Abstract
Study design: Survey.
Objective: To measure the utilization of upper extremity reconstructive surgery and the clinicians' perceptions of the outcomes provided for persons with tetraplegia across the Model Spinal Cord (SCI) Injury Systems.
Setting: Model SCI Systems.
Methods: Participants: A clinician from each of the Model Centers. Main outcome measure: A mailed survey eliciting responses with respect to: (1) utilization of upper extremity reconstructive procedures and (2) the clinicians' perceived outcomes of these procedures.
Results: In all, 76% responded positively about the availability and appropriateness of upper extremity surgical reconstruction at their center. Of the respondents, 75% felt that surgery recipients were generally satisfied with their surgeries, 80% felt that the surgery made a positive impact on recipients' lives, 81% felt that recipients showed increased independence, and 70% reported a positive impact on recipients' occupation. In all, 93% felt insurance companies should pay for the procedures. Compared to the satisfaction of surgery recipients using a similar instrument, clinicians anticipated slightly greater improvements in all areas except occupation.
Conclusions: There is a positive perception of the benefits of reconstructive surgery for tetraplegia; however, procedures are not routinely offered at all centers. The primary reasons reported for this include the misconception that insurance does not remit payment, that a surgeon is not available, and that surgical candidates are referred to another center.
Sponsorship: Support was provided by the United States Department of Education, National Institute on Disability and Rehabilitation Research. Award #H133N50018, Rehabilitation Research and Development Center of Excellence in Functional Electrical Stimulation Department of Veterans Affairs.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Ainsley J, Voorhees C, Drake E . Reconstructive surgery for quadriplegic persons. Am J Occup Ther 1985; 39: 715–721.
Castro-Sierra A, Lopez-Pita A . A new surgical technique to correct triceps paralysis. Hand 1983; 15: 42–46.
Ejeskar A, Dahllof A . Results of reconstructive surgery in the upper limb of tetraplegic participants. Paraplegia 1988; 26: 204–208.
Freehafer AA, Mast WA . Transfer of the brachioradialis to improve wrist extension in high spinal-cord injury. J Bone Joint Surg (Am) 1967; 49: 648–652.
Freehafer AA, Peckham PH, Keith MW . New concepts on treatment of the upper limb in tetraplegic: surgical restoration and functional neuromuscular stimulation. Hand Clinics 1988; 4: 563–574.
Gellman H, Kan D, Waters RL, Nicosa A . Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma. J Bone Joint Surg 1994; 76A: 398–402.
Hentz VR, Brown M, Keoshian LA . Upper limb reconstruction in quadriplegia: functional assessment and proposed treatment modifications. J Hand Surg 1983; 8: 119–130.
Hentz VR, House J, McDowell C, Moberg E . Rehabilitation and surgical reconstruction of the upper limb in tetraplegia: an update. J Hand Surg 1993; 7A: 964–967.
Hentz VR, Leclerq C (eds) Surgical Rehabilitation of The Upper Limb in Tetraplegia. WB Saunders: London 2002.
Keith MW, Lacey SH . Surgical rehabilitation of the tetraplegic upper extremity. J Neuro Rehabil 1991; 5: 75–87.
Keith MW, Kilgore KL, Peckham PH, Wuolle KS, Creasey G, Lemay M . Tendon transfers and functional electrical stimulation for restoration of hand function in spinal cord injury. J Hand Surg 1996; 21A: 89–99.
Lacey SH, Wilber RW, Peckham PH, Freehafer AA . The posterior deltoid to triceps transfer a clinical and biomechanical assessment. J Hand Surg 1986; 11A: 542–547.
Lamb DW, Chan KM . Surgical reconstruction of the upper limb in traumatic quadriplegia. J Bone Joint Surg 1983; 65B: 291–298.
McCarthy CK, House JH, Van Heest A, Kawiecki JA, Dahl A, Hanson D . Intrinsic balancing in reconstruction of the tetraplegic hand. J Hand Surg 1997; 22A: 596–604.
Moberg E . The present state of surgical rehabilitation of the upper limb in tetraplegia. Paraplegia 1987; 25: 351–356.
Vanden Berghe A, Van Laere M, Hellings S, Vercauteren M . Reconstruction of the upper extremity in tetraplegia: functional assessment, surgical procedures and rehabilitation. Paraplegia 1991; 29: 103–112.
Zancolli EA . Paralytic supination contracture of the forearm. J Bone Joint Surg 1967; 49A: 1275–1284.
Owings R, Wickstrom J, Perry J, Nickel VL . Biceps brachii rerouting in treatment of paralytic supination contracture of the forearm. J Bone Joint Surg 1971; 53A: 137–142.
Burman M . Paralytic supination contracture of the forearm. J Bone Joint Surg 1956; 38A: 303–312.
Zaoussis AL . Osteotomy of the proximal end of the radius for paralytic supination deformity in children. J Bone Joint Surg 1963; 45B: 523–527.
Lipseir E, Weizenbluth M . Derotation osteotomy of the forearm in management of paralytic supination deformity. J Hand Surg 1993; 18A: 1069–1074.
Stover SL, DeLisa JA, Whiteneck GG (eds) Spinal Cord Injury: Clinical Outcomes from the Model Systems. Aspen Publishers: Maryland 1995.
Wuolle KS, Bryden AM, Peckham PH, Murray PK, Keith M . Satisfaction with upper extremity surgery in individuals with tetraplegia. Arch Phys Med Rehabil 2003; 84: 1145–1149.
Acknowledgements
We thank Mary Jo Roach Ph.D., Kevin Kilgore Ph.D., William Memberg M.S., and Ronald Hart M.S. for their assistance in the statistical analysis of data and critical review of the manuscript. We additionally thank the Model Spinal Cord Injury Systems for participating in this study. This study was funded by the United States Department of Education, Office of Special Education and Rehabilitation Services, National Institute on Disability and Rehabilitation Research. Part of this work was presented at the American Spinal Injury Association Annual Meeting held on April 14–16, 2000 in Chicago, IL, USA.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bryden, A., Wuolle, K., Murray, P. et al. Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems. Spinal Cord 42, 169–176 (2004). https://doi.org/10.1038/sj.sc.3101579
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3101579
Keywords
This article is cited by
-
Identifying barriers to upper extremity reconstruction in tetraplegia: a systematic scoping review
Spinal Cord (2021)
-
How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management
Spinal Cord (2016)
-
Access to surgical upper extremity care for people with tetraplegia: an international perspective
Spinal Cord (2015)
-
Issues influencing the decision to have upper limb surgery for people with tetraplegia
Spinal Cord (2012)
-
Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury
Spinal Cord (2009)
