Advanced Assessment of the Upper Limb in Tetraplegia: A Three-Tiered Approach to Characterizing Paralysis

Top Spinal Cord Inj Rehabil, 2018 · DOI: 10.1310/sci2403-206 · Published: July 1, 2018

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

This article introduces a three-tiered approach to evaluating motor function in individuals with tetraplegia, focusing on the characteristics of weak and fully paralyzed muscles during acute rehabilitation. The three tiers include evaluating voluntary strength, lower motor neuron integrity, and latent motor responses in paralyzed muscles. This in-depth analysis of paralysis after SCI can help mitigate potential secondary conditions and identify effective interventions.

Study Duration

Not specified

Participants

Individuals with tetraplegia

Evidence Level

Not specified

Key Findings

1
Latent motor responses can be detected in individuals classified with motor complete SCI, suggesting potential for recovery.
2
LMN damage is more likely to occur one segment caudal to the site of injury, influencing hand position and the development of a tenodesis grasp.
3
Understanding LMN status and latent motor responses is important for guiding upper limb interventions and determining eligibility for motor learning-based interventions.

Research Summary

The article proposes a three-tiered approach to assess motor function in tetraplegic upper limbs, including voluntary strength testing, evaluation of LMN integrity using electrical stimulation, and evaluation of latent motor responses using EMG recording. Evaluating LMN status and latent motor responses can help guide interventions, prevent secondary conditions, and improve the classification of injury level. Detailed characterization of paralysis, focusing on weak or paralyzed muscles, can provide insights into appropriate interventions and improve upper limb management for individuals with tetraplegia.

Practical Implications

Preventive Care

Knowledge of LMN pathology early after injury can focus early intervention activity toward prevention of secondary conditions.

Intervention Guidance

Careful analysis of LMN-paralyzed muscles and possible latent motor responses can indicate eligibility for motor learning-based interventions.

Surgical Planning

Reconstructive surgery, including tendon and nerve transfer, can be more effectively implemented with knowledge of LMN status and the existence of latent motor responses.

Study Limitations

1
Challenges may arise in employing these techniques in higher-level patients, particularly when assessing paralyzed shoulder muscles.
2
Clinical characteristics such as spasticity and tone may prevent accurate assessment of voluntary and stimulated muscle responses.
3
Incorporating additional testing during acute rehabilitation can be challenging due to decreasing lengths of stay and increasing pressure to increase productivity.

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