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Evaluation of a Task-Based Intervention After Tendon Transfer to Restore Lateral Pinch

      Abstract

      Objective

      To quantify changes in pinch force and brachioradialis (BR) activation after a task-based training program designed to improve pinch force after BR to flexor pollicis longus (FPL) transfer.

      Design

      One-group repeated-measures design compared pinch force and BR activation pre- and posttraining. Significant differences were tested with Wilcoxon signed-rank tests for pairwise comparisons at the P≤.05 level.

      Setting

      Testing occurred in a Veterans Affairs Medical Center research laboratory and training was in a home setting.

      Participants

      Participants with cervical spinal cord injury (SCI) and previous BR to FPL transfer were enrolled in the study (N=8). Six patients completed the training program and posttraining measures.

      Interventions

      The 10-week training was a home program that included novel activities to increase BR activation and practice producing pinch force in a variety of upper limb postures. Participants were provided with the task-based training equipment and instructed to practice 3 times per week.

      Main Outcome Measures

      Fine-wire electromyography of the transferred BR was recorded in maximum effort pinch force (N). Secondary measures included the strength and activation of the antagonist elbow extensor.

      Results

      Pinch force increased 3.7N (.38kg) and BR muscle activation increased 10% (P≤.05) after the training. There was no increase in elbow extension strength, but participants with previous posterior deltoid to triceps transfer achieved greater activation of the antagonist elbow extensor.

      Conclusions

      The findings from this pilot study suggest that outcomes of tendon transfer and conventional therapy can be improved for patients with chronic cervical SCI.

      Keywords

      List of abbreviations:

      ATM (automated teller machine), BR (brachioradialis), EMG (electromyogram), FPL (flexor pollicis longus), MVC (maximum voluntary contraction), PD (posterior deltoid), SCI (spinal cord injury)
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