Australian surgeons have restored arm and hand movement to patients with tetraplegia – paralysis of both upper and lower limbs – using a technique that connects healthy nerves with injured nerves to restore power in paralysed muscles.
Two years after surgery, and following intensive physical therapy, the patients were able to reach their arm out in front of them and open their hand to pick up and manipulate objects as well as propel their wheelchair and transfer into bed or a car.
They can now perform everyday tasks independently, including feeding themselves, brushing teeth and hair, writing, and using tools and electronic devices.
Details are published in a paper in the journal The Lancet.
While it was only a small study, the researchers have seen enough to suggest nerve transfers could achieve similar functional improvements to traditional tendon transfers, with the benefit of smaller incisions and shorter immobilisation times after surgery.
“For people with tetraplegia, improvement in hand function is the single most important goal,” says research leader Natasha van Zyl, from Austin Health in Melbourne.
“We believe that nerve transfer surgery offers an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions to perform everyday tasks, and giving them greater independence and the ability to participate more easily in family and work life.”
The study recruited 16 adults (average age 27 years) with traumatic, early (less than 18 months post injury) spinal cord injury to the neck (C5-C7), who were referred to Austin Health for restoration of function in the upper limb. Most were the result of motor vehicle accidents or sports injuries.
All underwent single or multiple nerve transfers in one or both upper limbs to restore elbow extension.
In traditional tendon transfer surgery on upper limbs, muscles that still work but are designed for another function are surgically re-sited to do the work of muscles that are paralysed.
Nerve transfers allow direct reanimation of the paralysed muscle itself. They also can reanimate more than one muscle at a time, have a shorter period of immobilisation after surgery, and avoid the technical problems associated with of tendon transfer surgery.
The researchers say previous single case reports and small retrospective studies have shown nerve transfer surgery to be feasible and safe in people with tetraplegia, but theirs is the first prospective study to use standardised functional outcome measures and combinations of multiple nerve and tendon transfer surgeries.
Nick Carne is the editor of Cosmos Online and editorial manager for The Royal Institution of Australia.
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