title: Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia.
abstract: To describe and evaluate the concept of early active rehabilitation after tendon transfer to restore grip function in tetraplegia.
  
  
  
  Retrospective cohort study.
  
  
  
  Two nonprofit rehabilitation units in Sweden and Switzerland.
  
  
  
  All patients with tetraplegia who underwent tendon transfer to restore grip ability during 2009 to 2013 (N=49).
  
  
  
  Reconstructive tendon transfer surgery with early active rehabilitation to restore grip ability in tetraplegia.
  
  
  
  Grip and pinch strength, grip ability test, and outcome of prioritized activities.
  
  
  
  In the 49 surgeries performed, postoperative complications included 2 patients with bleeding and 2 infections related to the surgery. There were no reported ruptures or lengthening of transferred tendons. Within 24 hours after surgery, all 47 patients (100%) with finger flexion reconstruction succeeded to activate their finger flexion. All but 1 patient with reconstructed thumb flexion sucessfully activated their thumb flexion (n=40). Three weeks after surgery, all patients (100%) were able to perform basic activities of daily living, and instrumental activities of daily living were achieved by 74%. One year after surgery, the maximum grip strength in restored finger flexion was on average 6.9kg (range, 1.5-15kg; n=29). The maximum pinch strength in restored thumb flexion was on average 3.7kg (range, 1-20; n=29). On average, grip ability improved from 33 to 101 (n=19) according to the COPM. Prioritized activity limitations, as measured with the COPM, equated to an average of 3.5 steps (2.5 steps preoperatively to 6 steps postoperatively). Patients' perceived satisfaction with this improvement was 4 steps (increasing from 2 steps preoperatively to 6 steps postoperatively).
  
  
  
  Grip reconstructive surgery followed by early active rehabilitation can be considered a reliable procedure that leads to substantial improvements in grip and pinch strength and activity performance among patients with tetraplegia.
authors.affiliation: Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden. Electronic address: johanna.wangdell@vgregion.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Wangdell
authors.affiliation: Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.
authors.forename: Lina
authors.initials: L
authors.lastname: Bunketorp-Käll
authors.affiliation: Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Koch-Borner
authors.affiliation: Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden; Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Fridén
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D052581:Pinch Strength; D011183:Postoperative Complications / Q000453:epidemiology; D011782:Quadriplegia / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D013709:Tendon Transfer / Q000379:methods / Q000534:rehabilitation*
keywords: Quadriplegia; Reconstructive surgical procedures; Rehabilitation; Spinal cord injuries; Tendon transfer; Upper extremity