Background: The purpose of the present study was to document the value of an implanted multichannel neuroprosthesis (Freehand Systemê) for restoring hand grasp in the first Australians to receive this device. Methods: Hand function in C5 quadriplegic patients was assessed via measurement of pinch forces, a grasp release test and tests of activities of daily living (ADL). Comparisons were made between presurgery scores and scores recorded after rehabilitation when the neuroprosthesis was and was not in use. Results: A significant difference for both lateral pinch (P = 0.003) and palmar grasp (P = 0.003) was found between forces recorded with and without the use of the neuroprosthesis after rehabilitation, but not between forces recorded presurgery and during rehabilitation without the neuroprosthesis. All subjects were able to grasp, move and release more objects within the 30‐s test period with the neuroprosthesis than without it. Collective results for the eight ADL tests for all six subjects show that, in 35 of the 48 (73%) occasions, less physical assistance and/or adaptive equipment was required when the Freehand systemê was employed compared to when it was not used. In 41 of the 48 (85%) occasions, the six subjects expressed a preference for using the neuroprosthesis to perform these activities of daily living. Twelve months after rehabilitation, five of the six subjects still used the neuroprosthesis daily or every second day. Conclusion: The Freehand neuroprosthesis has provided useful hand function with few surgical and technical difficulties in these patients. Regular ongoing use of the device indicates user satisfaction.

Fifteen quadriplegic (tetraplegic) patients from the spinal injuries unit of the austin hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way. 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.