Outcomes of tendon transfer surgery and occupational therapy in a child with tetraplegia secondary to spinal cord injury.

Abstract

Tendon transfer surgery to augment hand function lost to spinal cord injury (SCI) has gained acceptance as a rehabilitation option for adults but has yet to be fully explored in children. In this study, hand function and performance of activities of daily living in an 11-year-old child with an SCI were evaluated before and after surgical transfers of the brachioradialis to the flexor pollices longus and the extensor carpi radialis longus to the flexor digitorum profundus. With the use of a single-subject AB design, repeated measures of pinch force, the Jebsen Test of Hand Function for Children and the Grasp and Release Test were obtained before tendon transfer surgery and at 2 1/2 6, and 12 months after surgery. Activities of daily living were assessed with the Functional Independence Measure (FIM) and the Common Object Test (COT) before surgery and 12 months after surgery. Each assessment revealed a significant improvement in hand function after surgery. Pinch force was measurable only after tendon transfers and increased throughout the first year. By two standard deviation analyses, after surgery there were significantly more task completions for all Grasp and Release Test objects, and task completion times were shorter for the light and heavy objects of the Jebsen Test of Hand Function for Children. FIM results showed that self-catheterization and cutting food were possible only after surgery, and results of the COT revealed new unilateral and bilateral abilities that facilitated the client's independence in writing, eating, applying toothpaste, and brushing teeth. This single-subject study demonstrates the benefits of tendon transfers for active grasp in a child with an SCI.