Early Active Rehabilitation After Grip Reconstructive Surgery in Tetraplegia

Objective: To describe and evaluate the concept of early active rehabilitation after tendon transfer to restore grip function in tetraplegia.

Design: Retrospective cohort study.

Setting: Two nonprofit rehabilitation units in Sweden and Switzerland.

Participants: All patients with tetraplegia who underwent tendon transfer to restore grip ability during 2009 to 2013 (N=49).

Intervention: Reconstructive tendon transfer surgery with early active rehabilitation to restore grip ability in tetraplegia.

Main outcome measures: Grip and pinch strength, grip ability test, and outcome of prioritized activities.

Results: 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).

Conclusions: 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.