Abstract
Objective
To identify key components of conventional therapy after brachioradialis (BR) to flexor
pollicis longus (FPL) transfer, a common procedure to restore pinch strength, and
evaluate whether any of the key components of therapy were associated with pinch strength
outcomes.
Design
Rehabilitation protocols were surveyed in 7 spinal cord injury (SCI) centers after
BR to FPL tendon transfer. Key components of therapy, including duration of immobilization,
participation, and date of initiating therapy activities (mobilization, strengthening,
muscle reeducation, functional activities, and home exercise), were recorded by the
patient's therapist. Pinch outcomes were recorded with identical equipment at 1-year
follow-up.
Setting
Seven SCI rehabilitation centers where the BR to FPL surgery is performed on a routine
basis.
Participants
Thirty-eight arms from individuals with C5-7 level SCI injury who underwent BR to
FPL transfer surgery (N=34).
Intervention
Conventional therapy according to established protocol in each center.
Main Outcome Measures
The frequency of specific activities and their time of initiation (relative to surgery)
were expressed as means and 95% confidence intervals. Outcome measures included pinch
strength and the Canadian Occupational Performance Measure (COPM). Spearman rank-order
correlations determined significant relations between pinch strength and components
of therapy.
Results
There was similarity in the key components of therapy and in the progression of activities.
Early cast removal was associated with pinch force (Spearman ρ=−.40, P=.0269). Pinch force was associated with improved COPM performance (Spearman ρ=.48,
P=.0048) and satisfaction (Spearman ρ=.45, P=.0083) scores.
Conclusions
Initiating therapy early after surgery is beneficial after BR to FPL surgery. Postoperative
therapy protocols have the potential to significantly influence the outcome of tendon
transfers after tetraplegia.
Keywords
List of abbreviations:
BR (brachioradialis), CI (confidence interval), COPM (Canadian Occupational Performance Measure), FPL (flexor pollicis longus), IC (International Classification for Surgery of the Hand in Tetraplegia), MMT (manual muscle test), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Footnotes
The research described here was supported by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service. Award number A4069-R, Vincent R Hentz, Surgical Service, Palo Alto Health Care System. Supported also by Searle Funds of the Chicago Community Trust.
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
