title: Contralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury.
abstract: BACKGROUND
  Central neurological injury (CNI) is a major contributor to physical disability that affects both adults and children all over the world. The main sequelae of chronic stage CNI are spasticity, paresis of specific muscles, and poor selective motor control. Here, we apply the concept of contralateral peripheral neurotization in spasticity releasing and motor function restoration of the affected upper extremity.
  
  
  OBJECTIVE
  A clinical investigation was performed to verify the clinical efficacy of contralateral C7 neurotization for rescuing the affected upper extremity after CNI.
  
  
  METHODS
  In the present study, 6 adult hemiplegia patients received the nerve transfer surgery of contralateral C7 to C7 of the affected side. Another 6 patients with matched pathological and demographic status were assigned to the control group that received rehabilitation only. During the 2-year follow-up, muscle strength of bilateral upper extremities was assessed. The Modified Ashworth Scale and Fugl-Meyer Assessment Scale were used for evaluating spasticity and functional use of the affected upper extremity, respectively.
  
  
  RESULTS
  Both flexor spasticity release and motor functional improvements were observed in the affected upper extremity in all 6 patients who had surgery. The muscle strength of the extensor muscles and the motor control of the affected upper extremity improved significantly. There was no permanent loss of sensorimotor function of the unaffected upper extremity.
  
  
  CONCLUSIONS
  This contralateral C7 neurotization approach may open a door to promote functional recovery of upper extremity paralysis after CNI.
authors.affiliation: ‡Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; ¶Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China; §State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
authors.forename: Xu-Yun
authors.initials: XY
authors.lastname: Hua
authors.forename: Yan-Qun
authors.initials: YQ
authors.lastname: Qiu
authors.forename: Tie
authors.initials: T
authors.lastname: Li
authors.forename: Mou-Xiong
authors.initials: MX
authors.lastname: Zheng
authors.forename: Yun-Dong
authors.initials: YD
authors.lastname: Shen
authors.forename: Su
authors.initials: S
authors.lastname: Jiang
authors.forename: Jian-Guang
authors.initials: JG
authors.lastname: Xu
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Gu
authors.forename: Wen-Dong
authors.initials: WD
authors.lastname: Xu
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009416:Nerve Regeneration / Q000502:physiology*; D016067:Nerve Transfer / Q000379:methods*; D010291:Paresis / Q000209:etiology / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation; D055815:Young Adult