Abstract
Objective
To describe and evaluate the concept of early active rehabilitation after tendon transfer
to restore grip function in tetraplegia.
Design
Retrospective cohort study.
Setting
Two nonprofit rehabilitation units in Sweden and Switzerland.
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.
Keywords
List of abbreviations:
ADL (activities of daily living), BR (brachioradialis), CMC1 (first carpometacarpal joint), COPM (Canadian Occupational Performance Measure), ROM (range of motion)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the Swedish Research Council (grant no. 11200), Göteborg University, and Sahlgrenska University Hospital.
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
