OBJECTIVE: Tendon transfer surgery to augment hand function lost to spinal cord injury (SCI) has gained acceptance as a rehabilitation option for adults but has yet to be fully explored in children. In this study, hand function and performance of activities of daily living in an 11-year-old child with an SCI were evaluated before and after surgical transfers of the brachioradialis to the flexor pollices longus and the extensor carpi radialis longus to the flexor digitorum profundus. METHOD: With the use of a single-subject AB design, repeated measures of pinch force, the Jebsen Test of Hand Function for Children and the Grasp and Release Test were obtained before tendon transfer surgery and at 2 1/2 6, and 12 months after surgery. Activities of daily living were assessed with the Functional Independence Measure (FIM) and the Common Object Test (COT) before surgery and 12 months after surgery. RESULTS: Each assessment revealed a significant improvement in hand function after surgery. Pinch force was measurable only after tendon transfers and increased throughout the first year. By two standard deviation analyses, after surgery there were significantly more task completions for all Grasp and Release Test objects, and task completion times were shorter for the light and heavy objects of the Jebsen Test of Hand Function for Children. FIM results showed that self-catheterization and cutting food were possible only after surgery, and results of the COT revealed new unilateral and bilateral abilities that facilitated the client's independence in writing, eating, applying toothpaste, and brushing teeth. CONCLUSION: This single-subject study demonstrates the benefits of tendon transfers for active grasp in a child with an SCI.

Activities of Daily Living↗

PubMedDate not supplied

A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury.

Three children (five hands) between 6 and 11 years of age with cervical level spinal cord injuries underwent tendon transfers to restore voluntary lateral pinch. Repeated measures of pinch force and the Grasp and Release Test (GRT) were obtained before surgery and at regular intervals after tendon transfers. The Functional Independence Measure (FIM) was administered before surgery and at 12 months after surgery. Responses to open-ended questions were used to supplement the FIM data at 1 year after surgery. Before surgery, no measurable force was obtained in any hand; after tendon transfers, pinch and finger flexion forces increased throughout the follow-up period. On the GRT, manipulation of the heavy objects was possible only after tendon transfers. Improvements were realized in feeding, grooming, bladder management, play, and school tasks. Each child requested surgery to restore pinch in the nondominant hand. Two hands required tenolysis procedures. Despite capsulotomies and aggressive therapy, three hands continued to have range limitations at the metacarpophalangeal joints.

Activities of Daily Living↗