scholarly journals Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers

Author(s):  
Agnes Sturma ◽  
Laura A. Hruby ◽  
Anna Boesendorfer ◽  
Clemens Gstoettner ◽  
Dario Farina ◽  
...  
BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030262 ◽  
Author(s):  
Rachel Stockley ◽  
Rosemary Peel ◽  
Kathryn Jarvis ◽  
Louise Connell

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.


2016 ◽  
Vol 6 (4) ◽  
pp. 42 ◽  
Author(s):  
Aurora Messina ◽  
Natasha Van Zyl ◽  
Michael Weymouth ◽  
Stephen Flood ◽  
Andrew Nunn ◽  
...  

The Lancet ◽  
2019 ◽  
Vol 394 (10198) ◽  
pp. 565-575 ◽  
Author(s):  
Natasha van Zyl ◽  
Bridget Hill ◽  
Catherine Cooper ◽  
Jodie Hahn ◽  
Mary P Galea

Stroke ◽  
2012 ◽  
Vol 43 (1) ◽  
Author(s):  
Jacqueline Winter ◽  
Susan M. Hunter ◽  
Julius Sim ◽  
Peter Crome

2019 ◽  
Vol 101-B (2) ◽  
pp. 124-131 ◽  
Author(s):  
J. Isaacs ◽  
A. R. Cochran

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.


2017 ◽  
Vol 36 (3) ◽  
pp. 151-172 ◽  
Author(s):  
A. Forli ◽  
M. Bouyer ◽  
M. Aribert ◽  
C. Curvale ◽  
M. Delord ◽  
...  
Keyword(s):  

2019 ◽  
Vol 45 (1) ◽  
pp. 43-50
Author(s):  
James P. Ledgard ◽  
Claudia R. Gschwind

Nerve transfers are increasingly utilized for upper limb reconstruction in tetraplegia. We reviewed the literature for results achieved by nerve transfers for elbow extension, wrist control and finger and thumb flexion and extension. Muscle strength grading was the only outcome measure consistently reported. The results confirm that nerve transfers can effectively reanimate muscles in selected cases, with comparable strength with those achieved with tendon transfer for elbow extension but inferior strength for finger and thumb flexion. Transfer of supinator nerve branches to the posterior interosseous nerve appears to be reliable and offers increased span and better hand opening than is observed after tendon transfers. Only one publication demonstrated how reinnervation of muscles with nerve transfers translated into improved function, activity and participation for patients. More prospective studies, using standardized outcome measures, are needed to define the precise role of nerve transfers.


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