Combined nerve and tendon transfer strategy for the restoration of grasp in tetraplegia; a case report.

Introduction: By combining nerve and tendon transfer procedures, a more versatile hand function can be expected. Here we report the long-term outcomes of novel, individualized reconstruction strategies using combined nerve and tendon transfer procedures (CNaTT) to restore prehension and grasp in two patients with tetraplegia.

Case Presentation: Two women, 45 years of age, underwent bilateral nerve transfer according to the Bertelli S-PIN (supinator to posterior interosseous nerve transfer) procedure.

Nature's Touch: The Experience of Using Nature for Health Improvements in Patients with Mental Illness. A Qualitative Study.

This study aims to describe staff experiences of nature as a tool for working with people with mental illnesses. A qualitative study consisting of nine interviews with staff working with nature as a tool was conducted. The data were analysed using qualitative content analysis.

Clinical outcome of elbow extension restoration by posterior deltoid-to-triceps transfer in tetraplegia: a retrospective review of 51 patients.

In this study, we report the functional and perceived outcomes of 51 posterior deltoid-to-triceps transfers in patients with tetraplegia. With a minimum follow-up of 12 months, patients were divided into two subcategories based on preoperative posterior deltoid strength: Medical Research Council (MRC) 3 and MRC 4/5. At 12-month follow-up, all patients achieved antigravity elbow extension.

Wrist extensor pathomechanics: implications for tendon and nerve transfer.

Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators.

[Surgical reconstruction of arm and hand functions in tetraplegia : Current concepts].

The reconstruction of arm and hand functions is of enormous importance for tetraplegic patients as it enables at least some degree of independence. Depending on the level of the spinal cord injury, certain residual functions are present in the arms which can be used for surgical reconstruction of upper extremity functions. By utilizing tendon and nerve transfers missing functions can at least be partially reconstructed.

Different Thumb Positions in the Tetraplegic Hand.

Objective: To analyze factors associated with malposition that affects function of the thumb in individuals with tetraplegia.

Design: Retrospective cross-sectional study.

Setting: Rehabilitation Center for Spinal Cord Injury.

Implications of thumb position and trajectory in tetraplegia grip reconstruction - a cohort study.

Study Design: This study represents a retrospective observational cohort study.

Objectives: The objective of this study was to investigate the impact of thumb position on postoperative patient-rated and functional outcomes in grip reconstruction surgery.

Setting: All consecutive adult patients with tetraplegia undergoing grip reconstruction surgery at the Swiss Paraplegic Centre between 06/2008 and 11/2020 were assessed for eligibility.

A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia.

Upper extremity function is essential for the autonomy in patients with cervical spinal cord injuries and consequently a focus of the rehabilitation and treatment efforts. Routinely, an individualized treatment plan is proposed to the patient by an interprofessional team. It dichotomizes into a conservative and a surgical treatment pathway.

The state of the art in beyond 5G distributed massive multiple-input multiple-output communication system solutions.

Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal pro- cessing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on be- yond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.

Robot-assisted training with functional electrical stimulation enhances lower extremity function after spinal cord injury.

Introduction: Functional electrical stimulation (FES) synchronized with robot-assisted lower extremity training is used in spinal cord injury (SCI) rehabilitation to promote residual function.

Methods: Data of SCI inpatients who trained lower limb mobilization on a stationary robotic system were retrospectively analyzed. The primary outcome was the improvement of muscle strength from the first through to the last training session during FES-induced as well as voluntarily induced flexion and extension.

Biomechanical Modeling of Brachialis-to-Wrist Extensor Muscle Transfer Function for Daily Activities in Tetraplegia.

Unlabelled: We recently reported a novel case demonstrating the feasibility of a brachialis (BRA)-to-extensor carpi radialis brevis (ECRB) tendon transfer, but it is not yet known whether this transfer provides robust functional results across activities. The purpose of this study was to use biomechanical modeling to define the functional capacity of the BRA-to-ECRB tendon transfer in terms of enabling the performance of several activities of daily living.

Methods: A model of the transferred BRA-ECRB muscle-tendon unit was developed to calculate isometric elbow and wrist joint torque as a function of elbow and wrist angles resulting from different BRA reattachment locations from 50 to 80 mm proximal to the wrist joint crease.

Teamwork Pays! Ten Tips for a Great Surgeon-Scientist Collaboration.

This review represents our summary of what makes a great collaboration between a surgeon and a scientist. At first, with no perspective, such a collaboration seems easy and natural. But as time goes on, with more perspective, you realize how special it is.

Five-Year Results of a Randomized, Controlled Trial of Collagenase Treatment Compared With Needle Fasciotomy for Dupuytren Contracture.

Purpose: Over the past decade, collagenase treatment and needle fasciotomy (NF) have gained widespread popularity in the treatment of Dupuytren contracture. This prospective study was designed to compare the results of these treatments in terms of clinical and patient-reported outcomes.

Methods: A prospective, randomized, controlled trial included patients with a contracture of 20° or more in a single metacarpophalangeal joint.

Increased muscle fiber size and pathology with botulinum toxin treatment of upper extremity muscles in cerebral palsy.

Intramuscular injections of botulinum toxin A (BTX) are regularly used to treat skeletal muscle spasticity and relieve pain during rehabilitation therapy. However, while numerous preclinical studies have shown dramatic atrophic changes in muscle, little is known about the long-term effect of toxin on human skeletal muscle. In this study, muscle morphology was analyzed in biopsies taken from spastic upper extremity muscles of 8 cerebral palsy patients treated with BTX 5 months to 4 years prior sampling and was compared to muscles from 7 patients who had not ever received BTX treatment (overall 25 muscle biopsies obtained from 6 different muscles.

Electrical stimulation alters muscle morphological properties in denervated upper limb muscles.

Background: Damage to lower motor neuron causes denervation and degeneration of the muscles affected. Experimental and clinical studies of muscle denervation in lower extremities demonstrated that direct electrical stimulation (ES) of muscle can prevent denervation atrophy and restore contractility. The aim of this study was to identify possible myogenic effect of ES on denervated forearm and hand muscles in persons with spinal cord injury (SCI) and tetraplegia.

Rebalancing the Spastic Wrist by Transposition of Antagonistic Muscle-Tendon Complex.

Upper limb spasticity and spasticity-induced deformities after upper motor neuron lesions because of traumatic brain injury, encephalitis or cerebral palsy inhibit activities of daily living, result in impaired self-care and often dependence on assistance of carers. A key element of the dysfunction is wrist hyper-flexion and ulnar deviation deformity. Traditionally, this deformity has been corrected by transfer of the spastic flexor carpi ulnaris to the extensor carpi radialis brevis.

Outcome from a brachialis donor for wrist extension in tetraplegia-time to reconsider the International Classification for Surgery of the Hand in Tetraplegia (ICSHT).

Introduction: Surgical reconstruction after quadriplegia represents a powerful solution to restore lost function by injury. A case is presented in which surgical reconstruction of a patient with a C4 level spinal cord injury is performed using the brachialis (BRA) muscle as the donor.

Case Presentation: The patient previously had no hand function.

Improving hand function after spinal cord injury.

Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury. By adding new motor donors to the pool already available through tendon transfers, the effectiveness of treatment should improve. Planning which procedures and in which order to perform, along with their details must be delineated.

Long-term effect of task-oriented functional electrical stimulation in chronic Guillain Barré syndrome-a single-subject study.

Objective: Functional electrical stimulation (FES) can enhance motor learning of hand fine motor skills in neurological diseases with upper motoneuron lesions. Nevertheless, FES is rarely applied in patients with chronic Guillan-Barré syndrome (GBS) with preserved deep tendon reflexes allowing for stimulation via nerve. This single case report documents the results of an FES-supported, task-oriented grasp training to regain hand closure and pinch grip.

Surgical intervention for carpal tunnel syndrome in individuals with spinal cord injuries-patient characteristics, diagnostic considerations, and treatment outcomes.

Study Design: A retrospective chart audit.

Objectives: To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making.

Setting: Swiss Paraplegic Centre, Nottwil, Switzerland.

Surgical Mobilization of Skeletal Muscles Changes Functional Properties-Implications for Tendon Transfers.

Purpose: Tendon transfer surgery restores function by rerouting working muscle-tendon units to replace the function of injured or paralyzed muscles. This procedure requires mobilizing a donor muscle relative to its surrounding myofascial connections, which improves the muscle's new line of action and increases excursion. However, the biomechanical effect of mobilization on a donor muscle's force-generating function has not been previously studied under in vivo conditions.

Upper and lower motor neuron lesions in tetraplegia: implications for surgical nerve transfer to restore hand function.

Nerve transfers (neurotizations) performed under optimal conditions can restore some voluntary control in muscles of the upper extremities in patients with tetraplegia. However, the type of motoneuron lesions in target muscles for nerve transfers influences the functional outcome. Using standardized maps of motor point topography, surface electrical stimulation reliably defines the kind and extent of motoneuron lesion in the selected muscles.

Motor Point Topography of Fundamental Grip Actuators in Tetraplegia: Implications in Nerve Transfer Surgery.

The differentiation between an upper motoneuron (UMN) lesion and lower motoneuron (LMN) lesion of forearm muscles in patients with tetraplegia is critical for the choice of treatment strategy. Specifically, the M. pronator teres (PT), M.

Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia.

Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments.

Muscle contracture and passive mechanics in cerebral palsy.

Skeletal muscle contractures represent the permanent shortening of a muscle-tendon unit, resulting in loss of elasticity and, in extreme cases, joint deformation. They may result from cerebral palsy, spinal cord injury, stroke, muscular dystrophy, and other neuromuscular disorders. Contractures are the prototypic and most severe clinical presentation of increased passive mechanical muscle force in humans, often requiring surgical correction.