Restoration Of Hand Function Research Articles

Design and Optimization of a New Index Finger Exoskeleton Robot with Underactuated Mechanism

Spinal cord injury and stroke are the main diseases that lead to loss or decline of hand function, and hand rehabilitation exoskeletons can be used to help restore hand function. Due to the problems of traditional hand exoskeletons such as heavier weight, higher cost and limited mobility, this project aims to improve an index finger exoskeleton robot with an underactuated mechanism, improve its bending and extension angles, and optimize the robot to a certain extent. flexibility. At the same time, the genetic algorithm is combined in the control system to make all the control indexes reach excellent. This project establishes a 3D model through Solidworks, and at the same time proves the feasibility of improvement by establishing a kinematic model. In terms of design, the mechanism is adjusted according to the range of activities of MCP(metacarpophalangian joint) and PIP(proximal interphalangeal joint) to optimize the flexibility of the design model. In the aspect of control system, the genetic algorithm is combined with system identification and PID(Proportion Integration Differentiation)control, in order to reach the objective of establishing a more precise training model and finding appropriate PID parameters. This project has a positive effect on the medical efficiency of the underactuated hand exoskeleton.

Conformable Electrode Arrays for Wearable Neuroprostheses.

Wearable electrode arrays can selectively stimulate muscle groups by modulating their shape, size, and position over a targeted region. They can potentially revolutionize personalized rehabilitation by being noninvasive and allowing easy donning and doffing. Nevertheless, users should feel comfortable using such arrays, as they are typically worn for an extended time period. Additionally, to deliver safe and selective stimulation, these arrays must be tailored to a user's physiology. Fabricating customizable electrode arrays needs a rapid and economical technique that accommodates scalability. By leveraging a multilayer screen-printing technique, this study aims to develop personalizable electrode arrays by embedding conductive materials into silicone-based elastomers. Accordingly, the conductivity of a silicone-based elastomer was altered by adding carbonaceous material. The 1:8 and 1:9 weight ratio percentages of carbon black (CB) to elastomer achieved conductivities between 0.0021-0.0030 S cm-1 and were suitable for transcutaneous stimulation. Moreover, these ratios maintained their stimulation performance after several stretching cycles of up to 200%. Thus, a soft, conformable electrode array with a customizable design was demonstrated. Lastly, the efficacy of the proposed electrode arrays to stimulate hand function tasks was evaluated by in vivo experiments. The demonstration of such arrays encourages the realization of cost-effective, wearable stimulation systems for hand function restoration.

Management of Complex Forearm Injuries: Our Strategy of Reconstruction and Clinical Results.

The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an "as early as possible" reconstruction.

The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application

BackgroundAssistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance.MethodsFourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test.ResultsThe BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance.ConclusionThe BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.

Meat grinder hand injury in children: A report of 5 cases

Meat grinder injury is considered one of the leading causes that may result in mutilating hand injury. It is commonly occurred in children due to negligence, limited awareness and inexperience about the machine processing and its possible complications. We reported five cases of grinder-induced hand injuries, presented with their hands yet firmly wedged inside the grinder. Each hand was freed from inside of the grinder by reversed turning of the machine except for one case which needed extrication with the using of a cutting torch. After releasing of the injured hand, we performed amputation at the wrist level in two cases, at metacarpophalangeal levels in one case and we could perform revascularization in two cases. Meat grinder hand injuries in children is challenging, gentle and careful releasing of the hand without causing further damages along with meticulous repair of hand structure to restore hand function. The most important thing is to prevent household meat-grinder-related injuries through keeping it away from the reach of the children's hand.

Effectiveness of early rehabilitation in hand burns.

Hand burn trauma occurs quite commonly and the outcome of hand burns can significantly impact self-care daily function, work and employment, leisure activities, and overall health-related quality of life. The overall goal of the management of hand burn trauma is to optimize hand function. Rehabilitation and restoration of hand function are critical for the patient's independence and re-integration into society and work. The purpose of this study is to present our experience with 105 hand burn trauma patients admitted and treated in our burn center and to show the efficacy of early rehabilitation on their ability to return to their prior social life and work. In our study, we included that 105 patients with acute severe hand burn trauma were hospitalized in Gulhane burn center between 2017 and 2021. They underwent rehabilitation program daily sessions. Patients with hand burns are evaluated by ranges of motions (ROM), grip strength, Cochin Hand Function Scale (CHFS), and Michigan Hand Questionnaire (MHQ) 12 months after the injury. Overall, mean digital total active motion were >180°. The mean values for grip strength of dominant hand for men were 27.2±9.3 kg, for women were 22.0±8.8 kg and non-dominant hand for men were 24.05±13.8 kg, for women were 17.8±10.3 kg. Total score of 5 items was 19.0 in CHFS. The mean overall score on the MHQ was 62.3±27.4. All obtained data were within normal or accepted functional ranges. Spearman correlation coefficient indicates a negative correlation between MHQ and CHFS (p≤0.01). A comprehensive rehabilitation program is essential in helping patients to regain optimal function after hand burn trauma. Physiotherapy and occupational therapy is most beneficial when started at the time of admission.

Funkcionalna električna stimulacija gornjih ekstremiteta osoba s kvadriplegijom

Introduction. Traumatic injury to the cervical segment of the spinal cord causes disability and quadriplegia. Upper extremity mobility and restoration of hand function for people with quadriplegia is a priority. With coordinated electrical stimulation of peripheral muscles and nerves, known as functional electrical stimulation (FES), this is possible. Upper limb stimulators are designed to increase the physical function and are controlled by users through preserved, uncoupled and limited voluntary movements. Aim. By reviewing the available literature, the aim of the paper was to prove the importance of FES in motor control and functional ability of the upper limbs of people with quadriplegia. Material and method. Using the keywords "quadriplegia", "FES", "upper extremity", "functional ability", "motor control" and "traumatic injury", the three authors searched the databases PubMed, EMBASE, SciELO, BMC, Academia according to pre-established criteria. Edu, Web of Science and Science &amp; Technology (November 2021 - March 2022). Potential papers were selected using the Jovell and Navarro-Rubio classification of study design. Papers older than five years, papers that were not available in their entirety, or in English, were excluded. Fifty-seven papers were classified, and six were included in the research. Results. Functional electrical stimulators improved the functional ability of the upper extremities shortly after application. They cause neurophysiological changes in the central nervous system and cortical reorganization depending on the synchronization of the voluntary command and the successful execution of the planned task. Sensory stimulation is important in the preservation of neurological function because by synchronizing the voluntary command and successfully executing the planned task, neuroplasticity is stimulated. Conclusion. With the emergence of more research and analysis of the obtained results, we can expect the creation of new programs to improve the recovery process of the upper extremities, a greater degree of independence in daily life activities, and a better quality of life for people with quadriplegia.

Characteristics of Neurovascular Injury Associated with Tendon Injury of Hand: A Retrospective Study

Introduction: Normal function of a hand depends much on the integrity of its anatomical structures. Musculotendinous injuries of the hand are frequently associated with neurovascular injury. Repair or reconstruction of all structures is important for optimal restoration of hand function. Aim: To determine the characteristics of neurovascular injury associated with musculotendinous injuries of the hand. Materials and Methods: The present study was a retrospective observational study conducted in the trauma care centre of a tertiary care teaching hospital from September 2020 to August 2021. Patients sustaining acute tendon injury of the hand of all age group and both sexes were included (n=38). Various epidemiological data like age, sex, occupation etc., and clinical and operative findings were collected and were analysed. Descriptive statistics were used and results were expressed in terms of frequency and percentages. Results: The mean age of the study population was 24 years with male patients being 30 and female patients was eight. As far as side of involvement was concerned, 17 (44.7%) patients had left-side of injury and 21 (55.3%) patients had right-side of injury. Majority of the patients, 27 (71.1%) sustained flexor Zone V injury. As to the neurovascular involvement, isolated median nerve, i.e., 10 (41.7%) and radial artery i.e., 8 (44.4%) injuries were more common. Conclusion: Neurovascular injuries associated with tendon injury of the hand is common finding. Prior knowledge of their presence and association with specific tendon injuries are beneficial for their identification and management, which ultimately leads to optimal restoration of hand function.

Mechanical design and feasibility of a finger exoskeleton to support finger extension of severely affected stroke patients.

In this paper we presented the mechanical design and evaluation of a low-profile and lightweight exoskeleton that supports the finger extension of stroke patients during daily activities without applying axial forces to the finger. The exoskeleton consists of a flexible structure that is secured to the index finger of the user while the thumb is fixed in an opposed position. Pulling on a cable will extend the flexed index finger joint such that objects can be grasped. The device can achieve a grasp size of at least 7 cm. Technical tests confirmed that the exoskeleton was able to counteract the passive flexion moments corresponding to the index finger of a severely affected stroke patient (with an MCP joint stiffness of k = 0.63Nm/rad), requiring a maximum cable activation force of 58.8N. A feasibility study with stroke patients (n=4) revealed that the body-powered operation of the exoskeleton with the contralateral hand caused a mean increase of 46° in the range of motion of the index finger MCP joint. The patients (n=2) who performed the Box & Block Test were able to grasp and transfer maximally 6 blocks in 60 sec. with exoskeleton, compared to 0 blocks without exoskeleton. Our results showed that the developed exoskeleton has the potential to partially restore hand function of stroke patients with impaired finger extension capabilities. An actuation strategy that does not involve the contralateral hand should be implemented during further development to make the exoskeleton suitable for bimanual daily activities.

Distal nerve transfer (PT-AIN, SUP-PIN) for regaining hand function in C8, T1 root injury following extirpation of the right C8, T1 schwannoma.

A 48-year-old female was admitted to the authors' department due to hand weakness as a consequence of C8, T1 root injury. Eight months earlier, the patient had been treated by a pulmonary surgeon due to an expansive lesion near the apex of the right lung, which resulted in right lower brachial plexus palsy. Postoperative pathohistological findings indicated that the lesion was nerve schwannoma. The diagnostic process included physical examination, electromyoneurography, and MRI. A distal nerve transfer (pronator teres-anterior interosseus nerve [PT-AIN], supinator-posterior interosseus nerve [SUP-PIN]) was performed in order to restore hand function. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22110.

손 기능 회복을 위한 신경인지재활치료 도구개발 버전 2

The hand is the external brain. The hands are motor organs that carry out the commands given by the brain, and they are the sensory organs that provide the most information to the brain. When you move your hands or accept changes in the outside world with your hands, your brain is activated. Using your hands is an act that stimulates the highest levels of mental functioning. The purpose of this research and development is to contribute to the efficient and effective recovery of hand function through the continuous development of neurocognitive rehabilitation therapy training tools.&#x0D; Innovative improvements to the function of the hand function recovery training tool version I. The fixing part is equipped with silicone adhesive pads for easy movement and fixation. The height of the support is 75 mm, and the maximum height of the training tool is 200 mm. The height was considered so that the head could be relaxed and trained to restore hand function. The rotating part is very creative. 180° turns are possible on the forehead surface and 270° turns on the sagittal surface. In addition, the entire rotating part has been developed to be able to rotate 360° degrees.&#x0D; Innovative improvements in neurocognitive rehabilitation training tools for hand function training have enabled efficient and effective training. It is hoped that it will be actively used in clinical practice and contribute to the recovery of hand function in patients.

Soft tissue reconstruction of the thumb: Classification of defects and standardisation of treatment

The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects. This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (&lt; 3 cm), medium (4-8cm) and large defects (&gt; 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction. After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects. Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.

A Review of Hand Function Rehabilitation Systems Based on Hand Motion Recognition Devices and Artificial Intelligence.

The incidence of stroke and the burden on health care and society are expected to increase significantly in the coming years, due to the increasing aging of the population. Various sensory, motor, cognitive and psychological disorders may remain in the patient after survival from a stroke. In hemiplegic patients with movement disorders, the impairment of upper limb function, especially hand function, dramatically limits the ability of patients to perform activities of daily living (ADL). Therefore, one of the essential goals of post-stroke rehabilitation is to restore hand function. The recovery of motor function is achieved chiefly through compensatory strategies, such as hand rehabilitation robots, which have been available since the end of the last century. This paper reviews the current research status of hand function rehabilitation devices based on various types of hand motion recognition technologies and analyzes their advantages and disadvantages, reviews the application of artificial intelligence in hand rehabilitation robots, and summarizes the current research limitations and discusses future research directions.

Restoration of Hand Function in Isolated Lower Brachial Plexus Injury with Brachioradialis to Flexor Pollicis Longus and Biceps to Flexor Digitorum Profundus Transfer.

Background: Isolated lower (C8T1) brachial plexus injury (BPI) is uncommon and the aim of treatment is to achieve a satisfactory grasp enabling the use of the hand for daily activities. The aim of this study is to report the outcomes of the transfer of brachioradialis (BR) to flexor pollicis longus (FPL) and biceps to the flexor digitorum profundus (FDP) for an isolated lower BPI. Methods: This is a retrospective study of all patients with an isolated lower BPI who underwent a BR to FPL and biceps to FDP transfer for restoration of digital flexion over a 1-year period from May 2019 to June 2020. Patient demographic and injury data were collected at the presentation. Outcomes data included the ability to grasp and perform activities of daily living and DASH score. Results: The study included three patients (all men) with an average age of 30.3 years. All sustained an isolated lower BPI following a road traffic accident and tendon transfers were performed at a mean of 9.3 months after the initial injury. At a mean of 1-year follow-up, all three recovered grade M4 motor power of digital flexion, achieved good grasp function with pulp-to-palm distance of <1 cm. All are able to use the hand for independent as well as bimanual activities. The individual DASH scores were 36, 30 and 30. Conclusions: BR to FPL for thumb flexion and biceps to FDP using fascia lata graft to restore finger flexion is simple and effective surgeries in patients with isolated lower BPI. Level of Evidence: Level V (Therapeutic).

Outcomes of Combined Visual and Auditive Stimulation on Functions of Hand and Grip Strengths in Patients with Hemiplegia

Abstract Background Stroke is a major ailment that results from hypoxia, ischemia, blockage, or hemorrhage. The recovery of hand functions is an essential goal in stroke patients' recovery. Aim This study aimed to analyze the outcomes of rhythmic auditory stimulation (RAS) and mirror therapy on hand functions, as well as grip strength, in stroke patients. Materials and Methods A quasiexperimental study has been used based on criteria of inclusion, 30 patients were enrolled. The participants were assigned to two groups, 15 patients each. Group A (control group) underwent traditional physiotherapy. Group B (experimental group) underwent RAS and mirror therapy. Both the groups received 20 minutes of treatment, 20 sessions in 1 month. The Action Research Arm Test (ARAT) and hand-held dynamometer were used to evaluate results. Paired t-test has been used to analyze the data with the SPSS software tool. Results The paired t-test results showed that notable distinctions in ARAT mean pretest scores between two groups were not found. A notable change in ARAT results was present between the two groups with mean posttest score and difference in pretest to posttest. No notable distinctions in grip strength results were seen with mean pretest results. But a notable change was found in grip strength results among two groups with mean posttest scores. Conclusion Combining RAS and mirror therapy programs has shown beneficial effects on hand functions, as well as grip strength of stroke patients and can be used as adjunct interventions along with conventional physiotherapy to encourage restoration of hand functions in hemiparetic patients.

Reproducibility, Construct Validity, and Responsiveness of the Tetraplegia Upper Limb Activities Questionnaire, TUAQ. Part 2

ObjectiveTo test reliability, construct validity and responsiveness of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a patient-reported outcome measure that assesses perceived performance and satisfaction with 10 standardized activities. DesignOutcome measure psychometric evaluation. SettingSpinal cord injury units in 2 countries. ParticipantsReproducibility: 47 individuals with tetraplegia. Construct validity and responsiveness: 33 individuals with tetraplegia undergoing surgery to restore hand function (N=80). InterventionsReproducibility: The TUAQ was completed on 2 occasions, 2 weeks apart. Construct validity and responsiveness: Participants completed the TUAQ prior to surgery and 3-12 months after hand reconstruction surgery. Internal consistency was examined using Cronbach α. Two agreement parameters were examined: the SEM and minimal detectable change with 90% confidence interval (MDC90). Construct validity was evaluated using Pearson product moment correlation against a priori hypotheses. Responsiveness was assessed using paired t tests and effect size. ResultsTest-retest reliability and internal consistency was high (intraclass correlation coefficient of 0.89 for performance scale and 0.88 for satisfaction, Cronbach α of 0.92 and 0.90, respectively). For agreement the SEM scores were 4.7 and 3.5, with MDC90 of 10.9 and 8.2, respectively. Responsiveness and construct validity showed sound results with no ceiling or floor effects and with large effect size (>1.05). ConclusionsThe TUAQ demonstrates good psychometric properties for reliability and agreement for persons with tetraplegia and responsiveness and construct validity for surgical reconstruction of hand function for persons with tetraplegia. The TUAQ appears appropriate to be used as a patient-reported outcome measure for clinical and research purposes in this population.

Efficacy of contralaterally controlled functional electrical stimulation compared to cyclic neuromuscular electrical stimulation and task-oriented training for recovery of hand function after stroke: study protocol for a multi-site randomized controlled trial

BackgroundMulti-site studies in stroke rehabilitation are important for determining whether a technology and/or treatment can be successfully administered by sites other than the originating site and with similar positive outcomes. This study is the first multi-site clinical trial of a novel intervention for post-stroke upper limb rehabilitation called contralaterally controlled functional electrical stimulation (CCFES). Previous pilot and single-site studies showed positive effects of CCFES on upper limb impairment and hand dexterity in stroke survivors. The main purpose of this study is to confirm and demonstrate the efficacy of CCFES in a larger group of most likely responders across multiple clinical sites.MethodsUp to 129 stroke survivors with moderate to severe upper extremity hemiparesis at 4 clinical trial sites will be randomized to CCFES, cyclic neuromuscular electrical stimulation (cNMES), or task-oriented-training (TOT). Participants will receive 12 weeks of group-specific therapy. Blinded assessments of upper limb impairment and activity limitation, quality of life, and neurophysiology will be used to compare outcomes at baseline, after treatment, and up to 6 months post-treatment. The primary endpoint is change in dexterity from baseline to 6 months post-treatment.DiscussionLoss of hand function following stroke is a major rehabilitation problem affecting millions of people per year globally. More effective rehabilitation therapies are needed to restore hand function in these individuals. This study will determine whether CCFES therapy produces greater improvements in upper extremity function than cNMES or TOT, and will begin to elucidate the different mechanisms underlying each of the three treatments. This multi-site study is a critical step in advancing a novel method of rehabilitation toward clinical translation and widespread dissemination.Trial registrationClinicalTrials.gov NCT03574623. Registered prior to first enrollment; July 2, 2018.

Donor activation focused rehabilitation approach to hand closing nerve transfer surgery in individuals with cervical level spinal cord injury.

Case Series. To describe the donor activation focused rehabilitation approach (DAFRA) in the setting of the hand closing nerve transfers in cervical spinal cord injury (SCI) so that therapists may apply it to treatment of individuals undergoing this procedure. United States of America-Academic Level 1 Trauma Center. We reviewed the records of individuals with cervical SCI who underwent nerve transfer to restore hand closing and post-surgery DAFRA therapy at our institution. The three post-surgery phases of DAFRA included (1) early phase (0-12 months) education, limb preparation, and donor activation exercises, (2) middle phase (12-24 months) volitional recipient muscle activation and (3) late phase (18 + months) strengthening and incorporation of motion in activities of daily living. Subtle gains in hand closing were first observed at a mean of 8.4 months after hand closing nerve transfer surgery. Remarkable improvements including discontinuation of assistive devices, independence with feeding and urinary function, and measurable grip were observed. Function continued to improve slowly for one to two more years. A deliberate, slow-paced (monthly for >2 years post-surgery) and incremental therapy program-DAFRA-can be used to improve outcomes after nerve transfer to restore hand closing in cervical SCI. This work was made possible by funding from the Craig H. Neilsen Foundation Spinal Cord Injury Research on the Translation Spectrum (SCIRTS) Grant: Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury (PI: Ida Fox).

Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report.

Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. ThirteenPIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p= .005 and p= .008, respectively). SCIM self-care sub-score also statistically significant improved from 3 to 4 at 12 months (p= .016). No complication or donor morbidity occurred. Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.

Combined Nerve and Tendon Transfers for C7-T1 Brachial Plexus Avulsion Injury.

In patients with C7-T1 brachial plexus avulsions, complete loss of hand function is commonly seen. However, the reconstruction of hand function is difficult. To report the outcomes of hand function recovery after combined nerve and tendon transfers in C7-T1 brachial plexus injury. From 2012 to 2019, 8 patients with C7-T1 brachial plexus injury underwent combined nerve and tendon transfers for hand function restoration, which included the following: (1) the pronator teres motor branch to the anterior interosseous nerve and brachialis motor branch to the flexor digitorum superficialis branch for finger flexion, (2) the supinator motor branch to the posterior interosseous nerve for finger extension, (3) the brachioradialis tendon transfer for thumb opposition, and (4) the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve for sensory reconstruction. Patients were evaluated for functional improvement of finger flexion, finger extension, thumb opposition, and sensory recovery. No clinical donor deficits were observed. Seven of eight patients recovered finger and thumb flexion (4 patients scored British Medical Research Council grade M4 and 3 scored M3). The average grip strength was 3.4 kg. All patients regained finger extension (4 scored M4 and 4 scored M3), thumb opposition, and protective sensation on the ulnar hand. Patients were able to use their reconstructed hands in daily lives. Combined nerve and tendon transfers are reliable and effective. This strategy could be an option for hand function reconstruction after C7-T1 brachial plexus injury.