title: Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis.
abstract: Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI.
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH. Electronic address: anne.bryden@case.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Bryden
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH.
authors.forename: Harry A
authors.initials: HA
authors.lastname: Hoyen
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Keith
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH.
authors.forename: Melvin
authors.initials: M
authors.lastname: Mejia
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kilgore
authors.affiliation: The Cleveland Functional Electrical Stimulation Center, Cleveland, OH; MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nemunaitis
mesh_terms: D004185:Disability Evaluation; D004558:Electric Stimulation; D006801:Humans; D009046:Motor Neurons / Q000502:physiology*; D026741:Physical Therapy Modalities; D011782:Quadriplegia / Q000209:etiology* / Q000503:physiopathology* / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications*; D034941:Upper Extremity / Q000503:physiopathology
keywords: Reconstructive surgical procedures; Rehabilitation; Spinal cord injuries; Upper extremity