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Restoring Hand Function In Spinal Cord Injury using Nerve Transfer Surgery

Posted in Awards & Appointments on 18th Mar 2020

Research project, recently published in the Lancet, showed how nerve transfer surgery can be used in restoring hand function in spinal cord injury1.

Professor Mary Galea, Professorial Fellow from the University of Melbourne in Australia and her team have won the 2019 World Federation for NeuroRehabilitation (WFNR) Franz Gerstenbrand Award for their research.

SCI is a devastating, life-changing injury.  Every year between 250,000 and 500,000 people worldwide suffer a SCI, with just over 50% resulting in tetraplegia.  Loss of upper limb function impacts almost every aspect of a person’s life, their independence, work, social life, and family.  Regaining arm and hand function is the highest priority for people with tetraplegia. Previously some arm and hand functions have been reconstructed using tendon transfers, which move the tendon of a functioning muscle to a new insertion site to recreate the function of a paralysed muscle.  Nerve transfers are an attractive surgical option as they allow direct reanimation of the muscle anatomically and biomechanically designed to perform that function.

Professor Mary Galea led a research group from the Department of Medicine at the Royal Melbourne Hospital and the Victorian Spinal Cord Service at Austin Health, together with Dr Natasha van Zyl, a plastic and reconstructive surgeon at Austin Health, in the largest prospective, consecutive case series of nerve transfers undertaken to date at a single centre in the tetraplegic population.

The study involved 16 participants (13 male, 3 female) with an average age of 27 years, and within 18 months of traumatic SCI affecting the mid-cervical region.  Most of the injuries were the result of motor vehicle accidents or sports injuries.  Participants underwent single or multiple nerve transfers in one or both upper limbs to restore elbow extension, grasp, pinch, and hand opening (59 nerve transfer procedures in 27 limbs).  After immobilisation, intensive therapy was provided to maintain joint mobility and to practise activation of the donor muscle function paired with passive recipient muscle movement.  When reanimation of the recipient muscle(s) was first detected, recipient muscle strengthening was commenced through the patient activating donor muscle movement against resistance.

At the two-year time-point, significant improvements were observed in the participants’ ability to pick up and release objects of different sizes within a specified time and also in their independence.  Prior to surgery, none of the participants were able to perform the grasp or pinch strength tests, however two years later, pinch and grasp strength were sufficiently high to enable performance of most activities of daily living.  The outcomes in hands, where grasp and pinch had been reconstructed with nerve transfers, were similar to those reconstructed with tendon transfers. However, a hand reconstructed with a nerve transfer for grasp and pinch had a more natural appearance and feel for social interactions and extended (opened) more easily for use of electronic devices. Participants were satisfied with outcomes, would have the surgery again and would recommend it to others.

Professor David Good, WFNR President Elect said:

Congratulations – Mary and her team are well-deserved winners of the WFNR Franz Gerstenbrand Award.  This is a high quality project showing how nerve transplantation can improve spinal cord injury causing weakness of the upper extremity – it’s unique.  Great science in SCI patients.

Commenting on winning the Award, worth £3000, Mary said:

Our team is delighted to win the Award.  Nerve transfer surgery offers an exciting new option for the reanimation of upper limb function in tetraplegia and we’ll be using the prize for further research.

The 2020 WFNR Franz Gerstenbrand Award is now open for entries – visit http://wfnr.co.uk/education-and-research/wfnr-award/ for further information and an application form.