A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia

Frontiers in Rehabilitation Sciences, 2022 · DOI: 10.3389/fresc.2022.889577 · Published: June 30, 2022

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

This study aims to improve treatment plans for patients with cervical spinal cord injuries (cSCI) affecting their upper extremities. It explores how to predict the effectiveness of different treatment pathways, both conservative and surgical. The researchers analyzed data from 220 cSCI patients, focusing on factors like muscle strength, nerve integrity, and the severity of the spinal cord injury. They used this information to create a model that predicts muscle strength recovery. The goal is to use this prediction model to create individualized treatment plans that include electrical stimulation (ES) to improve hand and arm function, motor learning, and muscle strength.

Study Duration

24 weeks

Participants

220 patients with cervical spinal cord injury

Evidence Level

Not specified

Key Findings

1
Motor point (MP) mapping and ASIA Impairment Scale (AIS) are significant predictors of muscle strength acquisition in finger flexors (FDP) and extensors (EDC) at 24 weeks post-injury.
2
A relatively high proportion of lower motor neuron (LMN) lesions were found in the brachioradialis muscle, even when the core damage was not at the level of segmental innervation of the muscle.
3
The study provides a 'road map' to assist in the selection of early treatments after cSCI based on MP test results and AIS classification.

Research Summary

This study investigates predictors of muscle strength in upper extremities of patients with cervical spinal cord injuries (cSCI) to improve treatment planning. The research identifies motor point (MP) mapping and ASIA Impairment Scale (AIS) as significant predictors of muscle strength in finger flexors and extensors. The findings support the creation of individualized treatment plans incorporating electrical stimulation (ES) for motor learning, strengthening, and muscle property preservation.

Practical Implications

Individualized Treatment Plans

The prediction model enables tailored treatment plans, optimizing therapy based on individual patient characteristics.

Early Intervention Strategies

Early identification of muscle strength predictors allows for timely implementation of appropriate interventions like nerve transfers and electrical stimulation.

Optimized Electrical Stimulation

The findings guide the selection of electrical stimulation protocols for motor learning, strengthening, and muscle property preservation.

Study Limitations

1
The study only examined two extrinsic hand muscles and one double-jointed forearm muscle, reflecting only one aspect of the complexity in tetraplegic hand treatment.
2
The function and influence of the intrinsic musculature on the function and shape of the hand are not yet included.
3
The actual proportions of denervated and innervated regions within a muscle cannot be precisely determined in the case of partially innervated muscles.

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