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Thornton WA, Smulligan K, Weber KA, Tefertiller C, Mañago M, Sevigny M, Wiley L, Stevens-Lapsley J, Smith AC. Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38958637 DOI: 10.1080/10790268.2024.2363005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
CONTEXT/OBJECTIVE There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. DESIGN Retrospective, exploratory study. PARTICIPANTS 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. METHODS Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). OUTCOME MEASURES Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. RESULTS When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942-0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936-0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919-0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = -0.469, 95% CI: -0.719, -0.218, P = 0.0004). CONCLUSIONS Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.
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Affiliation(s)
- Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
- Craig Hospital, Englewood, Colorado, USA
| | - Katherine Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Mark Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Laura Wiley
- Department of Biostatistics & Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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2
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Dolbow DR, Gorgey AS, Johnston TE, Bersch I. Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective. J Clin Med 2023; 12:jcm12093150. [PMID: 37176591 PMCID: PMC10179213 DOI: 10.3390/jcm12093150] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
Electrical stimulation exercise has become an important modality to help improve the mobility and health of individuals with spinal cord injury (SCI). Electrical stimulation is used to stimulate peripheral nerves in the extremities to assist with muscle strengthening or functional activities such as cycling, rowing, and walking. Electrical stimulation of the peripheral nerves in the upper extremities has become a valuable tool for predicting the risk of hand deformities and rehabilitating functional grasping activities. The purpose of this paper is to provide healthcare providers perspective regarding the many rehabilitation uses of electrical stimulation in diagnosing and treating individuals with SCI. Electrical stimulation has been shown to improve functional mobility and overall health, decrease spasticity, decrease the risk of cardiometabolic conditions associated with inactivity, and assist in the diagnosis/prognosis of hand deformities in those with tetraplegia. Studies involving non-invasive stimulation of the spinal nerves via external electrodes aligned with the spinal cord and more invasive stimulation of electrodes implanted in the epidural lining of the spinal cord have demonstrated improvements in the ability to stand and enhanced the stepping pattern during ambulation. Evidence is also available to educate healthcare professionals in using functional electrical stimulation to reduce muscle spasticity and to recognize limitations and barriers to exercise compliance in those with SCI. Further investigation is required to optimize the dose-response relationship between electrical stimulation activities and the mobility and healthcare goals of those with SCI and their healthcare providers.
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Affiliation(s)
- David R Dolbow
- Department of Physical Therapy, College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
- College of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Therese E Johnston
- Department of Physical Therapy, Arcadia University, Glenside, PA 19038, USA
| | - Ines Bersch
- International FES Centre®, Swiss Paraplegic Center, CH-6207 Nottwil, Switzerland
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Gatskiy AA, Tretyak IB, Tsymbaliuk VI, Tsymbaliuk YV. Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE22301. [PMID: 36193034 PMCID: PMC9552560 DOI: 10.3171/case22301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cervical spinal cord injury (CSCI) causes severe motor deficit in upper extremities. The mixed segmental CSCI pattern is reflected in the combination of time-sensitive (TS) and non-TS myotomes in the upper extremities. Nerve transfers (NTs) restore upper extremity function yet remain TS procedures. A combination of neurological, magnetic resonance imaging (MRI), and electromyography (EMG) studies allows the identification of TS and non-TS myotomes in the upper extremities. OBSERVATIONS Nineteen months after NTs, flexor pollicis longus (FPL) and deep flexor of the index finger (FDP2) recovered to M4 (right UE), FPL recovered to M3 and FDP2 to M2 (left EU). The long head of the triceps brachii muscle recovered to M4 bilaterally. The Capabilities of Upper Extremity Questionnaire (CUE-Q) score for unilateral arm functionality increased by 44% (right) and 112.5% (left) and for bilateral arm functionality by 400%; the CUE-Q score for unilateral hand and finger function increased by 283% (right) and 166% (left). LESSONS The combination of neurological, MRI, and EMG studies before surgery and data obtained during surgery provides reliable information on the CSCI pattern, specifically the availability of motor donor nerves. Simultaneous bilateral restoration is required in the event of CSCI and significantly improves the unilateral and bilateral function of the UEs.
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Affiliation(s)
- Alexander A. Gatskiy
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
| | - Ihor B. Tretyak
- Restorative Neurosurgery Department, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
| | | | - Yaroslav V. Tsymbaliuk
- Group of Chronic Pain Treatment, Romodanov Neurosurgery Institute of NAMS of Ukraine, Kyiv, Ukraine
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4
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Mittal N, Majdic BC, Peterson CL. Intermittent theta burst stimulation modulates biceps brachii corticomotor excitability in individuals with tetraplegia. J Neuroeng Rehabil 2022; 19:73. [PMID: 35843943 PMCID: PMC9290267 DOI: 10.1186/s12984-022-01049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial magnetic stimulation (TMS) that can increase corticomotor excitability of hand muscles in individuals with spinal cord injury (SCI). The objective of this study was to determine the effect of iTBS on the corticomotor excitability of the biceps brachii in individuals with tetraplegia. METHODS Ten individuals with low cervical SCI (C5-C8) and ten nonimpaired individuals completed three independent sessions. Motor evoked potentials (MEPs) served as our measure of corticomotor excitability and were collected before and after iTBS. MEPs were normalized by the electromyography corresponding to maximum voluntary contraction and analyzed using linear mixed effects models to determine the effect of iTBS (active or sham) on normalized MEPs (nMEPs). iTBS effects were compared to a ratio of active and resting motor thresholds as a measurement of corticomotor conductance potential. RESULTS Relative to sham, active iTBS increased nMEPs over time (p < 0.001) in individuals with SCI, but not nonimpaired individuals (p = 0.915). The amplitude of nMEPs were correlated with the biceps corticomotor conductance potential (p < 0.001), with nMEPs decreasing as the ratio increased at different rates after sham or active iTBS. CONCLUSIONS Preliminary results suggest that iTBS increases biceps corticomotor excitability in individuals with tetraplegia with effects that may be predicted by corticomotor conductance potential. Clinical trial registration NCT03277521 Registered on clinicaltrials.gov on August 24, 2017.
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Affiliation(s)
- Neil Mittal
- grid.224260.00000 0004 0458 8737Biomedical Engineering, College of Engineering, Rehabilitation Engineering to Advance Ability Lab, Virginia Commonwealth University, Biotech Eight, 737 N 5th Street, Richmond, VA 23219 USA
| | - Blaize C. Majdic
- grid.224260.00000 0004 0458 8737Biomedical Engineering, College of Engineering, Rehabilitation Engineering to Advance Ability Lab, Virginia Commonwealth University, Biotech Eight, 737 N 5th Street, Richmond, VA 23219 USA
| | - Carrie L. Peterson
- grid.224260.00000 0004 0458 8737Biomedical Engineering, College of Engineering, Rehabilitation Engineering to Advance Ability Lab, Virginia Commonwealth University, Biotech Eight, 737 N 5th Street, Richmond, VA 23219 USA
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Manna M, Mortenson WB, Kardeh B, Douglas S, Marks C, Krauss EM, Berger MJ. Patient perspectives and self-rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury. PM R 2022; 15:579-586. [PMID: 35352495 DOI: 10.1002/pmrj.12811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/06/2022] [Accepted: 03/16/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer. OBJECTIVE To explore the perspectives of patients with chronic SCI (>2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure. DESIGN Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre- and post-interviews were completed following an educational presentation. SETTING Two local SCI clinics. PARTICIPANTS Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female). INTERVENTION An educational slide presentation on nerve transfer concepts. MAIN OUTCOME MEASURES The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education. RESULTS Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased self-rated scores on understanding of nerve transfer (p < .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery. CONCLUSIONS These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.
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Affiliation(s)
- Mariam Manna
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD),Vancouver, British Columbia, Canada; GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
| | - Bahareh Kardeh
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
| | - Sam Douglas
- University of Victoria, Victoria, British Columbia, Canada
| | - Chris Marks
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Emily M Krauss
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Fessler RG, Liu CY, McKenna S, Fessler RD, Lebkowski JS, Priest CA, Wirth ED. Safety of direct injection of oligodendrocyte progenitor cells into the spinal cord of uninjured Göttingen minipigs. J Neurosurg Spine 2021; 35:389-397. [PMID: 34243160 DOI: 10.3171/2020.12.spine201853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was conducted as a final proof-of-safety direct injection of oligodendrocyte progenitor cells into the uninjured spinal cord prior to translation to the human clinical trials. METHODS In this study, 107 oligodendrocyte progenitor cells (LCTOPC1, also known as AST-OPC1 and GRNOPC1) in 50-μL suspension were injected directly into the uninjured spinal cords of 8 immunosuppressed Göttingen minipigs using a specially designed stereotactic delivery device. Four additional Göttingen minipigs were given Hanks' Balanced Salt Solution and acted as the control group. RESULTS Cell survival and no evidence of histological damage, abnormal inflammation, microbiological or immunological abnormalities, tumor formation, or unexpected morbidity or mortality were demonstrated. CONCLUSIONS These data strongly support the safety of intraparenchymal injection of LCTOPC1 into the spinal cord using a model anatomically similar to that of the human spinal cord. Furthermore, this research provides guidance for future clinical interventions, including mechanisms for precise positioning and anticipated volumes of biological payloads that can be safely delivered directly into uninjured portions of the spinal cord.
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Affiliation(s)
- Richard G Fessler
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | | | - Stephen McKenna
- 3Department of Neurosurgery, Stanford University, Palo Alto; and
| | - R David Fessler
- 1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Jane S Lebkowski
- 4Asterias Biotherapeutics, a wholly owned subsidiary of Lineage Cell Therapeutics, Carlsbad, California
| | - Catherine A Priest
- 4Asterias Biotherapeutics, a wholly owned subsidiary of Lineage Cell Therapeutics, Carlsbad, California
| | - Edward D Wirth
- 4Asterias Biotherapeutics, a wholly owned subsidiary of Lineage Cell Therapeutics, Carlsbad, California
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7
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Dengler J, Mehra M, Steeves JD, Fox IK. Evaluation of Functional Independence in Cervical Spinal Cord Injury: Implications for Surgery to Restore Upper Limb Function. J Hand Surg Am 2021; 46:621.e1-621.e17. [PMID: 33454154 DOI: 10.1016/j.jhsa.2020.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. METHODS Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5-C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. RESULTS Data were available for individuals with symmetrical (n = 204) and asymmetrical (n = 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. CONCLUSIONS People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jana Dengler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | | | - John D Steeves
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Healthcare System, St. Louis, MO.
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8
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Yeung C, Salim S, Fox IK, Novak CB, Dengler J. Identifying barriers to upper extremity reconstruction in tetraplegia: a systematic scoping review. Spinal Cord 2021; 59:1088-1095. [PMID: 33911190 DOI: 10.1038/s41393-021-00631-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic scoping review OBJECTIVES: The purpose of this study was to understand the barriers to accessing upper extremity (UE) reconstructive surgery among those living with tetraplegia, and to identify gaps in knowledge. METHODS Using standardized scoping review methods, a literature search was conducted using four databases and 1069 articles were procured. Two independent reviewers systematically screened the articles in two phases. Retrieved articles underwent thematic analysis using a constructivist grounded theory methodology. RESULTS The reviewed articles (n = 25) were published between 2002 and 2019, and study designs included: cross-sectional (64%), retrospective (16%), and review articles (8%). Common barriers to UE reconstruction were categorized into factors related to patients, providers, and systems. These general domains included lack of awareness of UE reconstruction and its benefits among people with tetraplegia and providers, poor interdisciplinary working relationships, and a lack of specialized centers that provide these reconstructive surgeries. Specific patient-related barriers related to intrinsic (coping skills, trust, fear) and extrinsic (support network, finances, postoperative course) factors that influenced decision-making. CONCLUSIONS There are many barriers that prevent individuals with tetraplegia from accessing surgery at different levels of the healthcare system. Establishing specialized centers with strong interdisciplinary working relationships and raising awareness about the advantages and disadvantages of UE reconstruction through peer networks may help to improve accessibility. Using a value-based, patient-centered approach by exploring how individuals with SCI weigh each decision factor when considering surgery may help providers develop treatment options that better align with their goals.
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Affiliation(s)
- Celine Yeung
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Sabrin Salim
- Translational Research Program, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine B Novak
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada. .,Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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McCann MM, Fisher KM, Ahloy-Dallaire J, Darian-Smith C. Somatosensory corticospinal tract axons sprout within the cervical cord following a dorsal root/dorsal column spinal injury in the rat. J Comp Neurol 2020; 528:1293-1306. [PMID: 31769033 PMCID: PMC7102935 DOI: 10.1002/cne.24826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
Abstract
The corticospinal tract (CST) is the major descending pathway controlling voluntary hand function in primates, and though less dominant, it mediates voluntary paw movements in rats. As with primates, the CST in rats originates from multiple (albeit fewer) cortical sites, and functionally different motor and somatosensory subcomponents terminate in different regions of the spinal gray matter. We recently reported in monkeys that following a combined cervical dorsal root/dorsal column lesion (DRL/DCL), both motor and S1 CSTs sprout well beyond their normal terminal range. The S1 CST sprouting response is particularly dramatic, indicating an important, if poorly understood, somatosensory role in the recovery process. As rats are used extensively to model spinal cord injury, we asked if the S1 CST response is conserved in rodents. Rats were divided into sham controls, and two groups surviving post-lesion for ~6 and 10 weeks. A DRL/DCL was made to partially deafferent one paw. Behavioral testing showed a post-lesion deficit and recovery over several weeks. Three weeks prior to ending the experiment, S1 cortex was mapped electrophysiologically, for tracer injection placement to determine S1 CST termination patterns within the cord. Synaptogenesis was also assessed for labeled S1 CST terminals within the dorsal horn. Our findings show that the affected S1 CST sprouts well beyond its normal range in response to a DRL/DCL, much as it does in macaque monkeys. This, along with evidence for increased synaptogenesis post-lesion, indicates that CST terminal sprouting following a central sensory lesion, is a robust and conserved response.
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Affiliation(s)
- Margaret M. McCann
- Department of Comparative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA94305-5342
- Margaret M. McCann, Creighton University, Department of Biomedical Sciences, 2500 California Plaza, Criss II, Omaha NE 68178
| | - Karen M. Fisher
- Department of Comparative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA94305-5342
| | - Jamie Ahloy-Dallaire
- Department of Comparative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA94305-5342
- Département des sciences animales, Université Laval, 2425 rue de l’Agriculture, Québec, Québec, Canada G1V 0A6
| | - Corinna Darian-Smith
- Department of Comparative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA94305-5342
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Vu PP, Chestek CA, Nason SR, Kung TA, Kemp SW, Cederna PS. The future of upper extremity rehabilitation robotics: research and practice. Muscle Nerve 2020; 61:708-718. [PMID: 32413247 PMCID: PMC7868083 DOI: 10.1002/mus.26860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 01/14/2023]
Abstract
The loss of upper limb motor function can have a devastating effect on people's lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body's motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain-machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain-machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.
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Affiliation(s)
- Philip P. Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cynthia A. Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Robotics Institute, University of Michigan, Ann Arbor, Michigan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
| | - Samuel R. Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Theodore A. Kung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stephen W.P. Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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11
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Mooney A, Hewitt AE, Hahn J. Nothing to lose: a phenomenological study of upper limb nerve transfer surgery for individuals with tetraplegia. Disabil Rehabil 2020; 43:3748-3756. [PMID: 32356497 DOI: 10.1080/09638288.2020.1750716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: For individuals with tetraplegia, regaining upper limb function forms the highest priority for improving quality of life. Use of nerve transfers to reconstruct upper limb function is increasing, however little is known about individual's decision to have and experience of the surgery and associated rehabilitation outcomes. This qualitative study aimed to understand the experience of surgery on the lives of individuals with tetraplegia 18 months post-surgery.Method: In-depth, semi-structured interviews were conducted with five purposively selected individuals who have undergone upper limb nerve transfers at a metropolitan health service, Melbourne, Australia, specializing in spinal cord injury rehabilitation. Collaizi's phenomenological framework guided data analysis, resulting in an essence statement describing the individuals' experience.Results: An essence statement comprising three themes; Deciding on Surgery, Facing Challenges: Surgery to Recovery and Evaluating Surgical Outcomes, was developed.Conclusion: The study suggests that for individuals with tetraplegia, hope to regain lost upper limb function forms a core consideration in the decision to have surgery. For clinicians supporting patient's decision, balancing hope with the realities of surgery is important. Even small changes in upper limb function had an important influence on participant's confidence in social situations through enhanced participation in a range of everyday activities.IMPLICATIONS FOR REHABILITATIONIn making a decision to have surgery, individuals with tetraplegia benefit from two way discussions with the healthcare team and others who have already undergone surgery.Healthcare teams need to help prepare individuals for the challenges of surgery including: expectations of pain, hospital stay, initial loss of independence and the time it may take to see re-innervation of target muscles and subsequent functional changes.Surgery should be routinely considered as individuals' report that even small changes in upper limb function positively increases participation in everyday tasks and confidence in social situations.When evaluating changes in upper limb function, patient-centered measures should be used.
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Affiliation(s)
- Alysha Mooney
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Alana E Hewitt
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.,Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Jodie Hahn
- Victorian Spinal Cord Service, Austin Health, Victoria, Australia
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12
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Fox I, Hoben G, Komaie G, Novak C, Hamm R, Kahn L, Whitehead M, Juknis N, Ruvinskaya R, Mackinnon S, James A. Nerve transfer surgery in cervical spinal cord injury: a qualitative study exploring surgical and caregiver participant experiences. Disabil Rehabil 2019; 43:1542-1549. [PMID: 31560228 DOI: 10.1080/09638288.2019.1669225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate perceptions of surgical participants and their caregivers regarding novel nerve transfer surgery to restore upper extremity function in cervical level spinal cord injury. MATERIALS AND METHODS A qualitative study design was used. A multidisciplinary team developed semi-structured interview guides. Interviews were recorded, transcribed and analyzed using basic text analysis. RESULTS Participants had limited information about procedures to improve function after spinal cord injury. When discussing their choice to undergo nerve (as compared to traditional tendon) transfer surgery, they describe a desire to avoid post-operative immobilization. Barriers included the pre-operative testing, cost and inconvenience of travel for surgery, and understanding complex health information related to the procedure. While expectations matched descriptions of outcomes among participants and were generally positive, caregivers expressed disappointment. The long time interval for gains in function to be realized and relatively incremental gains achieved were frustrating to all. CONCLUSIONS People with cervical spinal cord injury and their caregivers need more information about options to restore function and about realistic range of improvements with treatment. Further work to mitigate barriers and develop health information materials around nerve transfer surgery may improve medical decision making around and appropriate use of this newer treatment option.IMPLICATIONS FOR REHABILITATIONNerve transfer surgery is a novel and acceptable means of improving upper extremity function in the setting of cervical spinal cord injury.People with cervical spinal cord injury and their caregivers need information about options to restore hand and arm function and mitigation of barriers around these treatment options.
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Affiliation(s)
- Ida Fox
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, United States.,Division of Plastic Surgery, Veterans Administration Saint Louis Health Care System, Saint Louis, United States
| | - Gwendolyn Hoben
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, United States
| | - Goldie Komaie
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
| | - Christine Novak
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Rebecca Hamm
- School of Physical Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Lorna Kahn
- Milliken Hand Rehabilitation Center, Department of Occupational Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Meredith Whitehead
- School of Physical Therapy, Washington University School of Medicine, Saint Louis, United States
| | - Neringa Juknis
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, Saint Louis, United States
| | - Rimma Ruvinskaya
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, Saint Louis, United States
| | - Susan Mackinnon
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
| | - Aimee James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, United States
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13
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Li J, Du L, Liu H, Gao F, Liu L, Guo Y, Wang C, Yang M, Li J, Zhang Y. [Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:542-547. [PMID: 29806340 DOI: 10.7507/1002-1892.201711078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury. Methods Between July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C 6 to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery. Results There was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 ( P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery. Conclusion Tendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.
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Affiliation(s)
- Jun Li
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068,
| | - Liangjie Du
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Hongwei Liu
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Feng Gao
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Lu Liu
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Yun Guo
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Chong Wang
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Mingliang Yang
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Jianjun Li
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Youle Zhang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
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14
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Brock JH, Graham L, Staufenberg E, Im S, Tuszynski MH. Rodent Neural Progenitor Cells Support Functional Recovery after Cervical Spinal Cord Contusion. J Neurotrauma 2018; 35:1069-1078. [PMID: 29279015 DOI: 10.1089/neu.2017.5244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Previously, we and others have shown that rodent neural progenitor cells (NPCs) can support functional recovery after cervical and thoracic transection injuries. To extend these observations to a more clinically relevant model of spinal cord injury, we performed unilateral midcervical contusion injuries in Fischer 344 rats. Two-weeks later, E14-derived syngeneic spinal cord-derived multi-potent NPCs were implanted into the lesion cavity. Control animals received either no grafts or fibroblast grafts. The NPCs differentiated into all three neural lineages (neurons, astrocytes, oligodendrocytes) and robustly extended axons into the host spinal cord caudal and rostral to the lesion. Graft-derived axons grew into host gray matter and expressed synaptic proteins in juxtaposition with host neurons. Animals that received NPC grafts exhibited significant recovery of forelimb motor function compared with the two control groups (analysis of variance p < 0.05). Thus, NPC grafts improve forelimb motor outcomes after clinically relevant cervical contusion injury. These benefits are observed when grafts are placed two weeks after injury, a time point that is more clinically practical than acute interventions, allowing time for patients to stabilize medically, simplifying enrollment in clinical trials, and enhancing predictability of spontaneous improvement in control groups.
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Affiliation(s)
- John Hoffman Brock
- 1 VA San Diego Healthcare System , San Diego, California.,2 University of California , San Diego, La Jolla, California
| | - Lori Graham
- 2 University of California , San Diego, La Jolla, California
| | | | - Sarah Im
- 2 University of California , San Diego, La Jolla, California
| | - Mark Henry Tuszynski
- 1 VA San Diego Healthcare System , San Diego, California.,2 University of California , San Diego, La Jolla, California
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15
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Fox IK, Miller AK, Curtin CM. Nerve and Tendon Transfer Surgery in Cervical Spinal Cord Injury: Individualized Choices to Optimize Function. Top Spinal Cord Inj Rehabil 2018; 24:275-287. [PMID: 29997430 PMCID: PMC6037328 DOI: 10.1310/sci2403-275] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Recent adaption of nerve transfer surgery to improve upper extremity function in cervical spinal cord injury (SCI) is an exciting development. Tendon transfer procedures are well established, reliable, and can significantly improve function. Despite this, few eligible surgical candidates in the United States undergo these restorative surgeries. Evidence Acquisition: The literature on these procedures was reviewed. Results: Options to improve function include surgery to restore elbow extension, wrist extension, and hand opening and closing function. Tendon transfers are reliable and well tolerated but require weeks of immobilization and limits on extremity use. The role of nerve transfers is still being established. Early results indicate variable return of meaningful function with less immobilization but longer periods (up to years) required to gain appreciable function. Conclusion: Nerve and tendon transfer surgery sacrifice an expendable donor to restore a missing and more critical function. These procedures are well described in hand surgery; are reliable, well tolerated, and covered by insurance; and should be part of the SCI rehabilitation discussion.
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Affiliation(s)
- Ida K. Fox
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Amanda K. Miller
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Catherine M. Curtin
- Department of Surgery, Veterans Affairs Healthcare System, Palo Alto, California
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16
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Manley NC, Priest CA, Denham J, Wirth ED, Lebkowski JS. Human Embryonic Stem Cell-Derived Oligodendrocyte Progenitor Cells: Preclinical Efficacy and Safety in Cervical Spinal Cord Injury. Stem Cells Transl Med 2017; 6:1917-1929. [PMID: 28834391 PMCID: PMC6430160 DOI: 10.1002/sctm.17-0065] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Cervical spinal cord injury (SCI) remains an important research focus for regenerative medicine given the potential for severe functional deficits and the current lack of treatment options to augment neurological recovery. We recently reported the preclinical safety data of a human embryonic cell‐derived oligodendrocyte progenitor cell (OPC) therapy that supported initiation of a phase I clinical trial for patients with sensorimotor complete thoracic SCI. To support the clinical use of this OPC therapy for cervical injuries, we conducted preclinical efficacy and safety testing of the OPCs in a nude rat model of cervical SCI. Using the automated TreadScan system to track motor behavioral recovery, we found that OPCs significantly improved locomotor performance when administered directly into the cervical spinal cord 1 week after injury, and that this functional improvement was associated with reduced parenchymal cavitation and increased sparing of myelinated axons within the injury site. Based on large scale biodistribution and toxicology studies, we show that OPC migration is limited to the spinal cord and brainstem and did not cause any adverse clinical observations, toxicities, allodynia, or tumors. In combination with previously published efficacy and safety data, the results presented here supported initiation of a phase I/IIa clinical trial in the U.S. for patients with sensorimotor complete cervical SCI. Stem Cells Translational Medicine2017;6:1917–1929
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Affiliation(s)
- Nathan C Manley
- Asterias Biotherapeutics Inc., Dumbarton Circle, Fremont, California, USA
| | | | | | - Edward D Wirth
- Asterias Biotherapeutics Inc., Dumbarton Circle, Fremont, California, USA.,Geron Corporation, Menlo Park, California, USA
| | - Jane S Lebkowski
- Asterias Biotherapeutics Inc., Dumbarton Circle, Fremont, California, USA.,Geron Corporation, Menlo Park, California, USA
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17
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Harris CA, Muller JM, Shauver MJ, Chung KC. Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia. J Hand Surg Am 2017; 42:495-505.e11. [PMID: 28669418 PMCID: PMC5753404 DOI: 10.1016/j.jhsa.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that upper extremity reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. METHODS Nineteen patients with C4-8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semistructured interviews were conducted and transcripts evaluated using grounded theory methodology. RESULTS Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: (1) functional dissatisfaction, (2) awareness of UER, and (3) acceptance of surgery. Patients' ability to meet these criteria was determined by 3 checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. CONCLUSIONS We built a conceptual model that outlines how patients' personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. CLINICAL RELEVANCE To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.
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Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - John-Michael Muller
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Melissa J Shauver
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI.
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18
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Li L, Stampas A, Shin H, Li X, Zhou P. Alterations in Localized Electrical Impedance Myography of Biceps Brachii Muscles Paralyzed by Spinal Cord Injury. Front Neurol 2017; 8:253. [PMID: 28676786 PMCID: PMC5476999 DOI: 10.3389/fneur.2017.00253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022] Open
Abstract
This study assessed electrical impedance myography (EIM) changes after spinal cord injury (SCI) with a localized multifrequency technology. The EIM measurement was performed on the biceps brachii muscle at rest condition of 17 cervical SCI subjects, and 23 neurologically intact subjects as control group. The results showed that there was a significant decrease in muscle reactance (X) and phase angle (θ) at selected frequencies (i.e., 50 and 100 kHz) in SCI compared to control. There was no significant difference in muscle resistance (R) between the two groups. The anisotropy examination revealed that SCI group had a decreased anisotropy ratio in resistance. In addition, the multifrequency spectrum analysis showed a decreased slope of the log(freq)-resistance regression in SCI group when compared to healthy control. Findings of the EIM changes are related to inherit muscle changes after the injury. Since EIM requires no patient effort and is quick and convenient to conduct, it may provide a useful tool for examination of paralyzed muscle changes after SCI.
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Affiliation(s)
- Le Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Research Center, Houston, TX, United States.,Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Henry Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Research Center, Houston, TX, United States.,Guangdong Work Injury Rehabilitation Center, Guangzhou, China
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19
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Dunn JA, Hay-Smith EJ, Keeling S, Sinnott KA. Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years. Arch Phys Med Rehabil 2017; 97:S88-96. [PMID: 27233596 DOI: 10.1016/j.apmr.2015.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/18/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. DESIGN Quantitative-qualitative mixed-methods study. SETTING Community based in New Zealand. PARTICIPANTS People (N=9) living with tetraplegia for >10 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. RESULTS Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. CONCLUSIONS Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Spinal Unit, Burwood Hospital, Christchurch, New Zealand.
| | - E Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Sally Keeling
- Health Care of the Elderly, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - K Anne Sinnott
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand
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20
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Bersch I, Fridén J. Role of Functional Electrical Stimulation in Tetraplegia Hand Surgery. Arch Phys Med Rehabil 2016; 97:S154-9. [DOI: 10.1016/j.apmr.2016.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 12/19/2015] [Accepted: 01/01/2016] [Indexed: 11/17/2022]
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21
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Lo C, Tran Y, Anderson K, Craig A, Middleton J. Functional Priorities in Persons with Spinal Cord Injury: Using Discrete Choice Experiments To Determine Preferences. J Neurotrauma 2016; 33:1958-1968. [PMID: 27080545 DOI: 10.1089/neu.2016.4423] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Major goals of rehabilitation and health interventions in people with spinal cord injury (SCI) are to improve functional independence, increase social participation, and enhance quality of life (QOL). Determining functional areas perceived by consumers as most important can assist in research prioritization, planning for delivery of health services, and policy development. Five high priority areas of functioning for the SCI population (arm/hand use, walking, bladder/bowel control, sexual function, and relief of pain) were chosen to determine the preferences for these five attributes. A discrete choice experiment was conducted involving 151 persons with SCI sampled from Australia and the United States of America. Consistent with prior research, arm/hand function had the highest preference, with odds ratios of subjects being 44-76% more likely to choose arm/hand function over the other four functions. Preference for normal arm/hand function was found to be significantly more preferred by the group with paraplegia compared with those with tetraplegia; that is, retaining and not trading off existing arm/hand function for other improved functions. There were no significant differences found in preferences between bladder/bowel function and walking or elimination of pain, although walking was preferred in earlier (≤ 10) post-injury years and pain amelioration became more important with a longer duration (>10 years) post-injury. Sexual function had the lowest preference when traded against the other four functions. Understanding the functional preferences of persons with SCI will help to inform future research design, as well as enabling successful translation of research into practice and health policy, meeting the needs of people with SCI.
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Affiliation(s)
- Charles Lo
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - Yvonne Tran
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - Kim Anderson
- 2 Department of Education, The Miami Project to Cure Paralysis, Department of Neurological Surgery, Lois Pope Life Center, University of Miami , Miami, Florida
| | - Ashley Craig
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - James Middleton
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
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22
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Anderson KD, Cowan RE, Horsewell J. Facilitators and Barriers to Spinal Cord Injury Clinical Trial Participation: Multi-National Perspective of People Living with Spinal Cord Injury. J Neurotrauma 2016; 33:493-9. [DOI: 10.1089/neu.2015.4064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kim D. Anderson
- Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Rachel E. Cowan
- Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jane Horsewell
- The European Spinal Cord Injury Federation, Nottwil, Switzerland
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23
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Cain SA, Gohritz A, Fridén J, van Zyl N. Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury. J Brachial Plex Peripher Nerve Inj 2015; 10:e34-e42. [PMID: 27917237 PMCID: PMC5023083 DOI: 10.1055/s-0035-1558427] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Several nerve transfers have now been successfully performed for upper limb reanimation in tetraplegia. This study was performed to review the use of nerve transfers for upper limb reanimation in tetraplegia. METHODS Medline and Embase (1950 to February 11, 2015) were searched using a search strategy designed to include any studies that reported cases of nerve transfer in persons with cervical spinal cord injury (SCI). RESULTS A total of 103 manuscripts were selected initially and full-text analysis produced 13 studies with extractable data. Of these manuscripts, 10 reported single cases and 3 reported case series. Eighty-nine nerve transfers have been performed in 57 males and 2 females with a mean age of 34 years. The mean SCI level was C6 (range: C5-7), time to surgery post-SCI was 19.9 months (range: 4.1-156 months), and follow-up time was 18.2 months (range: 3-60 months). All case reports recorded a Medical Research Council (MRC) score of 3 or 4 for recipient muscle power, but two early case series reported more variable results. CONCLUSION This review documents the current status of nerve transfer surgery for upper limb reanimation in tetraplegia and summarizes the functional results in 59 cases with 89 nerve transfers performed, including 15 cases of double-nerve transfer and 1 case of triple-nerve transfer.
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Affiliation(s)
- Sarah A. Cain
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andreas Gohritz
- Tetraplegia Hand Surgery, Swiss Paraplegia Centre, Nottwil, Switzerland
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Basel, Switzerland
| | - Jan Fridén
- Tetraplegia Hand Surgery, Swiss Paraplegia Centre, Nottwil, Switzerland
- Center of Advanced Reconstruction of Extremities (CARE), National Reference Center for Tetraplegia Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Natasha van Zyl
- Department of Plastic and Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Priest CA, Manley NC, Denham J, Wirth ED, Lebkowski JS. Preclinical safety of human embryonic stem cell-derived oligodendrocyte progenitors supporting clinical trials in spinal cord injury. Regen Med 2015; 10:939-58. [DOI: 10.2217/rme.15.57] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: To characterize the preclinical safety profile of a human embryonic stem cell-derived oligodendrocyte progenitor cell therapy product (AST-OPC1) in support of its use as a treatment for spinal cord injury (SCI). Materials & methods: The phenotype and functional capacity of AST-OPC1 was characterized in vitro and in vivo. Safety and toxicology of AST-OPC1 administration was assessed in rodent models of thoracic SCI. Results: These results identify AST-OPC1 as an early-stage oligodendrocyte progenitor population capable of promoting neurite outgrowth in vitro and myelination in vivo. AST-OPC1 administration did not cause any adverse clinical observations, toxicities, allodynia or tumors. Conclusion: These results supported initiation of a Phase I clinical trial in patients with sensorimotor complete thoracic SCI.
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Affiliation(s)
- Catherine A Priest
- Geron Corporation, 149 Commonwealth St., Menlo Park, CA 94025, USA
- California Institute of Regenerative Medicine, 210 King St., San Francisco, CA 94107, USA
| | - Nathan C Manley
- Asterias Biotherapeutics Inc., 230 Constitution Drive, Menlo Park, CA 94025, USA
| | - Jerrod Denham
- Geron Corporation, 149 Commonwealth St., Menlo Park, CA 94025, USA
- Dark Horse Consulting, 1999 South Bascom Ave Suite 700, Campbell, CA 95008, USA
| | - Edward D Wirth
- Geron Corporation, 149 Commonwealth St., Menlo Park, CA 94025, USA
- Asterias Biotherapeutics Inc., 230 Constitution Drive, Menlo Park, CA 94025, USA
| | - Jane S Lebkowski
- Geron Corporation, 149 Commonwealth St., Menlo Park, CA 94025, USA
- Asterias Biotherapeutics Inc., 230 Constitution Drive, Menlo Park, CA 94025, USA
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Blabe CH, Gilja V, Chestek CA, Shenoy KV, Anderson KD, Henderson JM. Assessment of brain-machine interfaces from the perspective of people with paralysis. J Neural Eng 2015; 12:043002. [PMID: 26169880 DOI: 10.1088/1741-2560/12/4/043002] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE One of the main goals of brain-machine interface (BMI) research is to restore function to people with paralysis. Currently, multiple BMI design features are being investigated, based on various input modalities (externally applied and surgically implantable sensors) and output modalities (e.g. control of computer systems, prosthetic arms, and functional electrical stimulation systems). While these technologies may eventually provide some level of benefit, they each carry associated burdens for end-users. We sought to assess the attitudes of people with paralysis toward using various technologies to achieve particular benefits, given the burdens currently associated with the use of each system. APPROACH We designed and distributed a technology survey to determine the level of benefit necessary for people with tetraplegia due to spinal cord injury to consider using different technologies, given the burdens currently associated with them. The survey queried user preferences for 8 BMI technologies including electroencephalography, electrocorticography, and intracortical microelectrode arrays, as well as a commercially available eye tracking system for comparison. Participants used a 5-point scale to rate their likelihood to adopt these technologies for 13 potential control capabilities. MAIN RESULTS Survey respondents were most likely to adopt BMI technology to restore some of their natural upper extremity function, including restoration of hand grasp and/or some degree of natural arm movement. High speed typing and control of a fast robot arm were also of interest to this population. Surgically implanted wireless technologies were twice as 'likely' to be adopted as their wired equivalents. SIGNIFICANCE Assessing end-user preferences is an essential prerequisite to the design and implementation of any assistive technology. The results of this survey suggest that people with tetraplegia would adopt an unobtrusive, autonomous BMI system for both restoration of upper extremity function and control of external devices such as communication interfaces.
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Bragge P, Piccenna L, Middleton J, Williams S, Creasey G, Dunlop S, Brown D, Gruen R. Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part II: Background to a research strategy. Spinal Cord 2015; 53:721-8. [PMID: 26099209 DOI: 10.1038/sc.2015.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Literature review/semi-structured interviews. OBJECTIVE To develop a spinal cord injury (SCI) research strategy for Australia and New Zealand. SETTING Australia. METHODS The National Trauma Research Institute Forum approach of structured evidence review and stakeholder consultation was employed. This involved gathering from published literature and stakeholder consultation the information necessary to properly consider the challenge, and synthesising this into a briefing document. RESULTS A research strategy 'roadmap' was developed to define the major steps and key planning questions to consider; next, evidence from published SCI research strategy initiatives was synthesised with information from four one-on-one semi-structured interviews with key SCI research stakeholders to create a research strategy framework, articulating six key themes and associated activities for consideration. These resources, combined with a review of SCI prioritisation literature, were used to generate a list of draft principles for discussion in a structured stakeholder dialogue meeting. CONCLUSION The research strategy roadmap and framework informed discussion at a structured stakeholder dialogue meeting of 23 participants representing key SCI research constituencies, results of which are published in a companion paper. These resources could also be of value in other research strategy or planning exercises. SPONSORSHIP This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand Spinal Cord Injury Network.
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Affiliation(s)
- P Bragge
- National Trauma Research Institute, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - L Piccenna
- National Trauma Research Institute, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - J Middleton
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, New South Wales, Australia
| | - S Williams
- The Spinal Cord Injury Network, Sydney, New South Wales, Australia
| | - G Creasey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - S Dunlop
- Experimental and Regenerative Neuroscience, School of Animal Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - D Brown
- Spinal Research Institute, Heidelberg, Victoria, Australia
| | - R Gruen
- Monash University, Melbourne, Victoria, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Bragge P, Piccenna L, Middleton JW, Williams S, Creasey G, Dunlop S, Brown D, Gruen RL. Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part I: rapid review of SCI prioritisation literature. Spinal Cord 2015; 53:714-20. [DOI: 10.1038/sc.2015.85] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/21/2015] [Accepted: 02/16/2015] [Indexed: 01/08/2023]
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Hawasli AH, Chang J, Reynolds MR, Ray WZ. Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note. Global Spine J 2015; 5:110-7. [PMID: 25844283 PMCID: PMC4369208 DOI: 10.1055/s-0034-1396760] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/03/2014] [Indexed: 01/07/2023] Open
Abstract
Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.
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Affiliation(s)
- Ammar H. Hawasli
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jodie Chang
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Matthew R. Reynolds
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Wilson Z. Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States,Address for correspondence Wilson Z. Ray, MD Department of Neurosurgery, Washington University School of Medicine660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110United States
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Gascoigne AC, Flood S. Tendon transfers. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fox IK, Davidge KM, Novak CB, Hoben G, Kahn LC, Juknis N, Ruvinskaya R, Mackinnon SE. Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity. Hand (N Y) 2015; 10:60-7. [PMID: 25767422 PMCID: PMC4349853 DOI: 10.1007/s11552-014-9677-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral nerve transfers are being used to improve upper extremity function in cervical spinal cord injury (SCI) patients. The purpose of this study was to evaluate feasibility and perioperative complications following these procedures. METHODS Eligible SCI patients with upper extremity dysfunction were assessed and followed for a minimum of 3 months after surgery. Data regarding demographics, medical history, physical examination, electrodiagnostic testing, intraoperative nerve stimulation, recipient nerve histomorphometry, surgical procedure, and complications were collected. RESULTS Seven patients had surgery on eight limbs, mean age of 28 ± 9.9 years and mean time from SCI injury of 5.1 ± 5.2 years. All patients had volitional elbow flexion and no volitional hand function. The nerve to the brachialis muscle was used as the expendable donor, and the recipients included the anterior interosseous nerve (AIN) (for volitional prehension), nerve branches to the flexor carpi radialis, and flexor digitorum superficialis. Two patients underwent additional nerve transfers: (1) supinator to extensor carpi ulnaris or (2) deltoid to triceps. No patients had any loss of baseline upper extremity function, seven of eight AIN nerve specimens had preserved micro-architecture, and all intraoperative stimulation of recipient neuromuscular units was successful further supporting feasibility. Four patients had perioperative complications; all resolved or improved (paresthesias). CONCLUSION Nerve transfers can be used to reestablish volitional control of hand function in SCI. This surgery does not downgrade existing function, uses expendable donor nerve, and has no postoperative immobilization, which might make it a more viable option than traditional tendon transfer and other procedures.
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Affiliation(s)
- Ida K. Fox
- />Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA
| | - Kristen M. Davidge
- />Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Christine B. Novak
- />Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, EW2-422, Toronto, ON M5T 2S8 Canada
| | - Gwendolyn Hoben
- />Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA
| | - Lorna C. Kahn
- />Milliken Hand Center, The Rehabilitation Institute of Saint Louis, Suite 6F, 4921 Parkview Place, Saint Louis, MO 63110 USA
| | - Neringa Juknis
- />Division of Neurorehabilitation, Spinal Cord Injury Program, Department of Neurology, Washington University School of Medicine, Box 8518, 660 South Euclid Avenue, Saint Louis, MO 63110 USA
| | - Rimma Ruvinskaya
- />Division of Neurorehabilitation, Spinal Cord Injury Program, Department of Neurology, Washington University School of Medicine, Box 8518, 660 South Euclid Avenue, Saint Louis, MO 63110 USA
| | - Susan E. Mackinnon
- />Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Box 8238, 660 South Euclid Avenue, Saint Louis, MO 63110 USA
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Fox PM, Suarez P, Hentz VR, Curtin CM. Access to surgical upper extremity care for people with tetraplegia: an international perspective. Spinal Cord 2015; 53:302-5. [PMID: 25687516 DOI: 10.1038/sc.2015.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/14/2014] [Accepted: 01/02/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Survey. OBJECTIVES To determine whether upper extremity reconstruction in patients with tetraplegia is underutilized internationally and, if so, what are the barriers to care. SETTING International-attendees of a meeting in Paris, France. METHODS One hundred and seventy attendees at the Tetrahand meeting in Paris in 2010 were sent a 13-question survey to determine the access and utilization of upper limb reconstruction in tetraplegic patients in their practice. RESULTS Respondents ranged the globe including North America, South America, Europe, Asia and Australia. Fifty-nine percent of respondents had been practicing for more than 10 years. Sixty-four percent of respondents felt that at least 25% of people with tetraplegia would be candidates for surgery. Yet the majority of respondents found that <15% of potential patients underwent upper extremity reconstruction. Throughout the world direct patient referral was the main avenue of surgeons meeting patients with peer networking a distant second. Designated as the top three barriers to this care were lack of knowledge of surgical options by patients, lack of desire for surgery and poor referral patterns to appropriate upper extremity surgeons. CONCLUSION The results of this survey, of a worldwide audience, indicate that many of the same barriers to care exist regardless of the patient's address. This was a preliminary opinion survey and thus the results are subjective. However, these results provide a roadmap to improving access to care by improving patient education and interdisciplinary physician communication.
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Affiliation(s)
- P M Fox
- 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA
| | - P Suarez
- Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA
| | - V R Hentz
- 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA
| | - C M Curtin
- 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA
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Ballas R, Fattal C, Teissier J. Anterior glenohumeral joint stabilization in tetraplegic patients by medializing the anterior head of deltoid muscle. J Hand Surg Am 2015; 40:148-51. [PMID: 25455098 DOI: 10.1016/j.jhsa.2014.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/01/2014] [Accepted: 10/13/2014] [Indexed: 02/02/2023]
Abstract
To improve control of the upper limb in high-level tetraplegic patients, the proximal shoulder must be the first consideration. Medialization of the anterior part of the deltoid muscle provides stabilization and is then an antagonist to the posterior deltoid when a pectoralis major palsy exists. It can also be performed in isolation in high-level tetraplegia even when there is little hope of distal extremity reconstruction to stabilize the shoulder. It also precedes the ability to restore elbow extension and perform further reconstructive hand surgery. We describe the surgical technique and report a clinical case.
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Affiliation(s)
- Richard Ballas
- Department of Orthopedic Surgery, Hospital of Saint-Pierre, University of La Réunion Island, Saint-Pierre, La Réunion Island; Laboratoire DIMPS, Le Tampon, Ile de La Réunion; Centre Mutualiste Neurologique Propara and the Hand and Upper Limb Institute, Montpellier, France.
| | - Charles Fattal
- Department of Orthopedic Surgery, Hospital of Saint-Pierre, University of La Réunion Island, Saint-Pierre, La Réunion Island; Laboratoire DIMPS, Le Tampon, Ile de La Réunion; Centre Mutualiste Neurologique Propara and the Hand and Upper Limb Institute, Montpellier, France
| | - Jacques Teissier
- Department of Orthopedic Surgery, Hospital of Saint-Pierre, University of La Réunion Island, Saint-Pierre, La Réunion Island; Laboratoire DIMPS, Le Tampon, Ile de La Réunion; Centre Mutualiste Neurologique Propara and the Hand and Upper Limb Institute, Montpellier, France
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Abstract
Development of neural prostheses over the past few decades has produced a number of clinically relevant brain-machine interfaces (BMIs), such as the cochlear prostheses and deep brain stimulators. Current research pursues the restoration of communication or motor function to individuals with neurological disorders. Efforts in the field, such as the BrainGate trials, have already demonstrated that such interfaces can enable humans to effectively control external devices with neural signals. However, a number of significant issues regarding BMI performance, device capabilities, and surgery must be resolved before clinical use of BMI technology can become widespread. This chapter reviews challenges to clinical translation and discusses potential solutions that have been reported in recent literature, with focuses on hardware reliability, state-of-the-art decoding algorithms, and surgical considerations during implantation.
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Gorgey AS, Timmons MK, Michener LA, Ericksen JJ, Gater DR. Intra-rater reliability of ultrasound imaging of wrist extensor muscles in patients with tetraplegia. PM R 2013; 6:127-33. [PMID: 24041587 DOI: 10.1016/j.pmrj.2013.08.607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 08/28/2013] [Accepted: 08/31/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES (i) To determine the intra-rater reliability and precision of the ultrasound cross-sectional area (CSA) measurements of the wrist extensors in individuals with spinal cord injury (SCI), and (ii) to determine whether tetraplegia has a negative influence on the reliability and precision for these measurements. DESIGN A repeated-measures cross-sectional study. SETTINGS Clinical hospital and academic settings. METHODS The study was conducted with 20 men with SCI (9 paraplegia and 11 tetraplegia) and 10 able-bodied controls. Ultrasound images were captured of the right side extensor carpi radialis-longus (ECRL) and the extensor digitorum communis (EDC) were captured in 2 sessions separated by 48-72 hours. RESULTS The intraclass correlation coefficients for the CSA measurements of the ECRL and EDC muscles were greater than 0.87 for all 3 groups. The standard error of the measure (SEM) ranged from 0.11-0.22 cm(2) for the ECRL and 0.13-0.27 cm(2) for the EDC. The minimal detectable change of ECL ranged from 0.16 to 0.31 cm(2) and of EDC from 0.19 to 0.38 cm(2). The group differences in muscle CSA of both muscles were found; these differences were greater than the calculated minimal detectable changes. The intraclass correlation coefficients were lower and the SEMs and minimal detectable changes were higher for the group with tetraplegia compared with the able-bodied controls and the group with paraplegia. CONCLUSIONS This study documented substantial intra-rater reliability of measurements of the ECRL and ECD CSA by using ultrasound images, which support the use of this technique to effectively evaluate the musculoskeletal changes after SCI and during rehabilitation. Skeletal muscle atrophy in persons with tetraplegia might have a negative influence on the reliability and precision of these CSA measurements; however, these differences in reliability and precision are not of clinical significance.
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Affiliation(s)
- Ashraf S Gorgey
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Spinal Cord Injury and Disorders Service, Department of Veterans Affairs Medical Center, Hunter Holmes McGuire Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249(∗).
| | - Mark K Timmons
- Physical Medicine and Rehabilitation, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Division of Physical Therapy, Virginia Commonwealth University, Richmond, VA(†)
| | - Lori A Michener
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Division of Physical Therapy, Virginia Commonwealth University, Richmond, VA(‡)
| | - Jeffery J Ericksen
- Physical Medicine and Rehabilitation, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA(§)
| | - David R Gater
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA(‖)
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Wangdell J, Carlsson G, Fridén J. Enhanced independence: experiences after regaining grip function in people with tetraplegia. Disabil Rehabil 2013; 35:1968-74. [DOI: 10.3109/09638288.2013.768709] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nerve transfer strategies for spinal cord injury. World Neurosurg 2012; 80:e319-26. [PMID: 23043992 DOI: 10.1016/j.wneu.2012.10.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/14/2012] [Accepted: 10/02/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating condition, which beleaguers its victims with long-term health issues. Nerve transfer is a feasible option for restoration of critical limb function in patients with SCI that potentially improves independence and quality of life. METHODS This article delineates the general principles of nerve transfer and its specific application pertinent to SCI. The available nerve transfer strategies are described based on the targeted limb function, mostly involving critical upper extremity function. The role of nerve transfer for paraplegia, diaphragm reanimation, and bladder reinnervation is also discussed. RESULTS Nerve transfer offers several advantages over the traditionally used tendon transfer. CONCLUSIONS Nerve transfer does not require prolonged immobilization and provides greater functional gain for a given transfer. Reconstruction of several facets of upper limb function potentially can be performed in a single stage. The merits of nerve transfer deserve further study to evaluate its value for spinal cord injury in humans.
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Kadivar Z, Sullivan JL, Eng DP, Pehlivan AU, O'Malley MK, Yozbatiran N, Francisco GE. Robotic training and kinematic analysis of arm and hand after incomplete spinal cord injury: a case study. IEEE Int Conf Rehabil Robot 2012; 2011:5975429. [PMID: 22275630 DOI: 10.1109/icorr.2011.5975429] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Regaining upper extremity function is the primary concern of persons with tetraplegia caused by spinal cord injury (SCI). Robotic rehabilitation has been inadequately tested and underutilized in rehabilitation of the upper extremity in the SCI population. Given the acceptance of robotic training in stroke rehabilitation and SCI gait training, coupled with recent evidence that the spinal cord, like the brain, demonstrates plasticity that can be catalyzed by repetitive movement training such as that available with robotic devices, it is probable that robotic upper-extremity training of persons with SCI could be clinically beneficial. The primary goal of this pilot study was to test the feasibility of using a novel robotic device for the upper extremity (RiceWrist) and to evaluate robotic rehabilitation using the RiceWrist in a tetraplegic person with incomplete SCI. A 24-year-old male with incomplete SCI participated in 10 sessions of robot-assisted therapy involving intensive upper limb training. The subject successfully completed all training sessions and showed improvements in movement smoothness, as well as in the hand function. Results from this study provide valuable information for further developments of robotic devices for upper limb rehabilitation in persons with SCI.
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Affiliation(s)
- Z Kadivar
- Dept of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA.
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Activity gains after reconstructions of elbow extension in patients with tetraplegia. J Hand Surg Am 2012; 37:1003-10. [PMID: 22425341 DOI: 10.1016/j.jhsa.2012.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 01/16/2012] [Accepted: 01/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Reconstruction of triceps function in persons with tetraplegia is an established surgical intervention. The purpose of this study was to investigate and evaluate patient perspective of gains in activity and satisfaction after surgical reconstruction of triceps function and subsequent rehabilitation. METHODS We studied the effects of surgery and rehabilitation in 14 persons (19 arms) treated with deltoid-to-triceps transfer. We used Canadian Occupational Performance Measurement standards to capture the performance and satisfaction of patient-identified activity goals. Follow-up was performed at 6 and 12 months postoperatively. To make group analyses, we classified activity goals according to the International Classification of Function, Disability, and Health categories of activities and participation, as well as relative to the position of the arm in space. RESULTS Patients reported improvement in performance after surgery, and satisfaction was rated even higher. Improvement was seen in all types of activities that patients had prioritized. No single goal was rated lower at 12 months' follow-up than before surgery. The most common activity gains were related to "driving a wheelchair" and the ability to "reach out," each of which represented 20% of expressed goals. Although "driving a wheelchair" and "moving the body" (transfers) were common goals, the smallest improvements for both performance and satisfaction after 12 months were seen in these areas. We observed the highest performance improvement in the category of "writing" and the ability to "stretch out the arm when lying down." CONCLUSIONS Improvement in activity continues over the first year after triceps reconstruction. Complex activities continue to improve over a longer period than simpler activities. We saw the highest improvement in activities performed without the aid of gravity and activities highly dependent on coordination. Such actions are difficult to compensate for by technique or skills, and therefore elbow extension is essential for performance. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Simpson LA, Eng JJ, Hsieh JTC, Wolfe DL. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma 2012; 29:1548-55. [PMID: 22320160 DOI: 10.1089/neu.2011.2226] [Citation(s) in RCA: 373] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Determining the priorities of individuals with spinal cord injury (SCI) can assist in choosing research priorities that will ultimately improve their quality of life. This systematic review examined studies that directly surveyed people with SCI to ascertain their health priorities and life domains of importance. Twenty-four studies (a combined sample of 5262 subjects) that met the inclusion criteria were identified using electronic databases (Medline, EMBASE, CINAHL, and PsycINFO). The questionnaire methods and domains of importance were reviewed and described. While the questionnaires varied across studies, a consistent set of priorities emerged. Functional recovery priorities were identified for the following areas: motor function (including arm/hand function for individuals with tetraplegia, and mobility for individuals with paraplegia), bowel, bladder, and sexual function. In addition, health, as well as relationships, emerged as important life domains. The information from this study, which identified the priorities and domains of importance for individuals with SCI, may be useful for informing health care and research agenda-setting activities.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Fridén J, Gohritz A. Novel Concepts Integrated in Neuromuscular Assessments for Surgical Restoration of Arm and Hand Function in Tetraplegia. Phys Med Rehabil Clin N Am 2012; 23:33-50, ix-x. [DOI: 10.1016/j.pmr.2011.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bertelli JA, Lehm VLM, Tacca CP, Duarte ECW, Ghizoni MF, Duarte H. Transfer of the Distal Terminal Motor Branch of the Extensor Carpi Radialis Brevis to the Nerve of the Flexor Pollicis Longus. Neurosurgery 2011; 70:1011-6; discussion 1016. [DOI: 10.1227/neu.0b013e3182367642] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
In tetraplegics, thumb and finger motion traditionally has been reconstructed via orthopedic procedures. Although rarely used, nerve transfers are a viable method for reconstruction in tetraplegia.
OBJECTIVE:
To investigate the anatomic feasibility of transferring the distal branch of the extensor carpi radialis brevis (ECRB) to the flexor pollicis longus (FPL) nerve and to report our first clinical case.
METHODS:
We studied the motor branch of the ECRB and FPL in 14 cadaveric upper limbs. Subsequently, a 24-year-old tetraplegic man with preserved motion in his shoulder, elbow, wrist, and finger extension, but paralysis of thumb and finger flexion underwent surgery. Seven months after trauma, we transferred the brachialis muscle with a tendon graft to the flexor digitorum profundus. The distal nerve of the ECRB was transferred to the FPL nerve.
RESULTS:
The branch to the ECRB entered the muscle in its anterior and proximal third. After sending out a first collateral, the nerve runs for 2.4 cm alongside the muscle and bifurcates intramuscularly. A main branch from the anterior interosseous nerve, which entered the muscle 3 cm from its origin on the radius, innervated the FPL. The ECRB and FPL nerves had similar diameters (∼1 mm) and numbers of myelinated fibers (∼180). In our patient, 14 months after surgery, pinching and grasping were restored and measured 2 and 8 kg strength, respectively.
CONCLUSION:
Transfer of the ECRB distal branch to the FPL is a viable option to reconstruct thumb flexion.
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Affiliation(s)
- Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil
- Center of Biological and Health Sciences, University of the South of Santa Catarina (Unisul), Tubarão, SC, Brazil
| | | | - Cristiano Paulo Tacca
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil
| | | | - Marcos Flávio Ghizoni
- Center of Biological and Health Sciences, University of the South of Santa Catarina (Unisul), Tubarão, SC, Brazil
| | - Hamilton Duarte
- Department of Anatomy, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Endress RD, Hentz VR. Biceps-to-triceps transfer technique. J Hand Surg Am 2011; 36:716-21. [PMID: 21463733 DOI: 10.1016/j.jhsa.2011.01.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/24/2011] [Indexed: 02/02/2023]
Abstract
Lack of voluntary active elbow extension inhibits many important functions in persons with tetraplegia. Biceps-to-triceps transfer can restore this function in selected patients. This article outlines the basic problem, indications and contraindications, surgical technique, and postoperative rehabilitation protocol for biceps-to-triceps transfer using the medial routing technique with suture anchoring of the biceps muscle tendon unit into the triceps aponeurosis and olecranon.
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Affiliation(s)
- Ryan D Endress
- Department of Surgery, Division of Plastic Surgery, Stanford University Hospital and Clinics, Stanford, CA, USA
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Jaspers Focks-Feenstra JH, Snoek GJ, Bongers-Janssen HMH, Nene AV. Long-term patient satisfaction after reconstructive upper extremity surgery to improve arm–hand function in tetraplegia. Spinal Cord 2011; 49:903-8. [PMID: 21445079 DOI: 10.1038/sc.2011.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Exploring the potential for neural recovery after incomplete tetraplegia through nonsurgical interventions. PM R 2011; 2:S279-85. [PMID: 21172689 DOI: 10.1016/j.pmrj.2010.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 11/23/2022]
Abstract
Persons with tetraplegia resulting from a cervical spinal cord injury believe that increasing upper limb (UL) function will improve their quality of life. Various lines of evidence demonstrate that persons with incomplete tetraplegia have the potential for improvements in both neural plasticity and function of the arms and hands. Therefore treatment to improve UL function in persons with incomplete tetraplegia should focus on improving motor control, not just compensation for the paralysis and sensory loss that follows a spinal cord injury. This article highlights the principles that underlie the facilitation of neural plasticity and functional changes: intensity, repeated practice, attention, and somatosensory augmentation. Evidence is presented for the application of these principles through the use of activity-based interventions in persons with tetraplegia and the hypothesis is proposed that the use of activity-based interventions will lead to greater, more beneficial neural plasticity as well as gains in UL function, in persons with incomplete tetraplegia.
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Biceps-to-triceps transfer for elbow extension in persons with tetraplegia. J Hand Surg Am 2010; 35:968-75. [PMID: 20513578 DOI: 10.1016/j.jhsa.2010.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 03/02/2010] [Accepted: 03/04/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Restoration of elbow extension via tendon transfer is an integral part of upper extremity surgical reconstruction in persons with tetraplegia. The purpose of this investigation was to assess patient satisfaction and elbow extension strength after biceps-to-triceps transfers. METHODS This is a retrospective chart review of biceps-to-triceps transfers in patients with spinal cord injury. Forty-five patients (77 arms) with spinal cord injury underwent biceps-to-triceps transfer. A total of 40 patients (68 arms) were available for follow-up. The average age at surgery was 17.3 years (range, 6.4-21.7 y).The biceps tendon was transferred around the medial aspect of the arm. The preoperative elbow extension strength was 0/5 (54 arms), 1/5 (10 arms), or 2/5 (4 arms). We also used the Canadian Occupational Performance Measure to measure patient-perceived outcome in a subset of 8 subjects. RESULTS Stringent manual muscle testing (MMT) for elbow extension revealed a statistically significant increase in muscle strength after surgery (p < .001). Forty-two arms were able to extend completely against gravity (MMT 3/5 or greater). Nine arms had a mild extension lag against gravity (MMT of 3/5). Therefore, 75% (51/68) of arms were able to function overhead. Seventeen arms had MMT scores less than 3/5. The top 5 goals of the 8 patients with completed preoperative and postoperative Canadian Occupational Performance Measure results were analyzed. After transfer, all 8 patients reported improved performance of and/or satisfaction with at least one goal. Performance and satisfaction were greatly improved (at least 4 points) for activities of living such as dressing, grooming, reaching for objects, recreational activities, wheelchair propulsion, and transfers. CONCLUSIONS Based on these results, we believe the biceps-to-triceps transfer is a reliable technique for restoration of elbow extension in persons with tetraplegia. Overhead function is obtainable in most cases with careful surgical technique and meticulous postoperative therapy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Harish Hosalkar
- Rady Children's Hospital, UCSD San Diego, San Diego, CA 92123, USA.
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