Archives of Physical Medicine and Rehabilitation
Original researchEvaluation of a Task-Based Intervention After Tendon Transfer to Restore Lateral Pinch
Section snippets
Participants
Participants with chronic cervical SCI and previous BR to FPL transfer were recruited. The International Classification for Surgery of the Hand in Tetraplegia was used to determine if an individual would benefit from BR to FPL surgery.1, 2 All participants were previously evaluated by the same surgeon (V.R.H.) and were in International Classification for Surgery of the Hand in Tetraplegia group ≥2 (manual muscle test grade 4 BR and grade 4 or 5 wrist extension strength). If BR to FPL transfer
Participants
Eight participants were admitted to the study to participate in the 10-week training program. All of the participants had chronic cervical SCI with complete injuries and a previous BR to FPL tendon transfer to restore pinch strength. From the medical record at the time of admission, 7 of the participants were classified with C5-7 level injuries. One participant (participant 6) was classified with a C4 injury, but met the criteria for BR to FPL surgery according to the International
Discussion
The task-based home training was effective for improving pinch force relative to individual pretraining measures. Recognizing patients who may benefit from the training should be determined on an individual basis because of the individual variability in pinch strength observed across participants. Pretraining pinch force in the range of 3N suggests that force is produced using passive tenodesis,9 and the transferred BR may not be active in pinch or surgical revision may be indicated (eg,
Conclusions
The outcome of BR to PFL tendon transfer, measured by pinch force and activation of the transferred BR, can be improved for individuals with chronic SCI, even many years after they have been discharged. There was significant gain of 3.7N of pinch force and a 10% increase in BR activation for participants who adhered to the novel training program described in this pilot study. There were no adverse effects from participating. Implementing the training program prior to discharge and increasing
Suppliers
- a.
LABView; National Instruments.
- b.
ATI Industrial Automation.
- c.
MA-300 cabled system; Motion Lab Systems, Inc.
- d.
MATLAB; MathWorks.
- e.
JMP statistical program; SAS Institute.
- f.
Theraputty; Patterson Medical-Sammons Preston.
- g.
Pace Weights; Pace Weights.
- h.
MiniMeds; FitBALL.
- i.
Baseline Hydraulic 50-lb Pinch Gauge; Patterson Medical-Sammons Preston.
Acknowledgments
We thank the clinical staff of the Spinal Cord Injury Service at the VA Palo Alto Health Care System, who were instrumental for recruitment and coordinating follow-up visits. We also thank volunteer Dave Izant, who was responsible for building the manipulation boards and modifications to the pinch pins so that those individuals with low forces could participate. We thank Jeffrey Jaramillo, DPT, who provided critical review of the manuscript.
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Cited by (5)
Rehabilitation after surgical reconstruction to restore function to the upper limb in tetraplegia: A changing landscape
2016, Archives of Physical Medicine and RehabilitationMeasurement of the Three-Dimensional Muscle Endpoint Forces in the Extended Thumb and Its Application to Determining Muscle Combinations that Enable Lateral Pinch Force Production Throughout the Plane of Flexion-Extension
2023, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBSRegional estimates of cortical thickness in brain areas involved in control of surgically restored limb movement in patients with tetraplegia
2020, Journal of Spinal Cord MedicineSurgical restoration of the hand in tetraplegia: Tendon and nerve transfers
2018, Spinal Cord Medicine: Third Edition
The research described here was supported by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service, Career Development Award B6857 and B0583-P, M. Elise Johanson, VA Palo Alto Health Care System, Research Service.
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: none.