Improving hand function after spinal cord injury

Abstract

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. To meet these demands, refined diagnostics are needed, along with awareness of the remaining challenges to restore intrinsic muscle function and to address spasticity and its consequences. This article summaries recent advances in surgical reanimation of upper extremity motor control, together with an overview of the development of neuro-prosthetic and neuromodulation techniques to modify recovery or substitute for functional losses after spinal cord injuries.

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

“…In addition to the traditional therapeutic treatment of the tetraplegic hand, there is also a choice of surgical procedures such as muscle tendon and nerve transfers that can improve hand–arm function. Nerve transfers in particular are time-sensitive if the recipient's muscle lacks intact lower motor neurons ( 2 , 3 ). These muscles should be stimulated as early as possible by direct electrical muscle stimulation with long pulse widths ( 4 ).…”

You Will Grasp Again: A Direct Spinal Cord/Computer Interface with the Spared Motor Neurons Restores the Dexterous Control of the Paralyzed Hand after Chronic Spinal Cord Injury

“…There are currently no effective treatments for regaining control of the hand after muscle paralysis. Hand surgery is established, although not possible in every case, and with several limitations 2 . Restoration of hand function has so far been achieved by neural interfaces recording the activity of the motor cortex 3 , either through closed-loop electrical stimulation of the muscle 4 or by controlling external devices 5 .…”