Gaining independence in tetraplegia. Cleveland technique

Considerable independence can be achieved by four simple operations that can be done for patients with tetraplegia. Transfers for wrist extension were done 17 times. Posterior deltoid transfers were done 59 times. Opponens transfers were done 112 times. Transfers for finger flexion were done 88 times. Opponens and finger flexion transfers should be done at the same time. There were 22 other operations done. The patients with C6, C7, and C8 complete neurologic motor levels were almost as independent after their tendon transfers as paraplegics. They could transfer from a chair, insert a catheter, write, type, hold a book, take care of their toilet needs, bathe themselves, eat food and drink, dress themselves, and perform other activities of daily living. The few patients with a C5 neurologic level that was surgically treated for wrist extension acquired automatic grasp or used a wrist driven splint. A posterior deltoid transfer was not done on any of the patients with a C5 neurologic level but it is recommended now.