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23 TO 30 YEAR FOLLOWUP OF TETRAPLEGIC PERSONS FOLLOWING TENDON TRANSFERS Alastair Rothwell, Jennifer Dunn, Khalid Mohammed & Anne Sinnott-Jerram from the.

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Presentation on theme: "23 TO 30 YEAR FOLLOWUP OF TETRAPLEGIC PERSONS FOLLOWING TENDON TRANSFERS Alastair Rothwell, Jennifer Dunn, Khalid Mohammed & Anne Sinnott-Jerram from the."— Presentation transcript:

1 23 TO 30 YEAR FOLLOWUP OF TETRAPLEGIC PERSONS FOLLOWING TENDON TRANSFERS Alastair Rothwell, Jennifer Dunn, Khalid Mohammed & Anne Sinnott-Jerram from the Upper Limb Group, Burwood Spinal Unit Christchurch New Zealand

2 The authors are all members of the BSU Upper Limb Group but none are employed directly by it or have received any financial benefit

3 Conclusions  Mean grasp & key pinch values maintained or improved  Active transfers had approximately twice strength of tenodeses  Levels of functional independence & expectations had been maintained

4  Re evaluate grasp & key pinch strength in same cohort years post transfer surgery  Determine effects of aging on active transfers & tenodeses  Determine long term outcomes on levels of function and satisfaction.

5  19 of the previous 24 from the 2001review were eligible & willing to participate in the 2012 review.  All had had bilateral simultaneous hand surgery between 1982 & 1989  Approval for study granted by regional ethics committee

6  Grasp & key pinch tested by same (recalibrated) digital analyser as for 2001 study and results recorded in newtons  ASHT positioning protocol used for testing  Best of three attempts recorded with minute rest between tests.  Same person (JD) performed all testing  Lamb & Chan questionnaire again used for function assessment with respondents asked to compare performance of each of the 25 tasks with that of 2001

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10 RESULTS

11 Years SD Range  Mean age  Mean time since SCI  Mean time from 1 st U.L. surg male 1 female

12 IC Right Left Total  O  O2/OCu  O3/OCu  OCu  OCu  OCu  Total

13  KEY PINCH  BR > FPL 27  PT > FPL 4  FPL tenodeses 6  Total 37  GRASP  ECRL > FDP 20  BR > FDP 6  FDP tenodeses 4  Total 30

14 Active n mean2001(Ns) mean2012(Ns) % change R (17.5) 32.9(12.9) -14 L (17.3) 27.1(13.7) -0.8 R & L combined -2.4% Tenodeses R (1.4) 11.5(9.2) L (10.7) 15.5(1.9) -51.2

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17 Active n mean2001(Ns) mean2012(Ns) % change R (31.7) 59.0(30.3) -5 L (36.9) 52.7(35.1) -8.1 R & L combined -10% Tenodeses R (4,2) 41.0(25.5) L (10.6) 23.0(24.0) +70.4

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20  Majority of participants believed no change in their ability to perform most of the 25 tasks  10 stated had decreased ability to propel manual wheelchair on the flat & up a slope  7 stated had decreased ability to pressure relieve  Overall 12 now used power chair for at least some of mobility needs compared to 5 in 2001

21 DISCUSSION

22  Mathowetz et al 1985: 0.5-1% loss/year from age 39 in normal population  Grabner & Enoka 1995: 1.5% loss/year from years  Frederkkson et al % males, 0.3% females loss/yr from years  Summary: 0.5%-1.5% loss/yr from age  Charlifue et al 2010: loss commences more quickly post SCI Current study:  The mean10% reduction of grasp & 2.5% of key pinch strength over the 11year period for the age range of our study group (47-61) falls within the normal population reduction

23  Smaby et al 2004: majority of daily tasks require grip of 10.5Ns or less for tetraplegic persons  Most of study participants had key pinch/grasp far in excess of 10.5 Ns (mean 30 & 56Ns respect.)  Hence the reported unchanged ability to perform daily tasks except for whchair prop. & wt relief  These tasks require use of shoulder & elbow muscles more than hand grip

24  Active transfers to provide key pinch and grasp, continue to provide hand function for ADLs for at least 23 and up to 30 years.  The % decline in strength of active transfers is similar to that of the normal population in the same age range.  The small number of participants with FDP tenodeses make invalid any conclusions regarding possible reasons for the dramatic increase in their strength.

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