Abstract
Study design:
Prospective control cohort study.
Objectives:
To develop a new test to analyse qualitatively grasping strategies in C6/C7 tetraplegic patients, and to quantify the effect of musculo-tendinous transfers.
Setting:
France.
Methods:
Twelve C6/C7 tetraplegic adults (17 arms; 31.3±7.9 years) and 17 healthy subjects (30.9±9.4 years) completed the study. We assessed participants' ability to grasp, move and release standardized balls of variable sizes and weights.
Outcome measures:
Failures, movement duration (MD), grip patterns, forearm orientation during transport.
Results:
In patients as well as in controls, the number of digits involved in prehension increased proportionally to the size and weight of the ball. C6 non-operated tetraplegic patients failed 38.2% of the tasks. They frequently used supine transport (51.4% of successful tasks). MD was longer, with a large distribution of values. The presence of active elbow extension poorly influenced the amount of failure nor grip configuration, but significantly reduced MD and supine transport (34%). Patients who were evaluated after hand surgery showed a trend towards improved MD and more frequent completion (failure 30%), especially for middle-sized and middle-weighted balls. Grip patterns were deeply modified, and all transports were made in pronation.
Conclusion:
The ‘Tetra Ball Test’ evidences the characteristics of grasping in tetraplegic patients and those influenced by surgery. It may be useful in understanding effects of surgical procedures. This preliminary study must be completed to evaluate the quantitative responsiveness and reproducibility of this test and to develop instrumented electronic balls to optimise it.
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References
Maynard Jr FM et al. International standards for neurological and functional classification of spinal cord injury. American spinal injury association. Spinal Cord 1997; 35: 266–274.
Yarkony GM et al. Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients. Arch Neurol 1987; 44: 93–96.
Harvey LA, Batty J, Jones R, Crosbie J . Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord 2001; 39: 37–43.
Laffont I et al. Kinematics of prehension and pointing movements in C6 quadriplegic patients. Spinal Cord 2000; 38: 354–362.
Hoffmann G, Roby-Brami A, Laffont I . Co-ordination of reaching movements in patients with a cervical spinal cord injury. Curr Psychol Cogn 2002; 21: 305–340.
Curtin M . An analysis of tetraplegic hand grips. Br J Occ Ther 1999; 62: 444–450.
Marino RJ, Shea JA, Stineman MG . The capabilities of upper extremity instrument: reliability and validity of a measure of functionnal limitation in tetraplegia. Arch Phys Med Rehabil 1998; 79: 1512–1521.
Revol M, Cormerais A, Laffont I, Pedelucq JP, Dizien O, Servant JM . Tendon transfers as applied to tetraplegia. Hand Clinic 2002; 18: 423–439.
Fattal C, Teissier J, Leclercq C, Revol M, Enjalbert M . Functional surgery of upper limb in tetraplegics since 50 years. Ann Readapt Med Phys 2003; 46: 144–155.
Fattal C . Critical review of the evaluation of the results of upper limb functional surgery in tetraplegia since 50 years. Ann Readapt Med Phys 2004; 47: 30–47.
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.
Dunkerley AL, Ashburn A, Stack EL . Deltoid triceps transfer and functional independence of people with tetraplegia. Spinal Cord 2000; 38: 435–441.
Leclercq C, Lemouel MA, Albert T . Surgical rehabilitation of the upper limbs after traumatic tetraplegia. Bull Acad Natl Med 2003; 187: 601–612.
Van Tuijl JH, Janssen-Potten YJM, Seelen HAM . Evaluation of upper extremity motor function tests in tetraplegics. Spinal Cord 2002; 40: 51–64.
Herbison GJ, Isaac Z, Cohen ME, Ditunno JF . Strength post spinal cord injury: myometer versus manual muscle test. Spinal Cord 1996; 34: 543–548.
Noreau L, Vachon J . Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord 1998; 36: 716–723.
Peolsson A, Hedlund R, Oberg B . Intra and inter-tester reliability and reference values for hand strength. J Rehab Med 2001; 33: 36–41.
Sollerman C, Ejeskar A . Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg 1995; 29: 167–176.
Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA . An objective and standardized test of hand function. Arch Phys Med Rehabil 1969; 50: 311–319.
Mulcahey MJ, Smith BT, Betz RR . Psychometric rigor of the Grasp and Release Test for measuring functional limitation of persons with tetraplegia: a preliminary analysis. J Spinal Cord Med 2004; 27: 41–46.
Fattal C, Leblond C . Assessment of functional abilities, handicap and quality of life in patients with spinal cord injuries. Ann Readapt Med Phys 2005; 48: 346–360.
Gresham GE et al. Quadriplegia Index of Function. Arch Phys Med Rehabil 1980; 61: 493.
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A . SCIM – spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997; 35: 850–856.
Landi A, Mulcahey MJ, Caserta G, Della Rosa N . Tetraplegia: update on assessment. Hand Clin 2002; 18: 377–389.
Cesari P, Newell KM . The scaling of human grip configurations. J Exp Psychol 1999; 25: 927–935.
McDowell CL, Moberg EA, House JH . The second international conference on surgical rehabilitation of the upper limb in tetraplegia (quadriplegia). J Hand Surg 1986; 11A: 604–608.
Zancolli EA . Structural and Dynamic Bases of Hand Surgery, 2nd edn. JB Lippincott: Philadelphia 1979, pp 174–182, and 229–262.
Scott TR, Atmore L, Heasman JM, Flynn RY, Vare VA, Gschwind C . Synergistic control of stimulated pronosupination with the stimulated grasp of persons with tetraplegia. IEEE Trans Neural Syst Rehabil Eng 2001; 9: 258–264.
Koshland GF, Galloway JC, Farley B . Novel muscle patterns for reaching after cervical spinal cord injury: a case for motor redundancy. Exp Brain Res 2005; 164: 133–147.
Rothwell AG, Sinnott KA, Mohammed KD, Dunn JA, Sinclair SW . Upper limb surgery for tetraplegia: a 10-year re-review of hand function. J Hand Surg [Am] 2003; 28: 489–497.
Remy-Neris O, Milcamps J, Chikhi-Keromest R, Thevenon A, Bouttens D, Bouilland S . Improved kinematics of unrestrained arm raising in C5–C6 tetraplegic subjects after deltoid to triceps transfer. Spinal Cord 2003; 41: 435–445.
Perreault EJ, Crago PE, Kirsch RF . Postural arm control following cervical spinal cord injury. IEEE Trans Neural Syst Rehabil Eng 2001; 9: 369–377.
Hoffmann G, Laffont I, Hanneton S, Roby-Brami A . How to extend the elbow with a weak or paralysed triceps? Control of arm kinematics for aiming in C6 C7 quadriplegic patients. Neuroscience 2006; 139: 749–765.
Ejeskar A, Dahlgren A, Friden J . Clinical and radiographic evaluation of surgical reconstruction of finger flexion in tetraplegia. J Hand Surg [Am] 2005; 30: 842–849.
Land NE, Odding E, Duivenvoorden HJ, Bergen MP, Stam HJ . Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury. Spinal Cord 2004; 42: 294–301.
Wuolle KS et al. Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis. J Hand Surg (Am) 1994; 19A: 209–218.
Teissier J, Fattal C, Egon G . Strategy for improving hand opening in the tetraplegic upper limb. Hand Clin 2002; 18: 497–502.
Coulet B, Allieu Y, Chammas M . Injured metamere and functional surgery of the tetraplegic upper limb. Hand Clin 2002; 18: 399–412.
Jeannerod M . The Neural and Behavioural Organisation of Goal-Directed Movements. Clarendon Press: Oxford 1988.
Santello M, Flanders M, Soechting JF . Postural hand synergies for tool use. J Neurosci 1998; 18: 10105–10115.
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Laffont, I., Hoffmann, G., Dizien, O. et al. How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers. Spinal Cord 45, 502–512 (2007). https://doi.org/10.1038/sj.sc.3102047
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DOI: https://doi.org/10.1038/sj.sc.3102047
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