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

Abstract

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. To select an optimal pathway, it is important to define predictors that substantiate the treatment strategy. Apart from standard assessments (Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the manual muscle test (MRC), and lower motoneuron integrity of key actuators for hand function performed by motor point (MP) mapping might serve as a possible predictor. Type of damage (upper motor neuron (UMN) or lower motor neuron (LMN) lesion) influences hand posture and thus treatment strategy as positioning and splinting of fingers, hands, arms, and surgical reconstructive procedures (muscle-tendon or nerve transfers) in choice and timing of intervention. For this purpose, an analysis of a database comprising 220 patients with cervical spinal cord injury is used. It includes ISNCSCI, MRC, and MP mapping of defined muscles at selected time points after injury. The ordinal regression analysis performed indicates that MP and ASIA impairment scale (AIS) act as predictors of muscle strength acquisition. In accordance with the innervation status defined by MP, electrical stimulation (ES) is executed either via nerve or direct muscle stimulation as a supplementary therapy to the traditional occupational and physiotherapeutic treatment methods. Depending on the objective, ES is applied for motor learning, strengthening, or maintenance of muscle contractile properties. By employing ES, hand and arm function can be predicted by MP and AIS and used as the basis for providing an individualized treatment plan.

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries

“…In a study involving 86 individuals with tetraplegia, it was shown that four different scenarios of hand forms develop, which have different innervation patterns regarding the LMN integrity of the critical muscles for hand opening and closing [62]. A subsequent investigation of the differently developing thumb positions, which also contribute significantly to the functionality of grasping and releasing, confirmed the findings previously obtained for the finger extensors and flexors [63].…”

Electrical Stimulation Exercise for People with Spinal Cord Injury: A Healthcare Provider Perspective

“…Looking at the patterns of damage to the individual muscles of the forearm and hands in people with tetraplegia may be useful in predicting the development of different hand deformities. Testing within the first six to eight weeks after the onset of a SCI, motor point mapping can serve as a predictor for the development of voluntary muscle activity 24 weeks after injury [79].…”

“…Electrical stimulation can be considered a diagnostic tool (motor point mapping) to detect eventual damage to the lower motor neuron. Identifying the type of damage at an early stage after the onset of SCI (six to eight weeks) serves as a predictor for the development of hand deformities 24 weeks after injury [79]. Prospectively, individualized treatment, as well as a targeted choice of appropriate stimulation parameters for the tetraplegic hand, can be applied in time.…”