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Rehabilitation After Spasticity-Correcting Upper Limb Surgery in Tetraplegia

Journal article
Authors Johanna Wangdell
Jan Fridén
Published in Archives of Physical Medicine and Rehabilitation
Volume 97
Issue 6
Pages S136-S143
ISSN 0003-9993
Publication year 2016
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages S136-S143
Language en
Links dx.doi.org/10.1016/j.apmr.2016.01.0...
Keywords Muscle spasticity, Quadriplegia, Reconstructive surgical procedures, Rehabilitation, Spinal cord, spinal-cord-injury, tendon transfer, hand, reconstruction, epidemiology, mobilization, decision, release, people, issues, Rehabilitation, Sport Sciences
Subject categories Sport and Fitness Sciences

Abstract

Objective: To describe the early active rehabilitation concept developed for spasticity-correcting surgery in tetraplegia and to report the outcomes in grip ability and change of performance and satisfaction in patients' prioritized activities 1 year postoperatively. Participants: All patients who underwent surgeries for correction of spasticity in tetraplegic hands between 2009 and 2013 in the studied unit (N=37). Interventions: Spasticity-correcting upper limb surgery with early active rehabilitation to restore grip ability in tetraplegia. Main Outcome Measures: Grasp and release test (GRT) and modified Canadian Occupational Performance Measure (COPM). Results: All patients could accomplish the early active rehabilitation concept. The complication rate related to the treatment was low. Compared with preoperatively, all evaluated individuals experienced improvements in grasp ability and activity performance and satisfaction at 1-year follow-up. The performance in prioritized activities, as measured by the COPM, improved by 2.6 scale steps. Satisfaction with performance improved 3.0 scale steps postoperatively (n=21). The grasp ability, measured by the GRT, improved significantly, from 80 preoperatively to 111 (n=10). Conclusions: The surgery, combined with the early active rehabilitation protocol, is a reliable and safe procedure. The ability to use the hand improved, and gains were maintained at least 1 year after surgery in all patients with respect to both the objective grasp ability and patients' subjective rating of their performance and satisfaction in their prioritized activities. The procedure should therefore be considered as an adjunct to other treatments of upper limb spasticity in spinal cord injury. (C) 2016 by the American Congress of Rehabilitation Medicine

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