Evaluation of a Task-Based Intervention After Tendon Transfer to Restore Lateral Pinch

Area of Science:

• Neurosurgery
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Cervical spinal cord injury (SCI) often impairs hand function, necessitating reconstructive surgery like brachioradialis (BR) to flexor pollicis longus (FPL) tendon transfer.
• Optimizing functional recovery after tendon transfer surgery is crucial for improving quality of life in individuals with SCI.

Purpose of the Study:

• To quantify the effects of a task-based training program on pinch force and BR muscle activation in individuals with chronic cervical SCI post-BR to FPL transfer.
• To assess if task-based training can enhance outcomes beyond standard rehabilitation protocols.

Main Methods:

• A one-group repeated-measures design was employed, comparing pinch force and BR activation before and after a 10-week home-based task-based training program.
• Participants (N=8, 6 completed) with cervical SCI and prior BR to FPL transfer underwent fine-wire electromyography during maximum effort pinch.
• Training involved novel activities to increase BR activation and practice pinch force in various upper limb postures.

Main Results:

• Significant increases in pinch force (3.7N) and BR muscle activation (10%) were observed post-training (P≤.05).
• No significant increase in elbow extension strength was noted.
• Individuals with prior posterior deltoid to triceps transfer showed enhanced antagonist elbow extensor activation.

Conclusions:

• Task-based training is a viable method to improve pinch force and muscle activation following BR to FPL tendon transfer in patients with chronic cervical SCI.
• This training modality shows promise for augmenting outcomes achieved through tendon transfer surgery and conventional therapies.