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Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia

  • Johanna Wangdell
    Correspondence
    Corresponding author Johanna Wangdell, OT, PhD, Sahlgrenska University Hospital, Mölndals sjukhus, House U1 Floor 5, SE-431 80 Mölndal, Sweden.
    Affiliations
    Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden

    Department of Hand Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden
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  • Lina Bunketorp-Käll
    Affiliations
    Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden

    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden
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  • Sabrina Koch-Borner
    Affiliations
    Swiss Paraplegic Center, Nottwil, Switzerland
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  • Jan Fridén
    Affiliations
    Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden

    Department of Hand Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden

    Swiss Paraplegic Center, Nottwil, Switzerland
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      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)
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