An Interdisciplinary Program to Restore Function to Patients with Tetraplegia (Also known as Quadriplegia)
A Unique Aspect of the Center for Neural Restoration is the Multidisciplinary Approach for Hand Function restoration that is used to benefit patients. In the US there are a pproximately 12,000 new Spinal cord injuries each year, and around 300,000 persons living with a spinal cord injury. The majority of these folks are healthy people in their most productive years of life. More than half of these injuries result in cervical (or neck) level injuries resulting in the loss of effective arm and hand function. Recovering even partial arm and hand function can have an enormous impact on independence and quality of life because these folks are dependent upon the upper extremity function for mobility and activities of daily living.
Currently, tendon transfers are the most common procedure for restoring hand function. The distal end of a working muscle is cut and reattached to replace a nonworking muscle. The tendon transfer sacrifices function at a lesser location for function at a more important location. These procedures offer functional gains for an estimated 70% of tetraplegic patients.
Nerve transfers are conceptually quite similar to tendon transfers. In this procedure, a healthy nerve serving one function is cut and reconnected to a nonfunctional nerve (below the injury level) serving a more important function. For example, a patient who has effective elbow flexion but no finger flexion may recover finger flexion by transferring some of the nerve branches that provide elbow flexion to the nerve that provides finger flexion. A number of nerve transfers have been developed for restoring function within the hand.
Nerve transfers may provide advantages over tendon transfers in some situations. First, they restore the original muscles without changing the arm’s anatomy. Second, they do not require casting and immobilization. Third, they offer potential reconstructions when no tendon transfer options are available. Finally, sacrifice of one simple function can potentially restore multiple functions. In some cases there is actually no perceivable functional loss from any musclegroups. It should be noted that, unlike tendon transfers, nerve transfers can take as long as 1 year to provide theintended function.
Surgeons at UCSD use both nerve and tendon transfer procedures are used to address SCI-related paralysis of the arms and hands. When a nerve transfer option is considered, neurophysiological testing is required. This is performed by Dr. Geoffrey Sheean, Director of neurophysiology. Dr. Justin Brown, who is a neurosurgeon and an expert in nerve transfers, works together with Dr. Reid Abrams, an orthopedic hand surgeon and expert in tendon transfers. Together they will develop the most effective strategy for recovery of hand function in patients with SCI- related hand impairment.