Nerve transfers for the restoration of hand function after spinal cord injury

2012 ◽  
Vol 117 (1) ◽  
pp. 176-185 ◽  
Author(s):  
Susan E. Mackinnon ◽  
Andrew Yee ◽  
Wilson Z. Ray
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Single Case ◽  
Motor Nerve ◽  
Hand Function ◽  
Public Health Problem ◽  
Nerve Transfers ◽  
Cord Injury ◽  
Significant Public Health Problem ◽  
Significant Public Health

Spinal cord injury (SCI) remains a significant public health problem. Despite advances in understanding of the pathophysiological processes of acute and chronic SCI, corresponding advances in translational applications have lagged behind. Nerve transfers using an expendable nearby motor nerve to reinnervate a denervated nerve have resulted in more rapid and improved functional recovery than traditional nerve graft reconstructions following a peripheral nerve injury. The authors present a single case of restoration of some hand function following a complete cervical SCI utilizing nerve transfers.

scholarly journals Improvement of hand functions of spinal cord injury patients with electromyography-driven hand exoskeleton: A feasibility study

2020 ◽  
Vol 1 ◽  
Author(s):  
Youngmok Yun ◽  
Youngjin Na ◽  
Paria Esmatloo ◽  
Sarah Dancausse ◽  
Alfredo Serrato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Degrees Of Freedom ◽  
Standardized Test ◽  
Hand Function ◽  
Severe Disabilities ◽  
Finger Movements ◽  
Control Approach ◽  
Cord Injury ◽  
Hand Exoskeleton

Abstract We have developed a one-of-a-kind hand exoskeleton, called Maestro, which can power finger movements of those surviving severe disabilities to complete daily tasks using compliant joints. In this paper, we present results from an electromyography (EMG) control strategy conducted with spinal cord injury (SCI) patients (C5, C6, and C7) in which the subjects completed daily tasks controlling Maestro with EMG signals from their forearm muscles. With its compliant actuation and its degrees of freedom that match the natural finger movements, Maestro is capable of helping the subjects grasp and manipulate a variety of daily objects (more than 15 from a standardized set). To generate control commands for Maestro, an artificial neural network algorithm was implemented along with a probabilistic control approach to classify and deliver four hand poses robustly with three EMG signals measured from the forearm and palm. Increase in the scores of a standardized test, called the Sollerman hand function test, and enhancement in different aspects of grasping such as strength shows feasibility that Maestro can be capable of improving the hand function of SCI subjects.

A critical reappraisal of corticospinal tract somatotopy and its role in traumatic cervical spinal cord syndromes

2021 ◽  
pp. 1-7
Author(s):  
Allan D. Levi ◽  
Jan M. Schwab
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Cervical Spinal Cord ◽  
Hand Function ◽  
Cervical Spinal Cord Injury ◽  
Pathophysiological Mechanism ◽  
Cord Injury ◽  
Central Cord Syndrome

The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function.

scholarly journals Design and Experimental Evaluation of a Vertical Lift Walker for Sit-to-Stand Transition Assistance

2012 ◽  
Vol 6 (1) ◽  
Author(s):  
Thomas C. Bulea ◽  
Ronald J. Triolo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Extremity ◽  
Grip Force ◽  
Hand Function ◽  
Electrical Power ◽  
Lower Extremity Weakness ◽  
Sit To Stand ◽  
Cord Injury ◽  
Vertical Lift

A walker capable of providing vertical lift support can improve independence and increase mobility of individuals living with spinal cord injury (SCI). Using a novel lifting mechanism, a walker has been designed to provide sit-to-stand assistance to individuals with partially paralyzed lower extremity muscles. The design was verified through experiments with one individual with SCI. The results show the walker is capable of reducing the force demands on the upper and lower extremity muscles during sit-to-stand transition compared to standard walkers. The walker does not require electrical power and no grip force or harness is necessary during sit-to-stand operation, enabling its use by individuals with limited hand function. The design concept can be extended to aid other populations with lower extremity weakness.

scholarly journals Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study

2019 ◽  
Vol 30 (2) ◽  
pp. 268-278 ◽  
Author(s):  
Ahmed A. Toreih ◽  
Asser A. Sallam ◽  
Cherif M. Ibrahim ◽  
Ahmed I. Maaty ◽  
Mohsen M. Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Animal Studies ◽  
Femoral Nerve ◽  
Lower Limbs ◽  
Nerve Transfers ◽  
Promising Therapeutic Approach ◽  
Cord Injury ◽  
Significant Motor

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

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
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