper Extremity Function

Nerve Transfers to Improve Upper Extremity Function

2015 ◽  
pp. 275-306
Author(s):  
Amy M. Moore ◽  
Benjamin Z. Phillips ◽  
Susan E. Mackinnon
Keyword(s):  
Upper Extremity ◽  
Nerve Transfers ◽  
Extremity Function ◽  
Upper Extremity Function

Nerve transfers in the upper extremity following cervical spinal cord injury. Part 2: Preliminary results of a prospective clinical trial

2019 ◽  
Vol 31 (5) ◽  
pp. 641-653 ◽  
Author(s):  
Jawad M. Khalifeh ◽  
Christopher F. Dibble ◽  
Anna Van Voorhis ◽  
Michelle Doering ◽  
Martin I. Boyer ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Cervical Spinal Cord ◽  
Motor Nerve ◽  
Upper Limbs ◽  
Nerve Transfers ◽  
Extremity Function ◽  
Cord Injury ◽  
Upper Extremity Function ◽  
Grade 3 ◽  
Flexion Strength

OBJECTIVEPatients with cervical spinal cord injury (SCI)/tetraplegia consistently rank restoring arm and hand function as their top functional priority to improve quality of life. Motor nerve transfers traditionally used to treat peripheral nerve injuries are increasingly used to treat patients with cervical SCIs. In this article, the authors present early results of a prospective clinical trial using nerve transfers to restore upper-extremity function in tetraplegia.METHODSParticipants with American Spinal Injury Association (ASIA) grade A–C cervical SCI/tetraplegia were prospectively enrolled at a single institution, and nerve transfer(s) was performed to improve upper-extremity function. Functional recovery and strength outcomes were independently assessed and prospectively tracked.RESULTSSeventeen participants (94.1% males) with a median age of 28.4 years (range 18.2–76.3 years) who underwent nerve transfers at a median of 18.2 months (range 5.2–130.8 months) after injury were included in the analysis. Preoperative SCI levels ranged from C2 to C7, most commonly at C4 (35.3%). The median postoperative follow-up duration was 24.9 months (range 12.0–29.1 months). Patients who underwent transfers to median nerve motor branches and completed 18- and 24-month follow-ups achieved finger flexion strength Medical Research Council (MRC) grade ≥ 3/5 in 4 of 15 (26.7%) and 3 of 12 (25.0%) treated upper limbs, respectively. Similarly, patients achieved MRC grade ≥ 3/5 wrist flexion strength in 5 of 15 (33.3%) and 3 of 12 (25.0%) upper limbs. Among patients who underwent transfers to the posterior interosseous nerve (PIN) for wrist/finger extension, MRC grade ≥ 3/5 strength was demonstrated in 5 of 9 (55.6%) and 4 of 7 (57.1%) upper limbs 18 and 24 months postoperatively, respectively. Similarly, grade ≥ 3/5 strength was demonstrated in 5 of 9 (55.6%) and 4 of 7 (57.1%) cases for thumb extension. No meaningful donor site deficits were observed. Patients reported significant postoperative improvements from baseline on upper-extremity–specific self-reported outcome measures.CONCLUSIONSMotor nerve transfers are a promising treatment option to restore upper-extremity function after SCI. In the authors’ experience, nerve transfers for the reinnervation of hand and finger flexors showed variable functional recovery; however, transfers for the reinnervation of arm, hand, and finger extensors showed a more consistent and meaningful return of strength and function.

scholarly journals Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function: Protocol of a prospective, quasi-experimental non-randomized study (OMARM)

2021 ◽  
pp. 1-14
Author(s):  
Uta Roentgen ◽  
Loek van der Heide ◽  
Ingrid E.H. Kremer ◽  
Huub Creemers ◽  
Merel A. Brehm ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Assistive Technology ◽  
Upper Extremity ◽  
Randomized Study ◽  
Intervention Group ◽  
Control Group ◽  
Full Potential ◽  
Extremity Function ◽  
Quasi Experimental ◽  
Upper Extremity Function

BACKGROUND: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. OBJECTIVE: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-) effectiveness compared with care as usual. METHODS: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n= 48) receiving care as usual and of an intervention group (optimized provision process) (n= 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.

Sign in / Sign up

Export Citation Format

Share Document