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- 2017
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Ingår i: Physical Review D. - 2470-0010 .- 2470-0029. ; 96:2
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Bersch, Ines, et al.
(författare)
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Electrical stimulation-a mapping system for hand dysfunction in tetraplegia
- 2018
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:5, s. 516-522
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Tidskriftsartikel (refereegranskat)abstract
- Study design Retrospective data analysis Objectives To define the distribution of the motor points and excitability of the key wrist and finger actuators in order to detect upper (UMN) and lower motor neuron (LMN) lesions potentially influencing the development of a tenodesis grasp. Setting A rehabilitation centre for spinal cord injuries, Nottwil, Switzerland. Methods Forearm muscles of 32 patients with tetraplegia (AIS A-D) were tested bilaterally with electrical stimulation (ES) to differentiate whether UMN or LMN was present. For testing, a standardised mapping was developed. All patients underwent the same positioning schedule. Results Sixteen hands developed a tenodesis grasps, 24 hands showed neither shortening nor tightening of the finger flexors. Two patients developed unilateral tenodesis grasp and showed no tightening of the finger flexors on the contralateral hand. Seven patients developed tenodesis grasps symmetrically and bilaterally, whereas one maintained an essentially open hand without tightening of the finger flexors. All hands that developed a tenodesis grasp showed a LMN lesion of the M. extensor digitorum communis (EDC). The frequency of the tenodesis grasp differed significantly between the groups with and without intact reflex arc (p < 0.0001). Conclusion Surface ES may serve as a diagnostic tool to detect an UMN or LMN lesion of the key actuator muscles affecting the tenodesis grasp. These findings provide information that is essential for the choice of treatment to optimise function of the tetraplegic hand.
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| 4. |
- Bersch, Ines, et al.
(författare)
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Motor Point Topography of Fundamental Grip Actuators in Tetraplegia: Implications in Nerve Transfer Surgery
- 2020
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Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert Inc. - 0897-7151 .- 1557-9042. ; 37:3, s. 441-447
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Tidskriftsartikel (refereegranskat)abstract
- The differentiation between an upper motoneuron (UMN) lesion and lower motoneuron (LMN) lesion of forearm muscles in patients with tetraplegia is critical for the choice of treatment strategy. Specifically, the M. pronator teres (PT), M. flexor digitorum profundus III (FDPIII), and M. flexor pollicis longus (FPL) were studied since they represent key targets in nerve transfer surgery to restore grasp function. Forearm muscles of 24 patients with tetraplegia were tested bilaterally with electrical stimulation (ES) to determine whether UMN or LMN lesion was present. For detecting and testing the nerve stimulation points, a standardized mapping was developed and clinically applied. The relationship between the anatomical segmental spinal innervation and the innervation pattern tested by ES was determined. The data of 44 arms were analyzed. For PT, 19 arms showed an intact UMN, 18 arms an UMN lesion, and seven arms partial denervation. For FDPIII, three arms demonstrated an intact UMN, 26 arms an UMN lesion, 10 arms partial denervation, and five arms denervation. For FPL, two arms presented an intact UMN, 16 arms an UMN lesion, 12 arms partial denervation, and 14 arms denervation. A total of 20.1% ES tested muscles were partially denervated. In four patients, only one arm could be tested because of surgery-related limitations. According to the level of lesion and the segmental spinal innervation, most denervated muscles were present in the patient group C6 to C8. The ES, together with the developed mapping system, is reliable and can be recommended for standardized testing in surgery and rehabilitation. It offers the possibility to detect if and to what extent UMN and LMN lesions are present for the target muscles. It allows for refined pre-operative diagnostics and prognostics in spinal cord injury neurotization surgery.
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- Koch-Borner, S., et al.
(författare)
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Rehabilitation After Posterior Deltoid to Triceps Transfer in Tetraplegia
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 97:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe and evaluate the rehabilitation concept after posterior deltoid to triceps transfer in patients with tetraplegia. Participants: Patients with tetraplegia who had posterior deltoid to triceps tendon transfer and had muscle strength measurements 1 year postsurgery from 2009 to 2013 (N=44). Interventions: Posterior deltoid to triceps tendon transfer to restore elbow extension and postoperative rehabilitation. Main Outcome Measures: Elbow extension range of motion and muscle strength and the modified Canadian Occupational Performance Measure (COPM). Results: Surgery was performed on 53 arms. No major complications (eg tendon rupture, lengthening) were reported. Muscle strength measured 1 year after surgery was on average grade 3 (out of 5) in the 53 operated arms. The ability to extend the elbow against gravity was achieved in 62% of the arms (muscle strength of grade >= 3). In patients with a preoperative elbow extension deficit (n=14), the deficit was reduced on average from 16 degrees to 9 degrees. The performance of the prioritized activities as measured with the COPM improved on average 2.6 scale steps, from 3.3 to 5.9. Satisfaction with the performance improved on average 3.2 scale steps, from 2.8 to 6.0. Conclusions: The posterior deltoid to triceps tendon transfer with the applied rehabilitation protocol is a safe and effective procedure. There were no tendon ruptures, and all patients were able to complete the rehabilitation protocol. The shorter restriction time after surgery allows the patient to be independent at an earlier stage of the rehabilitation and reduces hospitalization or care burden. (C) 2016 by the American Congress of Rehabilitation Medicine
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- Wangdell, Johanna, 1971, et al.
(författare)
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Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia
- 2016
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 97:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe and evaluate the concept of early active rehabilitation after tendon transfer to restore grip function in tetraplegia. Participants: All patients with tetraplegia who underwent tendon transfer to restore grip ability during 2009 to 2013 (N=49). Intervention: Reconstructive tendon transfer surgery with early active rehabilitation to restore grip ability in tetraplegia. Main Outcome Measures: Grip and pinch strength, grip ability test, and outcome of prioritized activities. Results: In the 49 surgeries performed, postoperative complications included 2 patients with bleeding and 2 infections related to the surgery. There were no reported ruptures or lengthening of transferred tendons. Within 24 hours after surgery, all 47 patients (100%) with finger flexion reconstruction succeeded to activate their finger flexion. All but 1 patient with reconstructed thumb flexion sucessfully activated their thumb flexion (n=40). Three weeks after surgery, all patients (100%) were able to perform basic activities of daily living, and instrumental activities of daily living were achieved by 74%. One year after surgery, the maximum grip strength in restored finger flexion was on average 6.9kg (range, 1.5-15kg; n=29). The maximum pinch strength in restored thumb flexion was on average 3.7kg (range, 1-20; n=29). On average, grip ability improved from 33 to 101 (n=19) according to the COPM. Prioritized activity limitations, as measured with the COPM, equated to an average of 3.5 steps (2.5 steps preoperatively to 6 steps postoperatively): Patients' perceived satisfaction with this improvement was 4 steps (increasing from 2 steps preoperatively to 6 steps postoperatively). Conclusions: Grip reconstructive surgery followed by early active rehabilitation can be considered a reliable procedure that leads to substantial improvements in grip and pinch strength and activity performance among patients with tetraplegia. (C) 2016 by the American Congress of Rehabilitation Medicine
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