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Rehabilitation After Spasticity-Correcting Upper Limb 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
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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 Göteborgs University, Gothenburg, Sweden

    Swiss Paraplegic Center, Nottwil, Switzerland
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      Abstract

      Objective

      To describe the early active rehabilitation concept developed for spasticity-correcting surgery in tetraplegia and to report the outcomes in grip ability and change of performance and satisfaction in patients' prioritized activities 1 year postoperatively.

      Design

      Retrospective case-control study.

      Setting

      Nonprofit rehabilitation unit.

      Participants

      All patients who underwent surgeries for correction of spasticity in tetraplegic hands between 2009 and 2013 in the studied unit (N=37).

      Interventions

      Spasticity-correcting upper limb surgery with early active rehabilitation to restore grip ability in tetraplegia.

      Main Outcome Measures

      Grasp and release test (GRT) and modified Canadian Occupational Performance Measure (COPM).

      Results

      All patients could accomplish the early active rehabilitation concept. The complication rate related to the treatment was low. Compared with preoperatively, all evaluated individuals experienced improvements in grasp ability and activity performance and satisfaction at 1-year follow-up. The performance in prioritized activities, as measured by the COPM, improved by 2.6 scale steps. Satisfaction with performance improved 3.0 scale steps postoperatively (n=21). The grasp ability, measured by the GRT, improved significantly, from 80 preoperatively to 111 (n=10).

      Conclusions

      The surgery, combined with the early active rehabilitation protocol, is a reliable and safe procedure. The ability to use the hand improved, and gains were maintained at least 1 year after surgery in all patients with respect to both the objective grasp ability and patients' subjective rating of their performance and satisfaction in their prioritized activities. The procedure should therefore be considered as an adjunct to other treatments of upper limb spasticity in spinal cord injury.

      Keywords

      List of abbreviations:

      ASIA (American Spinal Injury Association), COPM (Canadian Occupational Performance Measure), GRT (grasp and release test), SCI (spinal cord injury)
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