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Tetraplegia is a serious condition resulting from SCI that leads to complete or incomplete paralysis of all four limbs. Those suffering from it face a range of physical and psychological challenges. Personality, motivation and outlook on life play no small role in the desired rehabilitative outcomes.

Even an incomplete loss of arm and hand function has an immense impact on an individual’s ability to carry out everyday activities. Box 1 below illustrates in detail the American Spinal Injury Association (or ASIA)3 classification of a typical impairment of this type.

Table1

Example for Tetraplegia ASIA B sub C5/C6 and loss of muscle functions and sensitivity. In the ASIA scale, 0 indicates total paralysis (in red), 1 indicates palpable or visable contraction and 2 indicates active movement.

CS1-t box1

Table 1: ASIA Impairment Scale (AIS), touch functions are graded from 0 = absent, 1 = impaired to 2 = normal. Motor functions are graded from 0 = total paralysis to 5 = active movement with full range of motion and against gravity and provides normal resistance.

The patient must overcome significant obstacles to interact with his or her environment and is often dependent upon others to accomplish everyday activities. Learning to cope with this situation is a complex process that affects a patient’s quality of life.4 How a person deals with a condition such as tetraplegia may play a significant role in the true benefits of even proven surgical and medical interventions.

For instance, one accepted procedure — upper extremity surgery — has been shown to greatly improve the functioning of the hand and arm in persons suffering from tetraplegia6, resulting in positive life impacts, improvements in activities of daily living, increased independence and better quality of life.7

Box 1 | Upper Extremity Surgery Used for the Improvement of Functioning in Tetraplegia

Upper extremity surgery is a proven surgical technique that has shown improvement in the hand and arm functioning of individuals suffering from tetraplegia. The procedure consists of two approaches (Moberg, 1975):

  1. The restoration of elbow extension is achieved through the deltoid-to-triceps transfer. The totally paralyzed or weak triceps is restored utilizing the posterior deltoid, which is separately innervated.
  2. The restoration of hand grip is achieved in four steps:
    1. The construction, if needed, of a wrist extensor using the brachioradialis;
    2. The increase of the mechanical advantage of the weak flexor system through the release of the flexor pollicis longus tendon;
    3. Stabilization of the distal thumb joint with a Kirschner wire;
    4. Tenodesis of the flexor pollicis longus tendon.

The goal of the surgery, as described by Moberg, is to allow a “tripod pinch” as well as a degree of voluntary motion of the fingers. Mohammed et al. (1992), in a study of 57 patients and 97 reconstructions, reported that 70% had good or excellent subjective results.

Example for Tetraplegia ASIA B sub C5/C6 and loss of muscle functions and sensitivity.

General Introduction

However, surgery and its associated post-operative management alone may not guarantee positive results, and the rehabilitative process that follows must include the patient’s individual perspective in order to maximize his or her actual benefits.8910 In fact, a focus on "person-centered service" is increasingly emphasized in the field of rehabilitation management.11

This case study aims to illustrate a key challenge and opportunity in translating the potential of such a beneficial procedure into positive, meaningful outcomes for an individual patient.

The rehabilitative process includes the patient's individual perspective.