Rehabilitation After Surgical Reconstruction to Restore Function to the Upper Limb in Tetraplegia: A Changing Landscape

Arch Phys Med Rehabil, 2016 · DOI: 10.1016/j.apmr.2016.03.015 · Published: June 1, 2016

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

Upper limb reconstructive surgery can improve independence, return to work, societal participation, and quality of life for individuals with tetraplegia. Postoperative therapy is crucial for achieving successful functional outcomes after reconstructive surgery for individuals with tetraplegia. Sharing knowledge of current rehabilitation practice related to reconstructive surgery can improve treatment options, increase availability of muscle reeducation programs, and motivate long-term follow-up assessments.

Study Duration

Not specified

Participants

Individuals with tetraplegia

Evidence Level

Not specified

Key Findings

1
Specific guidelines for postoperative training paradigms after upper limb reconstructive surgery in tetraplegia are not readily available.
2
Identifying and overcoming patient, provider, and healthcare system barriers can improve access to upper limb surgical reconstruction for appropriate candidates with tetraplegia.
3
Early assessment of lower motor neuron integrity with surface electrical stimulation can improve individualized treatment plans after SCI.

Research Summary

This article addresses issues related to the availability and choice for surgery, preoperative assessments, postoperative training paradigms, and appropriate outcome measures for upper extremity reconstruction. It highlights the importance of shared knowledge of current rehabilitation practice to expand treatment options, increase availability of postoperative muscle reeducation programs, and motivate long-term follow-up assessments. The supplement includes articles detailing therapy protocols after tendon transfer procedures, spasticity-correcting surgery, and nerve transfers, emphasizing the need for standardized outcome measures and multicenter collaborations.

Practical Implications

Improved access to surgery

Interdisciplinary collaboration and patient education can overcome barriers and make surgical options available to all appropriate candidates.

Optimized treatment plans

Differentiating upper versus lower motor neuron damage results in a more complete characterization of functional changes after SCI with objective criteria to stratify individuals within a broader classification.

Enhanced rehabilitation protocols

Emerging postoperative treatment paradigms, guided by principles of motor learning and skill development, have the potential to improve the capacity for upper limb function in tetraplegia.

Study Limitations

1
Lack of specific guidelines for postoperative training paradigms.
2
Underutilization of surgeries to restore upper limb function in tetraplegia.
3
Heterogeneity of the patient population makes comparing treatment interventions challenging.

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