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Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery, a case report.

Authors
  • Aguirre-Güemez, Ana Valeria1
  • Mendoza-Muñoz, Mario2
  • Jiménez-Coello, Gabriela3
  • Rhoades-Torres, Gerald Martín3
  • Pérez-Zavala, Ramiro1
  • Barrera-Ortíz, Aida1
  • Quinzaños-Fresnedo, Jimena1
  • 1 División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico. , (Mexico)
  • 2 Servicio de Cirugía de la Mano y Microcirugía, Instituto Nacional de Rehabilitación, Mexico City, Mexico. , (Mexico)
  • 3 Médicos residentes de la especialidad de Medicina de Rehabilitación Instituto Nacional de Rehabilitación, Mexico City, Mexico. , (Mexico)
Type
Published Article
Journal
The journal of spinal cord medicine
Publication Date
Jul 01, 2021
Volume
44
Issue
4
Pages
621–626
Identifiers
DOI: 10.1080/10790268.2019.1660841
PMID: 31525150
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively). Upon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements. Nerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.

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